Aborting Health Care Reform

This article was first published by The American Prospect.

In September 1993, as Hillary Clinton lobbied Congress to pass her
health-reform bill, she plainly addressed the looming controversy over
reproductive care. "It will include pregnancy-related services, and
that will include abortion, as insurance policies currently do," she
told the Senate Finance Committee. Conservatives were incensed. But as
the history books record, it was industry pressure and legislative
malaise that killed Hillarycare, not debate over women’s rights.

On the campaign trail, Barack Obama did not shy away from the issue
of abortion, pledging, "On this fundamental issue, I will not yield."
In the context of health reform, though, the president and his staff
have been reluctant to directly address reproductive rights. In a March
interview with the Christian Broadcasting Network’s David Brody, the
White House’s chief domestic policy adviser, Melody Barnes — who once
sat on the board of Planned Parenthood — claimed she had never spoken
to the president about whether abortion services should be covered
under a universal health-care system. "We haven’t proposed a specific
benefits package or a particular health-care proposal, so we’re going
to be engaging with Congress to have this conversation," she said. When
Office of Management and Budget Director Peter Orszag was asked by Fox
News in July whether the public insurance plan should cover abortion,
he was vague. "I’m not prepared to rule it out," he said. The president
finally addressed the issue himself in a July 21 interview with Katie
Couric, in which he bucked reproductive rights groups by saying he
would consider deferring to the "tradition" of "not financing abortions
as part of government-funded health care."

Perhaps in response to the failure of the Clintons’ highly detailed
plan, Obama’s strategy has been to leave the nuts and bolts of health
reform up to the legislative branch, saying only that the resulting
bill must fulfill three goals: lower costs, provide Americans with more
health choices, and assure quality. That lack of detail has shoved
Congress deep into the weeds. Predictably, the president’s vagueness
hasn’t prevented anti-choicers from seizing upon the possible inclusion
of reproductive-health services as a vehicle to activate their base
against reform. "A vote for this legislation, as drafted, is a vote for
tax-subsidized abortion on demand," wrote Douglas Johnson, the National
Right to Life Committee legislative director, in a letter to Congress.
That message penetrated. At a July 14 press conference, Rep. Joe Pitts,
a Republican from Pennsylvania, claimed health reform undermined
Americans’ "right to life. Let’s make it explicit that no American
should be forced to finance abortions." As the health-care debate
reached a fever pitch in the weeks before Congress’ summer recess, Fox
News featured daily segments on the threat of "subsidized abortion."

Meanwhile, Obama declared in his July 18 radio address that he would
not sign any reform bill that did not include a public health-insurance
program. A public plan is central to progressives’ goals of lowering
costs by giving private insurers real, high-quality competition. A
government-funded insurance option might, eventually, serve as the
shell for a single-payer health-care system similar to those of Western
Europe. But if Congress acquiesces to abortion opponents and passes a
public plan that does not provide reproductive-health services
comparable to what Americans can purchase in the private market or
obtain through their employer, it will be a weaker plan with a smaller
constituency. After all, the typical woman spends five years of her
life pregnant, or trying to become so, but a full 30 years avoiding
pregnancy. Without good reproductive-health coverage and strong buy-in
from women — who use more health care than men — it is difficult to
see how a public plan would gain strength over time.

Contrary to conservative hand-wringing, reproductive rights have
been under constant assault in the health-reform debate. At stake is
not only whether a potential public plan covers contraception or
abortion but also whether existing private health insurers, 87 percent
of which currently offer some abortion access, will be able to continue
to do so once they are operating within the new health-insurance
exchanges. The exchanges will house both public and private plans after
reform and will be regulated by the federal government.

This increased government intervention in the health sector both
excites and terrifies advocates for better reproductive care. The
potential upside is that through a public plan, an expansion of
Medicaid, and more competition among private insurers, many more women
will be able to afford good reproductive health care. But the potential
downside is stark: A politicization of which reproductive-health
services insurers can cover, meaning that under anti-choice
administrations, abortion and even contraceptive limitations or bans
could become the norm.

For millions of American women, insurance-subsidized abortion is already off limits. After Roe v. Wade
legalized abortion in 1973, one of the religious right’s first
successes in limiting access to the procedure was the passage of the
Hyde Amendment. Since 1976, Hyde has banned Medicaid — the federal
health-insurance program for poor women and children — from paying for
abortions, except in the most extreme cases when a woman’s physical
health or life is in danger. Medicaid covers 7 million American women
of reproductive age, or 12 percent of women in that cohort. Federal
employees, members of the U.S. military, Peace Corps volunteers, and
prisoners are also barred from using their government health coverage
to access abortion.

