Understanding the health care reform abortion trap
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Who would have thought that after a year of ‘death panels’, ‘bending cost curves’ ‘Cornhusker Compromises’ and ‘reconciliation’, the success or failure of health care reform would end up riding on the question of federal funding for abortion?
Make no mistake – abortion will be the issue that determines whether or not some kind of health care reform makes it to the president’s desk.
So, what’s really going on here?
Historically, there has been a truce between the pro-life and pro-abortion forces in Congress on the question of federal funding for abortion dating back to 1976 when the Hyde Amendment, which barred the use of federal funds to pay for abortions, was signed into law.
However, there have been many contradictions in how the law was applied. For instance, while federal dollars contributed to state Medicaid programs – typically one-half of a state’s Medicaid budget – may not be used to pay for abortions, many states have permitted elective abortion coverage to be paid solely out of the funds the state contributes to their Medicaid program, thus thwarting the federal intent. Bear in mind that states have an obligation to follow federal guidelines on their Medicaid plans if they want the federal contributions. Yet, the federal government has never pushed the issue on providing elective abortion, despite the Hyde Amendment, so long as the states use their own money to pay for it.
Seeing an opportunity to resolve some of these issues in favor of the anti-abortion forces, Rep. Bart Stupak (D-MI) wedged a provision into the House health care reform bill that would bar any insurance policy being offered on the proposed insurance exchanges from including a benefit allowing payment for elective abortions if the beneficiary is receiving a subsidy from the federal government to buy that insurance. How did he do it? Pelosi couldn’t pass a health care reform bill through the House without Stupak and the votes he controlled.
Should the abortion language in the House bill ultimately become law, a woman or family accepting federal subsidies to purchase health care insurance on the insurance exchanges to be created, would not be permitted to buy an insurance policy with an elective abortion benefit. In that way, the federal money provided by way of the subsidies will not run the risk of being spent on buying an elective abortion benefit.
In the Senate bill that was passed, there is also language banning federal funds for abortion– but the language is far less stringent. Introduced by Sen. Ben Nelson (D-Neb.), the very same Ben Nelson who brought us the ‘Cornhusker Compromise’, the bill requires that those who receive federal subsidies to purchase their insurance may not pay for an elective abortion benefit with those federal funds. That is not to say that the insurance policy cannot offer this benefit – it is only to say that the federal funds may not be used to buy the benefit.
So, let’s say you are a family who is receiving federal monies to assist with buying health insurance on the exchange. The cost of the abortion benefit runs, by most estimates, about a dollar a month. You would be required to write two, separate monthly checks – one for the main body of coverage and one for the one dollar to cover your elective abortion coverage- and that dollar may not be a dollar received from the government via subsidies.
It’s not difficult to see why those in the House who are committed to keeping federal money out of abortion would find the Senate offering to be less than satisfying. While the Senate effort was a clever way to sidestep the issue, those in the House who support the pro-life agenda, including at least 12 very committed Democrats, understandably see the Senate action as falling well short of the House bill. And the pro-life House Democrats are not biting.
If you think that these 12 Democrats should hardly be in a position to hold up health care reform, you would be very much mistaken. Recall that the reform bill that passed the House did so on a vote of 220-215 with Stupak and friends voting in support of the bill. Subtract those 12 votes and the measure dies in the House.
While those who are supportive of health care reform and/or pro-abortion may find it difficult to believe that these 12 House Democrats would hold up legislation of such great importance in order to push their pro-life agenda, you might want to get used to the idea. There is no question that these Democrats are prepared to trash health care reform in support of the language they insist must be included.
In an interview with ABC’s George Stephanopoulis, Stupak said,
The bill that they are using as the vehicle is the Senate bill. If you go to page 2069 through page 2078, you would find in there the federal government would directly subsidize abortions … We’re not going to vote for this bill with that kind of language in there.
Via Politcal Ticker
And when asked if he was willing to live with the consquences of bringing down the bill, Stupak added,
Yes, we’re prepared to take responsibility. I mean, I’ve been catching it ever since last fall. I mean let’s face it, I want to see health care. But we’re not going to bypass some principles and beliefs that we feel strongly about.”
Via Political Ticker
I have no doubt whatsoever that he means it.
Pro-life folks tend to be very committed to an issue they see as being morally far more important than a health care reform bill and certainly more important than party loyalty. I don’t say that as a criticism. Like them or hate them, these folks feel strongly enough on the issue to run the political risks that attach to voting one’s conscious knowing that many of their constituents may disagree with them.
