Federal funds for abortions are now restricted to cases involving rape, incest
or danger to the health of the mother. Abortion opponents say those
restrictions should carry over to any health insurance sold through a new
marketplace envisioned under the legislation, an exchange where people would
choose private coverage or the public plan.
Advocates on both sides are preparing for a renewed battle over abortion,
which could jeopardize political support for President Barack Obama’s health
care initiative aimed at covering nearly 50 million uninsured and
restraining medical costs.
“We want to see people who have no health insurance get it, but this is a
sticking point,” said Richard Doerflinger, associate director of pro-life
activities for the U.S. Conference of Catholic Bishops. “We don’t want
health care reform to be the vehicle for mandating abortion.”
Donna Crane, policy director for NARAL Pro-Choice America, said abortion
opponents “want an abortion ban in private insurance, and that’s not
neutrality at all ? that’s a radical departure from current law. They want
something far more extreme than where I think the American public is.”
A compromise approved by a House committee last week attempted to balance
questions of federal funding, personal choice and the conscience rights of
clinicians. It would allow the public plan to cover abortion but without
using federal funds, only dollars from beneficiary premiums. Likewise,
private plans in the new insurance exchange could opt to cover abortion, but
no federal subsidies would be used to pay for the procedure.
“It’s a sham,” said Douglas Johnson, legislative director for National Right
to Life. “It’s a bookkeeping scheme. The plan pays for abortion, and the
government subsidizes the plan.”
Representative Lois Capps, a governing Democrat from California and author of
the compromise, said she was trying to craft a solution that would
accommodate both sides. Her amendment also would allow plans that covered no
abortions whatsoever ? not even in cases of rape, incest or to save the life
of the mother ? to be offered through the insurance exchange.
“With all due respect, not everyone adheres to what the Catholic bishops
believe,” said Capps, who supports abortion rights. “Our country allows for
both sides, and our health plan should reflect that as well.”
For years, abortion rights supporters and abortion opponents have waged the
equivalent of trench warfare over restrictions on federal funding. Abortion
opponents have largely prevailed, instituting restrictions that bar federal
funding for abortion, except in cases of rape and incest or if the mother’s
life would be endangered.
A law called the Hyde amendment applies the restrictions to Medicaid, forcing
states that cover abortion for low-income women to do so with their own
money. Separate laws apply the restrictions to the federal employee health
plan and military and other programs.
But the health overhaul would create a stream of federal funding not covered
by the restrictions.
The new federal funds would take the form of subsidies for low- and
middle-income people buying coverage through the health insurance exchange.
Subsidies would be available for people to buy the public plan or private
coverage. Making things more complicated, the federal subsidies would be
mixed in with contributions from individuals and employers. Eventually, most
Americans could end up getting their coverage through the exchange.
The Democratic health care legislation as originally introduced in the House
and Senate did not mention abortion. That rang alarm bells for abortion
Since abortion is a legal medical procedure, experts on both sides say not
mentioning it would allow health care plans in the new insurance exchange to
provide unrestricted coverage.
It would mirror the private insurance market, where abortion coverage is
widely available. A Guttmacher Institute study found that 87 percent of
typical employer plans covered abortion in 2002, while a Kaiser Family
Foundation survey in 2003 found that 46 percent of workers in employer plans
had coverage for abortions. The studies asked different questions, which
might help explain the disparity in the results.
In the Senate, the plan passed by the health committee is still largely silent
on the abortion issue. Staff aides confirmed that the public plan ? and
private insurance offered in the exchange ? would be allowed to cover
abortion, without funding restrictions.
Under both the House and Senate approaches, the decision to offer abortion
coverage in the public plan would be made by the health and human services
Abortion opponents are seeking a prohibition against using any federal
subsidies to pay for abortions or for any part of any costs of a health plan
that offers abortion. Such a proposal was rejected by the House Energy and
Commerce Committee, the same panel that approved Capps’ amendment.
But abortion opponents say they can’t accept a public plan that would cover
abortion. And they say private plans in the insurance exchange should offer
abortion coverage separately, as an option.
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