During a July 14 interview on MSNBC, Sen. Chuck Grassley, the
ranking Republican on the Senate Finance Committee, contended that when
it comes to abortion and health reform, "what we’re trying to do is
maintain current policy." Yet because any potential public health plan
would be funded by the federal government, what anti-choicers would
really like to ensure is that Hyde would also apply to any new public
insurance programs.

That isn’t likely to sit well with the public. Though past polls
have shown Americans are resistant to the concept of "taxpayer-funded
abortions," the public seems to see health reform under a different
light. According to a poll by the Mellman Group on behalf of the
National Women’s Law Center, 71 percent of Americans support coverage
for reproductive health, including contraception, under a public plan.
Sixty-six percent support coverage for abortion in a public plan.

None of the health-reform proposals being considered by Congress
explicitly threaten Hyde or the other existing federal bans on abortion
funding. In fact, reproductive-health-care advocates reluctantly admit
that the repeal of Hyde, although a long-term priority, is not on their
current agenda. After all, some Democrats, including Vice President Joe
Biden, have a history of support for the ban. "Hyde is discriminatory
against poor women, and we’d like to see it overturned," says Adam
Sonfield, a senior policy associate at the Guttmacher Institute. "But
it does not seem to be a political priority right now."

To protect against disruptions in American women’s access to
reproductive medicine, advocacy groups are recommending that an
independent council of medical experts — not a political appointee —
define which services will be covered by insurance plans participating
in the exchanges. Such a commission would likely argue for the
inclusion of abortion and contraceptive services. Though politically
volatile, family planning is rather uncontroversial in the insurance
industry and among public-health experts. For every $1 spent on public
family-planning services, the government saves $4.02. The public sector
alone saves $4.3 billion in medical costs each year thanks to the
family-planning coverage the federal government already provides poor
women through Medicaid and Title X. That’s because birth control and
abortion are simply much less costly than pregnancy.

The final health-reform bill will likely establish a council of
experts to advise the health and human services secretary on what
benefits should be covered. But in both the House and Senate proposals,
the council’s power is limited; it is still the HHS secretary who makes
the final call. This means that under anti-choice administrations,
abortion and contraceptive access could be threatened within the
health-insurance exchanges. "The potential there is that many, many
women could lose the coverage they presently have," said NARAL
Pro-Choice America President Nancy Keenan in July, as hundreds of
Senate amendments were being filed on health reform, many of them
seeking to prevent abortion coverage.

Another risk is that even if abortion services are covered, health
clinics that provide abortion — such as the Planned Parenthood network
— could be barred from participating in the exchange, meaning they
would not be able to offer insured services to patients in either
public or private plans. An amendment to the Senate Health, Education,
Labor, and Pensions (HELP) bill from Barbara Mikulski, a Democrat from
Maryland, would protect the status of clinics, but it attracted
opposition even from some Democrats, such as Sen. Bob Casey of
Pennsylvania, who identifies as pro-life.

For many congressional Republicans — and some of the 19 moderate
House Democrats who joined their cause — fanning the flames of the
abortion debate is, at least in part, a tactic for delaying reform. To
be fair, some family planning opponents do support the broader goal of
universal health care — the Catholic Church chief among them. But
according to Marilyn Keefe, director of reproductive-health programs at
the National Partnership for Women and Families, "The pressure [on
reproductive rights] largely comes from people who don’t support the
larger health-reform effort."

Advocates were able to ensure that both the House tri-committee
bill and the Senate HELP bill made it through committee without any
amendments limiting access to reproductive care. But as Tina Tchen,
director of the White House Office of Public Engagement, told a July 15
Planned Parenthood conference — perhaps in an effort to tamp down
expectations — "That was not easy. It was not easy in committee. It
won’t be easy to hold on the House floor. It won’t be easy to hold on
the Senate floor."

Women’s organizations find themselves in the strange position of
playing defense, even as a pro-choice president sits in the White House
and both houses of Congress have pro-choice majorities. "Depending on
some of the things that are being proposed, we could be worse off"
after health reform than before it, Planned Parenthood President Cecile
Richards said at the conference. "That is untenable. Those are some of
the tough conversations we’re having, frankly, with the White House and
Congress. We can’t be worse off."