But there is a problem in the moral logic being pursued by Stupak and friends – one that could just possibly have an impact on where this all ends up.
Based on the numbers we see with respect to people who die because they do not have health care coverage, Stupak and friends will be trading in lives in being – estimated at 44,000 a year – to save the lives of those not yet born. Of course, pro-life supporters would no doubt be quick to point out that elective abortions in the United States number approximately 1.3 million each year.
Still, that’s got to be a tricky one for even the most committed anti-abortion believer.
There are also some serious moral issues regarding those who might be denied elective abortion services, should Stupak have his way, and be forced to seek more affordable abortions outside the medical system. Many of us remember the barbaric days when women were forced to seek abortions in less than ideal circumstances leading to disastrous, life threatening results. Could anyone possibly want to see a return to such horrible practices?
Should the Stupak group vote against the Senate bill, as currently drafted, health care reform is over. It’s that simple. And yet, even if the Senate Democrats wanted to accommodate Stupak, and include his language in their legislation, it would seem impossible. The abortion provisions are not likely to qualify as an issue that can be resolved via reconciliation as it is not a budgetary issue. Thus, any effort to include the Stupak language in a Senate bill would necessarily re-open the Senate legislation to a filibuster vote. With there now being 41 GOP votes in the Senate to block the legislation, it is highly unlikely the bill could get through.
Where does this leave health care reform?
In very big trouble. It is difficult to see a way out of the box on this. Calls and letters from constituents in those districts represented by the House Democrats prepared to vote against the Senate Bill as a result of the abortion language will not likely carry much influence. As noted, anti-abortionists tend to put the importance of the issue above the desires of their constituents or anything else.
We’re about to discover just what kind of skills Nancy Pelosi and President Obama can bring to the table. It’s going to take all they’ve got – and then some -to find a way out of this mess.
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Several times I have thanked you and told others I genuinely respect your fairness, and 1.3 million abortions says something is wrong. Planned Parenhood is taken care of quit well, getting aid like its a forighn country. My eyes say the defining characteristics of conservativism and liberalism rally around two issues- 1)sbortion 2) gun control. Everyone can get along very well, able to find compromise,other than those two issues. With the big dough that Planned No- Parenthood gets, I don’t see why opposition to abortion in this is such a big deal to the Democrats. Thanks again for the guts to call it the way you see it.
The problem is that it may present an impossible hill to climb. As I say, even if the Senate Dems. were willing to come around and accept Stupak’s language, it would probably mean submitting the entire bill for a vote. And that is likely to fail under the filibuster rules.
In response to another comment. See in context »So, it becomes hard to see how Stupak’s insistence on this language can do anything but destroy the entire effort for reform. And that is unfortunate.
As we’ve seen this past year, there’s a third issue and it’s “Socialism”. I put that word in quotes because despite most people’s inabilities to define the word and despite that usually people are only talking about aspects of it, if they are talking about it at all, all you have to do in some circles in mutter the word and half the audience will work itself into a goddamned frenzy that’s fervor can only be matched by the likes of the Witch Hunts and Crusades (at least the first three). History repeats, and apparently we’re in the 1950’s again. We even kicked things off with an unprovoked war to bring everything full circle.
In response to another comment. See in context »This post demonstrates why health care reform has been so difficult to enact in multi-cultural America. Our health touches all aspects of our lives, and on some issues, our various cultures disagree too much for resolution. If we can’t come to an agreement on something as vital and as universal as our ability to fight disease and death, we may have to realize that our country has grown too far apart to govern.
[...] Understanding the health care reform abortion trap – Rick Ungar … [...]
Several things about this fascinate me. First of all, the right wingers have been beating the states rights drum over and over again recently. As you stated, this is one of the ways that the states were thwarting federal intent. States rights is fun and all until the states do something they dont like.
The second thing is what this does in its practical application. I have read a couple of times that having insurance makes no difference in the number of abortions. What it does make a difference in is when the abortion occurs. Basically, abortion is a pretty big decision that women do not take lightly. When they decide they want an abortion, they will get it. If they do not have insurance, they will save up for it, which takes time. Thus, this measure will probably not decrease the number of abortions. It will, however, increase the number of late term abortions.
Some use it as casually as birth control, having msny.
In response to another comment. See in context »How many is “some”? Two women? Twenty?
In response to another comment. See in context »Please accept my apology, ebizjoey. Should have left it to Rick, who is a much more reasonable person than I.
