Will Preserving the “Status Quo” Resolve the Abortion Debate?
by Naomi Freundlich
These provisions, contained in the Senate Finance bill and also in the Capps Amendment passed by the House Energy and Commerce Committee, are designed to be “abortion neutral,” meaning that they don’t restrict or expand abortion rights beyond the status quo. The status quo is as follows: Although Roe vs. Wade ensures access to safe, legal, abortion; since 1976, the Hyde Amendment has banned federal funding for abortion except in the case of rape, incest or threat to the life of the mother. This ban currently applies to Medicaid beneficiaries and also to federal employees and military personnel.
Obama has already said that abortion will not be included in any minimum benefits package mandated by the government. The Senate Finance and House Energy committee reform plans reiterate this provision; but they do allow insurers who choose to offer abortion as a covered service to participate in the exchanges. They just can’t use any federal funds to help pay for these services.
In the current schemes for health reform, many low and middle-income Americans will qualify for federal subsidies to help them purchase insurance on the exchanges. The government will not send these subsidies to individuals, but rather the funds will be paid directly to insurers. Plans that want to include some abortion services— 87% of private plans currently do offer these benefits—will have to segregate federal funds (derived from subsidies) from those paid directly by plan participants through premiums. If a woman enrolled in one of these plans elects to have an abortion, benefit payments can only come from the private, premium fund. This segregation of federal funds already happens in the 17 states that currently use state monies to cover abortion for Medicaid recipients.
The Capps Amendment goes further to try to achieve neutrality: Every exchange must include at least one plan that offers abortion benefits and at least one plan that does not. State laws requiring parental consent, mandatory waiting periods, informed consent and other restrictions on abortion will not be preempted by federal legislation. Finally, conscience clauses that allow doctors and hospitals to refuse to perform or even talk about abortion will be strengthened to prevent insurers from dropping these providers from their plans.
Rep. Lois Capps (D-CA) says that she is pro-choice and has long opposed the Hyde Amendment. So why is she championing legislation that would extend the Hyde restrictions further and restrict lower-income women’s access to a popular—and legal—medical service?
The answer from her office; “This is not the place to re-debate the abortion issue. What we could get consensus on is this common ground language that maintains the status quo.” In fact, Capps and other pro-choice Democrats in Congress are fighting for the hearts and minds of the 30 or so socially-conservative Democrats who have threatened to oppose any health reform bill that allows government funding of abortion. This week, the New York Times ran a front page story that declared, “the debate over health care in Congress is becoming a battlefield in the fight over abortion.”
The Times article goes on to describe efforts by hard-line abortion opponents like Rep. Bart Stupak (D-MI) and Senator Orrin Hatch (R-UT) to garner support in Congress for more extreme amendments that would prevent all insurance plans that participate in the exchanges from providing any abortion coverage—even if they use segregated funds. In this scenario, women could only obtain abortion coverage if they used their own money to buy a “rider” to their insurance policies.
Considering the fact that most women don’t plan to have abortions—thus the term, unintended pregnancy—it’s hard to imagine that such “riders” will be a popular option for anyone but the most committed pro-choice advocates. Also, this concept clearly discriminates against lower-income women who would be hard-pressed to pay these additional premiums. The fear is also that insurers would find it easier to just drop coverage for abortion from all of their plans—even those provided through employers and not on the exchanges.
Today, the Senate Finance Committee rejected the Hatch amendment to further restrict abortion by a 13-10 vote. But clearly, the issue is not yet decided. There are several more amendments under consideration and Republicans will continue use abortion as an obstacle to voting for comprehensive health reform. For many of these opponents of reform, achieving common ground is not a high priority and they will continue to spread mistruths about abortion and health reform.
Ruth Marcus, writing in Real Clear Politics points out the most egregious of these campaigns, including the widely disseminated charge from the National Right-to-Life Committee that Obama is pushing for “federal funding of abortion on demand” and a television ad broadcast by the Family Research Council that shows an older couple -- Harry and Louise on Medicare -- sitting at their kitchen table and worrying about how to afford a needed operation. The older man says, “They won't pay for my surgery, but we're forced to pay for abortions." Using scare tactics that mix the fear of draconian Medicare cuts with the fear of tax-payer funded abortion is a new—but powerful—low.
In the end, it’s a shame that health care reform had to get caught up in the irresolvable conflagration that is abortion politics. Perhaps it was inevitable. Pro-choice groups hoped that abortion would be included in the spectrum of comprehensive reproductive services that would be covered under the basic government-sanctioned plan. They also wanted to see restrictions on federal funding for abortion lifted. Neither of these is even remotely likely to occur as part of current health reform efforts. The goal of conservatives was—and is—to ultimately ban abortion for all but the most limited uses.
So, with a sigh of resignation—is this what it feels like to reach common ground?—many pro-choice advocates are grudgingly endorsing the Capps amendment and the Baucus bill restrictions, in hope that they will keep the abortion issue from derailing health reform. This underwhelming statement comes from the Center for Reproductive Right’s website:
“The Capps Amendment -- which means that no federal monies will be used for abortion, but does secure access to the service--is a defensive move primarily intended to ward off hostile Congressional amendments to women's abortion coverage. The amendment still segregates abortion from the larger field of healthcare, and should not be mistaken as sound policy. After healthcare reform is enacted, we look forward to a forthright dialogue that puts women's healthcare needs above politics."
Today, with its rejection of the Hatch amendment, the Senate bill moves one step closer to bypassing the most extreme challenge to abortion rights. Now, the work must start on trying to convince moderate Democrats who are queasy about abortion that current restrictions in the prevailing House and Senate bills are enough.
As health reform legislation works its way out of Congress, the list of sacrifices in the interest of compromise grows longer. A strong public plan, independent oversight of insurers, meaningful payment reform, immigrant health coverage—all these provisions are at risk of being sacrificed to some vague notion of achieving bipartisan support for health reform. Now, we can add comprehensive reproductive health coverage to this list. Are we getting closer to common ground?