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  • invalid-0

    I think that if you consider yourself a pro-choice progressives we need to think long and hard about our priorities on this. For anti-choicers who have social justice interests (which includes a lot of Catholics) health care reform is something that they desire because they view it as a matter of ‘distributive justice’ (ie, helping those with who are more impoverished to be less disadvantaged materially than the well off), but abortion takes priority as a ‘life and death issue) in their eyes. Do we consider abortion inclusion in health care insurance plans which receive federal subsidies to be an important enough issue to possibly derail reform efforts? I don’t, but come to your own conclusions knowing that many anti-choicers who could support reform otherwise would rather that there be no bill at all if they can’t get their way on this issue. Couldn’t we accept half a loaf now (assuming contraceptive care is included) and work for change later?

  • invalid-0

    The problem with that idea is the assumption that contraception will be included. You cannot safely assume that. History has shown again and again that if you give these anti-choice wackaloons the slightest taste, they immediately try to steal the whole pie. Cave on abortion, and contraception will be next on the chopping block. It’s ALREADY on the chopping block, because we blinked on abortion with Hyde. So I say no. No compromise. My body is MINE, and nobody, born or not, has the right to just hook themselves up to my body and leech off it for life support without my permission. No special rights for the unborn!


  • invalid-0

    Abortion inclusion in health care insurance plans is important enough because
    Abortion Care IS Health Care.

    How much longer can we wait for “later”?

    As a woman who elected to have an abortion, the fact that I had insurance that covered my procedure and aftercare allowed me to afford an appointment in my first trimester that could have otherwise been a barrier in costs. Thank GOD for that, for now I am in a place in my life where I am healthy physically and emotionally and able to afford and have resources to plan for my family.

    As a woman who went to work in health care, including gynecology and including abortion – I met women who were in tears and desperation because they found out their insurance didn’t cover their procedure, who had to work and borrow and struggle to raise money on their own, when they were making responsible, thoughtful, and often very emotional decisions about family planning. These include women who had used birth control that failed (even women whose husbands had vasectomies, for crying out loud…), and/or women who did not have the comprehensive sex ed course they needed, and/or women who had kids, and/or women whose health would have been at risk to have a child.

    And consider a poor woman who has reached her decision and is trying to be responsible in having a procedure earlier rather than later (“LATER” being an scary word in both terms of procedure and terms of unaffordable costs)
    … the idea of later and later for health reform change to recognize that abortion care is NECESSARY … is just too unbearable.

    People, please keep in mind that 1 in 3 women in the US has an abortion by the age of 45. ONE in 3. How can health care coverage be denied for 1 in 3 women in the US?

  • invalid-0

    Suppose the anti-choice folks got their way on abortion, but we get contraception explicitly included in the subsidized plans- what would you say then? Remember that there are democratic congresspersons for whom this is a sticking point. As a political reality, is it worth holding fast if it endangers reform and the democratic majority with elections coming in 2010?

  • megan

    As we have seen with the Hyde Amendment, when progressives pick their battles to compromise on access to abortion, low-income women lose.  And they lose for a very LONG time.  It’s been over 30 years now that the most vulnerable women in our society have been routinely denied their ability to make decisions about continuing pregnancies and becoming mothers.  Over 30 years that Congress has voted for the Hyde Amendment to restrict Medicaid funding for abortion, each and every year as part of the budget process.  How likely is it that if we give up abortion coverage now, that we’ll ever get it back?

    If history tells us anything, it’s that compromises on abortion aren’t compromises at all — they’re losses.  Plain and simple. 

    Try telling a woman living on $600/month that she needs to come up with $450 for her abortion or she’ll have another mouth to feed.  Abortion is part of women’s health care.

    What other procedure is provided to one out of every three women in this country and isn’t considered health care?  When you’re pregnant you medically need one of two things: prenatal care or an abortion.  Do people consider prenatal care elective?  I think not.

    Lastly, we’re not just talking about extending the Hyde Amendment to health care reform — we’re talking about all the women who currently DO have coverage through their insurance (which they have because most health insurance companies recognize abortion as part of women’s health care — what a radical idea!) losing that coverage.  We’re talking about an enormous expansion of inequality in health care.

    That’s not a compromise I’m willing to make and anyone who cares about the well-being of women and their families shouldn’t be willing to make it either.