In response to another comment. See in context »You can always say that some will do this- and, like all things, this is no doubt true. But, I don’t think the overwhelming number of women who make the decision to have an abortion do it casually. It has never made sense to legislate based on what the tiny few will do.
In response to another comment. See in context »I think you are right. If a woman feels it necessary to have an abortion – and I certainly agree that this is nothing that one takes lightly- they are going to get an abortion. The concern is that if insurance companies are blocked from providing this as a benefit, women who cannot afford to see a physician to do this, may return to the old, brutal and unbelievably dangerous way.
In response to another comment. See in context »While that issue of medically safe abortions is an issue in some cases, particularly in cases of difficult pregnancies, it is not the point I was making.
According to the intrawebs, abortion runs $350-$900. With complications, they can be as high as $10,000, but the vast majority are only a few hundred dollars.
Even people in poverty can afford to drop $300-$900 on an abortion, it just takes them a few months to save the money up.
Pro lifers seem to feel that late term abortions are particularly abhorrent. However, this plan will result in more late term abortions as women must wait months to get one in order to save the money.
For the women with more complicated procedures, I agree that safety is a problem. I am not particularly fond of increasing the risk that babies are born with horrible defects because mom screwed up the abortion.
In response to another comment. See in context »Bart Stupak and his crew have courage. They can’t be bought. I don’t even believe that life begins until you pop out of the womb. Big deal that the heart beats because the brain is dead in the womb and doctors declare a person to be deceased when the brain becomes dead even though the heart still beats. Having said that, why on God’s green earth should federal money go to pay for abortions. Most abortions are not due to rape or incest. They happen because somebody won’t buy a condom because they’re too embarrased to look at the clerks face in the pharmacy or because they are too stupid to use the pill or the IUD or they want a child in order to get a welfare check and then change their mind later. Basically if you play fast and stupid with your body you have no right to play fast and stupid with federal taxpayer money.
The health bill should not pass. We’re being lied to by the Obama Administration. They count ten years of taxes and six years of benefits and call that a deficit reducer. Higher income earners who own the small businesses that provide jobs will be taxed and layoffs will happen. The weak will be robbed in order to protect the strong. That’s what will happen if you take 500 billion dollars away from medicare which the fixed income seniors desperately need and give it to 30 million younger healthier stronger people who don’t have insurance. Finally, you ration the health care because more people are covered without adding doctors and you start getting increased cancer death rates like Canada and England.
Do this to get bipartisan support.
1. Tort reform for malpractive law suits.
2. Buy insurance across state lines.
From Charlie Ginsburg
Charlie-
Perfectly fine to believe that Stupak has courage. As you may have noticed, I was careful not to take a position on his point of view because, even though I personally come down on the side of a woman’s choice, I do appreciate the position of those who feel differently.
That said, as you seem to want to move on to a discussion of the actual health care bill, a few things.
1. 500 billion is not being taken away from Medicare. If you are going to call out the Administration on the numbers regarding spreading the cuts out over ten years while it takes six years for most of the reforms to take hold, then you should be equally clear on the Medicare realities.
1. Most of the cuts come in the guise of getting rid of Medicare Advantage which, for the most part, was a ‘give’ to the private insurance companies. The clear result has been the government paying, on average, 7% more for the same services and procedures when paying to Medicare Advantage versus what they would pay if paying directly from Medicare. The remainder of the cuts would come in fraud reduction.
Now, you can argue that these savings may never come to pass if you don’t believe that Medicare will be quite so successful at reducing fraud and you may well be right. But your characterization is inaccurate.
2. Suggesting that 500 billion is being taken from Medicare and given to 30 million younger people without insurance is simply and clearly incorrect.
3.There is absolutely nothing in the current version(s) of health care reform that result in rationing. You’re a bit behind the times. This was an argument you might have tried making when a public insurance option was still in the picture. You could argue that were the nation to go to a single-payer system (which it will, whether we like it or not as that will ultimately be the only option), then we have rationing issues. But that is just not in the cards in the current configuration. Again, you can argue that the legislation fails to cut the costs of medical care in the US – and you’ve got an argument there. But suggesting that ‘Obamacare’ brings rationing is, again, complet3ly inaccurate.
