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Health Care Reform & Abortion: Separating Fact From Fiction

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Over the weekend, the anger and rancor over health care reform was put on hold -- momentarily. The nation watched with a heavy heart as Senator Edward Kennedy was laid to rest in Arlington National Cemetery. While uncertainty remains around the future of health care reform, we can be sure that despite this temporary pause, the health care debate will heat up again. In a heated debate, tempers and passions fly, leaving much room for misinformation and confusion. Nowhere is this more true than on the issue of abortion.

We offer this fact sheet in order to separate fact from fiction regarding abortion and health insurance legislation. Our careful read of the current health care reform bills reveals that the legislation successfully strikes a delicate moral balance. It does as little as possible to change the current long-standing compromise on federal abortion funding, coverage and conscience clauses. It is worth noting that neither the major pro-life nor pro-choice organizations have formally endorsed the language contained in the legislation.

While the proposal is indeed in many regards "abortion neutral," it arguably does more in effect to expand options for pro-life Americans than for pro-choice Americans. This is the case given that the majority of Americans today participate in plans where their premiums pay for others' abortions; the reform proposal would ensure that more Americans can choose a plan that does not cover abortion.

The current health care reform legislation:
• Would not use taxpayer money to fund abortions;
• Would not require or compel any individual to choose an insurance option that covers abortion;
• Would make it easier for individuals to choose an insurance option that expressly does not cover abortion;
• Would safeguard all federal clauses and state abortion restrictions; and,
• Would likely reduce the number of abortions through preventive and supportive health care services.

1. Reform would not use taxpayer money for abortion.
Some pro-life advocates (though not all) have questioned whether the reform legislation would fund abortion with taxpayer dollars. The answer is that it would not. The assertion by several pro-life organizations that it would relies on a very thin and tenuous thread.

The proposed public plan, like private insurance plans in the Exchange, would be funded and paid for primarily by private individual out-of-pocket premiums. The legislation makes clear that both the public plan and private plans offered through the Exchange cannot use federal subsidies to pay for abortions; the plans must segregate federal subsidies so they cannot use those funds to pay for abortions. The only exception is that federal funds can be used in the case of rape, incest, or to preserve the life of the mother, which is directly in line with the Hyde Amendment, a law originally introduced by the late, pro-life stalwart Rep. Henry Hyde (R-IL), which has been on the books for over 30 years.

Those who claim the proposal does publicly fund abortion make two arguments: 1) Government subsidies provided on behalf of individuals would be used to buy policies that cover abortion; and 2) Federal money would be used to start up and administer a public plan and the public plan could cover abortion.

The first assertion fails to acknowledge that this breaks no new ground. Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), and the tax exemption for employer-provided health insurance are among several existing government subsidies that help people purchase health care services and private insurance policies -- 87% of which offer abortion as a covered service.

The second assertion ignores the fact that the public plan option follows the same model as Medicaid. No federal funding under Medicaid may be used for non-Hyde abortions, but individual states may allow Medicaid funding to cover these abortions, provided that it is paid for by state, not federal, tax dollars. The public plan option uses the exact same principle, except that it is an individual and not a state government deciding to pay for coverage that includes abortion.

If opponents applied the same logic behind these assertions to the rest of health care, the mere possibility of abortion funding through Medicaid, FSAs, HSAs or the federal tax exemption for employer-provided health benefits would require their elimination.

2. Reform would not compel or require any individual to choose an insurance option that covers abortion.
There is no mandate that abortions be covered by health insurers in either the public or the private plan. Under a provision entitled "Abortion Coverage Prohibited as Part of Minimum Benefits Package," the bill expressly prohibits abortion from being included in the "essential benefit package" (the services all plans must cover at a minimum). Private plans could cover abortion -- as most do today -- or choose not to.

The public plan is neither compelled to cover abortion, nor compelled not to. ("Nothing in this Act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of [non-Hyde abortions].") As explained above, should abortion be covered in certain public option plans, federal funds could not be used to pay for abortions in the public plan, except for in the rare instances of rape, incest, and life-threatening situations. And, of course, no one will be required or compelled to choose a public option plan out of the Exchange, whether it includes abortion or not.

3. Reform would make it easier for Americans to choose an insurance plan that does not cover abortion.
The current health care reform package would guarantee that the approximately 27 million Americans eligible for the Exchange have access to at least one plan that does not provide coverage of abortion. It also requires that at least one plan in the Exchange cover abortion (with non-governmental funds only).

Although this provision is in certain respects "abortion neutral," since nearly all insurance plans currently cover abortion, this will have the effect of allowing Americans more opportunity to choose a plan that does not cover abortion.

4. Reform would safeguard all current federal conscience protections and state abortion restrictions.
The current health care reform package ensures that existing federal conscience protections for health care providers and entities are upheld. The legislation contains a provision stating that nothing will have an effect on federal laws regarding "conscience protection; willingness or refusal to provide abortion; and discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion."

It would also keep in place state laws that restrict abortion by expressly bowing to these state laws.

5. Reform would likely reduce the number of abortions through prevention and support.
Prevention and support are keys to reducing abortions. Fifty-seven percent of abortions are performed on women at 200% of poverty or less. Half of all pregnancies are unintended and four in 10 unintended pregnancies end in abortion. On prevention, the current health care reform package would extend coverage to over 2 million women who are in need of access to contraception, but are not insured or covered by Medicaid.

On the support side, many women who are uninsured may also feel that the cost of pregnancy and early childhood is too financially difficult to bear without health coverage. The support given by health care reform may lead fewer women to opt for an abortion.

Moreover, there is no reason to think that having insurance that covers abortion is a significant factor in a woman's decision to have an abortion. Seventy-four percent of women pay for abortions out of their own pocket and only 13% rely on private insurance, though many have it.

Thus, the overall effect of this reform package, with increased prevention and support services, will likely be to reduce abortions.