  • invalid-0

    Anonymous- I was NOT arguing about what is desirable. I’m talking about the political reality. Should the perfect be the enemy of the good? Ideally, we’d have single payer of the sort Kucinich stumped for, but that’s off the table. Heck, there are indications that there might not be a public option in the final bill!!!

    Rethugs will hold the line no matter what. I don’t think we can afford to lose the Democrats who could get on board if you take abortion out of the plan.

    Are the women without insurance better off if the whole reform effort gets defeated? I’m thinking about what is the best result that can be had. Isn’t backing down on this worth it if that’s what it takes to get a bill passed? What would do the greatest good?

  • invalid-0

    The real question, in my mind, is why we’re nearly always ready to compromise on the points that disproportionately affect women, poor women, and women of color. It is foolish to think of this as an isolated incident. And maybe — just maybe — it’s politically the stronger position to stop capitulating to those who would destroy an existing family with abstract hand-wringing over a blatocyst. Like Loretta Ross said on this very website not so long ago: the middle ground does not start on my body.

  • invalid-0

    Anti-choice folks can be made to fall into line over the threat of abortion. They’re single issue extremists who care only about fetuses, but I want to know: Are we single issue too? Isn’t health care bigger than this?

  • invalid-0

    The woman making $600 a month could still use insurance even if it lacks abortion. What about all of the possible health problems other than an unwanted pregnancy? Megan- is this about helping women or is it about ideology?

  • http://www.eliminaracne.com invalid-0

    hi! thanks for sharing the article in the post, i can’t get this kind of information very often. i think it’s a very important theme and we all should take into account and be careful. thanks for the post again.

  • invalid-0

    How happy will you be if you get the bill you want, but it doesn’t pass? Don’t the 50 million people with no health care matter?

  • invalid-0

    and we’re single-issue for responding to them? Please. As Dana’s piece says, 2/3 of Americans FAVOR health care reform that includes abortion — and we have no idea whether that other 1/3 of Americans consider abortion a deal-breaker or not, just that they don’t favor it.

    If we give abortion coverage up now, we will never get it back. Call your local abortion fund to find out what happens when women and families don’t have coverage for abortion.

  • invalid-0

    Yes, I’m one of those single issue voters, the single issue being Women’s Lives, and I for one will not compromise when it comes to Women’s lives.

  • invalid-0

    Remember that there are democratic congresspersons for whom this is a sticking point. As a political reality, is it worth holding fast if it endangers reform and the democratic majority with elections coming in 2010?

    The political reality is that the OVERWHELMING majority of American women use/have used some form of effective contraception (and by ‘effective’ I do not mean those endorsed by the Vatican). The political reality is that in polling the overwhelimg majority of Americans believe that effective contraception is an unalloyed benefit. The political reality is that attempts to change the laws to deny women effective contraception would be political suicide.
    You and the ‘centrist’ wing of the Democratic party needs to develop a backbone and some common sense because if you do not there will be no dem majority after 2010

  • invalid-0

    I never said anything about backing down on contraception. In fact I proposed the opposite.

  • invalid-0

    Sorry I was unclear. I was aware that you didn’t wish to ‘back down’ on contraception. I was saying that refusing to include contraceptives in a nominally Democratic health care reform package because 6% of the American public might object is politically unrealistic. I was pointing out that opposition to contraception is a position with very little social or political support and that refusing to include contraception in a health care reform package is or should not be a politically viable position. I wish that conservatives of both parties would stop presenting access to contraception as some sort of viable trade off or compromise.

  • invalid-0

    I guess that I may have worded myself poorly. The “sticking point” I was referring to is the abortion issue. I was only talking about ensuring contraception because the comment (above titled: “ass-u-me”) suggested that backing down on abortion would entail losing on contraception (which I think is not true).

  • invalid-0

    Let’s not exaggerate here. This isn’t about hangers and back alleys. This is about dollars. More people getting money for health care (or even free health care), but with strings attached: none of the funds go to plans including abortion coverage. It’s a reasonable trade off.

  • invalid-0

    2/3 of Americans FAVOR health care reform that includes abortion

    Have you seen that Mellman poll? There’s a reason that it looks like it is an outlier. It gave a choice between: A) coverage that could not include abortion (even to save the mother) and which could not include contraception or B) coverage that could. Obviously, when you put the question that way you’ll get a lot of support for ‘A’. That doesn’t reflect Capps versus Stupak-Pitts.