4. Boy, do we all wish it were as simple as tort reform! While I acknowledge that the trial lawyers don’t want this discussed, and while I fully agree that we should be looking at ways to minimize the nonsense law suits, malpractice cases currently take about 2% of the health care dollar. You can argue that this is an inaccurate number because there is a lot of defensive testing done by physicians to protect themselves. However, the only way that can ever completely disappear is if we completely end malpractice suits, even for those with a completely legitimate claim. Even if we limit claims to situations where the physician is grossly negligent, instead of making a simple mistake that just happens in life, physicians will still have to practice defensive medicine. This is a much more complicated issue that you might think. If, God forbid, a physician did something seriously wrong to someone in your family, leaving you with the extra expense of a lifetime of serious care responsibilities and bills running into the millions over a lifetime, would you be prepared for the doctor or hospital to be in a ‘no fault’ situation? Would you be satisfied with an apology as you are sent home to face untold costs over a lifetime because of the error?
5. I’m all for selling insurance across state lines. indeed, under both the Senate and House bills, this will be permitted if the minimum standards required of an insurance policy to be included in the state health exchanges are met. There will be the selling of insurance across state lines! And, you know what? It may help a tiny bit but that is all it will be. Why? Because its not like an insurance company based in a lower cost state hasn’t heard that costs are higher in a higher cost state! If an insurance company is based in, say Rhode Island – a lower cost state- and someone in California – a high cost state- wants to buy one of their policies, do you really believe they won’t charge more for the policy knowing that the Californian will be getting the medical services from California docs and hospitals who charge more than the Rhode Island doctors?
In response to another comment. See in context »There are certainly problems with the bills we are looking at, but you should not allow yourself to fall for the nonsense you hear. If you think it through, it really is not all that hard to realize a lot of it is pure foolishness.
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I cannot believe that healthcare reform might be blocked by what amounts to $12/person/year.
Maybe we should reward people for not getting abortions, instead. “Haven’t had an abortion this year? Here’s your $12 black plus interest!”
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Did you here the one about the guy’s wife that killed all of his children because she wanted to make more room for the home invaders?
Oh what.
It wasn’t his wife. It was his country.
Back in the 60’s the Federal Government came into the public schools and brainwashed us as little children with the message that the children we were about to have were unwanted because the population was rising so fast. They launched a program called, “Zero Population Growth”. They pushed Family Planning and birth control pills. Now they call the same programs, “Safe Sex” but the results are the same. I think you and I both know that you only have to trick people for their few child bearing years and there is no going back.
Many of us never had a say in the future of our unborn.
I am the result of two living cells. One from each of my parents. They are the result of two living cells, one from each of their parents. I wasn’t just born. I am a continuation of life. I am a living thing that reaches back into time perhaps 400 million years and the result of billions of joining of pairs of cells. It is possible that if you were to follow my cells back to my parent’s cells and beyond that my family tree touches every living thing here on earth. That is if we limit ourselves to believing life was created here on earth. If it rained down from the immensity of the universe it could reach back into that immensity of time and space, and who knows what relationships and who knows what species.
My family line succeeded, at least until I came up against the Federal Government.
I have seen the Federal Government do little else to control the population.
The open borders, United States laws only apply to some, is a serious slap in the face. No. Not a slap in the face. It reaches well beyond that. Maybe back to the beginning of time and stretch to the bounds of the universe.
Stockybob,
“Back in the 60’s the Federal Government came into the public schools and brainwashed us as little children with the message that the children we were about to have were unwanted because the population was rising so fast. They launched a program called, “Zero Population Growth”. They pushed Family Planning and birth control pills.” This is nonsense, no public school taught little children any such thing.
“Many of us never had a say in the future of our unborn.” Meaningless.
“My family line succeeded, at least until I came up against the Federal Government.” Sorry to hear that and sounds like a great first line to a medical thriller. Did the theys or thems put something in the water?
So you’re speaking to over population and somehow you were able to get in a dig at immigration? Very clever and gets to the core of your logic that goes back to the beginning of time when man started gibbering and blabbering to each other and their echos stretched the bounds of the universe to a place we call the twilight zone.
I too was in school in the ’60s and never received any such program, lecture or anything else. Further, given the religious atmosphere in public schools at that time, the likelihood such a thing could have happened is less than zero.
In response to another comment. See in context »Additionally, I researched “Zero Population Growth” thinking maybe something happened I didn’t know about. It’s a definition – never a program.
Where do you come up with this stuff?
Rick,
What I cannot understand is that if the anti-abortion congressmen want to end abortion why don’t they submit a bill, debate it and outlaw the practice?
It wouldn’t pass.
In response to another comment. See in context »exactly.
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