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Baucus May Have Solved the Abortion-Health Care Riddle

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The health care proposal being floated by Senate Finance Committee Chairman Max Baucus will be attacked or hailed for a variety of reasons.

But I'll say this: based on what I've read so far, it may have solved the abortion riddle -- enough so that the Catholic Bishops may be able to endorse the plan. (The Bishops are the most important pro-life group because they ostensibly really want health care reform to pass, but for the abortion provisions).

First, the Baucus proposal eliminates the "public option" -- the idea of the government creating a publicly-administered health care plan people could choose if they don't like the private plans.

The public option drew the ire of pro-life groups because House legislation left open the possibility that this government-administered plan would cover abortion. There's a more nuanced debate about whether it would subsidize abortion directly (my opinion here) but Baucus short-circuits that debate by eliminating the public option entirely.

The second contentious area for abortion and health care involves the government subsidies to those who can't afford health insurance. Under the House legislation, the federal government would write checks to health insurance companies on behalf of needy citizens. That left open the possibility that the government could subsidize a health plan that covered abortion. (Again, I'm oversimplifying: the full, mind-numbing nuance can be found here).

But Baucus proposes a different mechanism: tax credits. The federal government would provide tax relief to offset the cost of insurance. Those not earning enough to pay taxes could get a refundable tax credit, i.e. a check.

It's possible that someone could use their tax cut to pay for insurance that covers abortion. But that was also true for George Bush's tax cuts -- and for John McCain's campaign proposal to subsidize health care through ... tax credits. If the Baucus plan is deemed to subsidize abortion, then so did the McCain plan.

There are a few remaining contentious areas. Pro-life folks want there to be an explicit ban on federal moneys subsidizing abortion and the Baucus approach doesn't mention it all. But Democrats might actually be willing to accept that anti-abortion language on the Baucus bill in ways they wouldn't on the House bill (because the Baucus bill just doesn't rely on direct subsidies in the same way). After all, the White House has indicated they want health care legislation to mirror the status quo, which means a ban on federal funding of abortion via the Hyde Amendment.

Then there's the question of the co-ops themselves. Let's say a co-op in the northeast offered a plan that covered abortion. The plan would be paid for by member premiums; administered by members themselves. No direct government subsidies there. But to get off the ground, the federal government would likely have to contribute start up money.

It would be quite indirect but it's possible that the feds might loan the co-op money to get off the ground and before the co-op can repay the loan, the entity offers insurance plans that cover abortion. That could be viewed as a (very, very) indirect subsidy of abortion. The political question is whether it's sufficiently indirect that the Catholic Church could support it.

Now, I should say that my assessment is based just on the general outline of the Baucus proposal and might change once I read the detailed bill. And I'm not arguing whether the plan ought to cover or abortion or not. I'm assessing the bill against the goal -- stated by pro-life and pro-choice leaders -- that health care should preserve the status quo on abortion.

But at first blush it looks like the Baucus bill "calls the question" for the Bishops. His proposal appears to solve the two abortion-related problems in the House bill. The Bishops say they would gladly support health care reform if only they could be assured it doesn't cover abortion.

We may soon see if that's true.