    Also, it is the votes in congress that count, and there are Democrats whose votes depend on including the Hyde standard. We’re talking about at least 19 votes, and there are more signals all the time that the public option itself may get jettisoned just to get more votes. I’m not willing to chance a repeat of what happened in 1993 over this.

    Call your local abortion fund to find out what happens when women and families don’t have coverage for abortion.

    Point taken. However, I’d say that you should talk to families who’ve lost their homes because they had no health insurance (or insufficient coverage). Did you know that medical crises contribute to half of all home foreclosure filings? What do you think those families would say?

    Health Care Expenses and Home Foreclosures

    The right is going to make health care reform fall over abortion and we’re single-issue

    If you’d LET them sink it over abortion, then yes, you are.

  • invalid-0

    The health care issue cannot be about the old problems or abortions., There are too many people like myself, reaching retirement age who do not have any health care protection. The President should not back down under pressure from republican and conservative democrats trying to keep their constituents. Mr. Obama should do the right thing. He promised health care for ALL THE PEOPLE and that is what he should do. He should not bend under the pressure because the rich who can afford it and have it and don’t need it will always try to stop health care reform. We do not need Co-ops either because it is an opportunity for the ones who can form non-profit organizations and hide monies away under the guize of “expense” will continue to get the benefits which should be reserved for people who really need it. Co-ops would only mean deregulation, like the gas companies etc. they still get all the cream and leave all the uninsured out in the cold and therefore the whole purpose of reforming health care would be redundant. Come on Mr. President, stick to the issue, insure the masses, reform Medicare and make the medical community and insurance companies be accountable.

  • invalid-0

    The “sticking point” I was referring to is the abortion issue.

    Indeed. You’ve been as clear about that as an employee of Democrats for Life or some other ‘centrist’ Trojan Horse organization.

  • invalid-0

    We’re talking about at least 19 votes, and there are more signals all the time that the public option itself may get jettisoned just to get more votes.

    So at heart, this isn’t at all about the false tension between coverage of all medical procedures or no health care reform.

    It’s about the actual (constant) tension between (1) what the people want and need, and (2) what their (democratically elected, government of the people by the people for the people) political representatives are willing to let them have.

    19 legislators (of the people by the people for the people) hijacking health care reform for 50 million people over the decontextualized idea of abortion. And you call the people opposing that chicanery “idealogues”? I call shenanigans.

  • invalid-0

    Who is it you feel is being dishonest- me or the 19 congresspersons?

  • therealistmom

    … just as soon as none of my tax money is used to fund the killing of born humans overseas in military actions.

  • invalid-0

    However, I’d say that you should talk to families who’ve lost their homes because they had no health insurance (or insufficient coverage).

    This is outrageous. the people who should be doing the talking to ‘families’ are the morons in congress who are desperately casting about for any excuse at all to explain their spineless, corrupt, collective failure to actually represent the American people. It could not be more obvious that the ‘pro-life’ Democrats are hoping to play the abortion card and blame the pro-choice community for yet another monumental failure of leadership.

    Did you know that medical crises contribute to half of all home foreclosure filings?

    well, duh.

    What do you think those families would say?

    I think the ones who are aware of political realities would say you’re a ‘centrist’ tool. Al From must be so proud.

  • invalid-0

    Expanding coverage (with or without abortion) is of benefit to everyone- how do you get from that to war?

  • invalid-0

    I think the ones who are aware of political realities would say you’re a ‘centrist’ tool.

    I think they’d say that focusing on one particular aspect of health care when it risks the others is short sighted and dogmatic.

    Al From must be so proud.

    Is From that different from our current president?

  • invalid-0

    The argument used by the anti-abortion movement is that they don’t wish to see ‘their’ tax monies going to pay for abortions or provide healthcare to women who might, at some time in the future, have an abortion.

    Folks like you always pander to them.

    There are many areas those of us occupying the considerable political territory to your left would not like to see ‘our’ tax monies go to. If you even listened to us you would understand that unnecessary wars are one of those areas. But, then, ‘centrists’ never listen to anyone on their left.

  • stacee84

    I’m saying that if the left wants health care, then by giving in on one issue they much improve their odds of getting 90% of what they want, but if they hold out for 100%, then they may get nothing.  What exactly was it that the right wanted, and that you were willing to give them in exchange for switching from public to private funding of the war? 


    That we have legitimate grievences with the right is irrelevant when the topic is how to get what centrists and the left both want. Just saying, "they screwed us over, now it’s our turn" is foolish if it means that health care reform fails.


    It doesn’t connect.