The National Catholic Review

The Baucus Health Care Reform bill has been criticized by Archbishop Raymond Burke, Prefect of the Apostolic Signatura. In an interview with Fox News, the former Archbishop of St. Louis said that, despite the claims of Baucus himself, the bill does provides a "mandate" for abortion. I am not sure what Archbishop Burke means by "mandate." The Baucus bill gives tax credits to poor individuals to subsidize the insurance plans the individuals have selected. That is too indirect to constitute "federal funding of abortion" let alone a "mandate."

According to Archbishop Burke, the bill "provides for the provision of abortion, so it’s simply not acceptable." This sentence is impossible to parse unless the objection is simply that it does not take steps to outlaw abortion, which is undoubtedly true. And, here we get to the key question that Catholics, and especially the USCCB, must face in the coming weeks: Where do we draw the line? How do we deal with the nettlesome policy issues surrounding abortion and health care reform?

I watched an episode of EWTN’s "The World Over" in which American Life League President Judie Brown took exception to the phrase "abortion neutral." She protested that we must never be neutral about abortion, but that is not what the phrase suggests. It means that the health care bill should not be used by either pro-life or pro-choice groups to change the status quo on abortion. We have other avenues for pursuing our pro-life goals. Health care reform is contentious enough.

Under current law, no federal funds can go to pay for an abortion through Medicaid (the issue does not arise in Medicare) except in cases of rape, incest or to save the life of the mother. This is the Hyde Amendment which goes back to 1977. But, it is also the case that under current law, if you do not participate in a federal insurance program you are free to purchase health insurance that covers abortion services. The real problem is this: Do we subsidize policies for poor and middle class people with federal funds and allow them to select plans that cover abortion? Is that federal funding of abortion? Or does that maintain the status quo, the difference being the subsidy not the freedom that people enjoy currently to select plans that do or do not include abortion? And, if the much-debated public option survives, should it include abortion services?

Let’s take the easy question first. If there is a public option, it must not cover abortion. The language of the Hyde Amendment regarding Medicaid should be extended to the public option. As for subsidies, I have suggested previously that there could be policy riders to cover abortion services. These would be purchased entirely out-of-pocket and, like all insurance riders, would be on top of a basic policy. The basic, underlying policy would be eligible for a subsidy. The Baucus bill, by providing tax credits, gets around the issue neatly in moral terms – there is no formal cooperation with evil in giving a tax credit to buy insurance and letting people choose whatever policy they want. But, tax credits are a cumbersome mechanism and I suspect some percentage of poor people who do their own taxes fail to harvest them. If the subsidies go directly from the federal Treasury to the insurance companies, then we have to try and guarantee that these not subsidize new insurance plans.

The word "new" is important. Consider the case of a woman who currently has an insurance policy that covers abortion. Because of her income level, she will be eligible for a subsidy. Even if the subsidy is direct to the government, I think that the commitment to keeping the bill abortion-neutral trumps the concern for indirect federal funding and, in the case described, the woman should receive the federal subsidy. New policies, however, should not qualify, at least that should be our goal but I also do not think this should be a deal-breaker, depending on the way the subsidy is delivered: If the subsidy is in the form of a voucher, payable to the insurance company of the individual’s choice, then a voucher is no different from a tax credit.

Only once in my life did I have a woman I know come to me and discuss the possibility that she might procure an abortion. She was a part-time employee who was already a single Mom, who was going back to school to try and improve her options in life. She did not have health insurance. I promised her that I would make whatever scheduling arrangements were needed to help her during her pregnancy and after, as well as trying to procure financial and other assistance through my network of friends in the Church. But, she was terrified of the medical bills a pregnancy entails, not least because her first delivery had required a couple of extra days in the hospital. I truly believe that if that young woman had health insurance, she would have carried that child to term. Instead, she chose the only option she knew she could afford and had an abortion.

This is an anecdote and even a bunch of anecdotes are not data. But, I suspect that many women are in the same situation as that waitress was. I suspect many women have abortions because they know how much it will cost, there is no uncertainty, and then they can move on. I suspect many women would choose to carry their child to term if they knew that, even if there are complications with the delivery, they will not go bankrupt, they can still afford the childcare for their other children, etc. Health care reform is pro-life per se. It should not be brought down short of requiring formal cooperation with evil. The Baucus plan does not require that. The Capps Amendment in the House Bill does. Drawing the line on this issue requires careful casuistry, in the best sense of the word. The problem with Archbishop Burke’s prognosis is not that it is too sweeping, although it is. The problem is that it helps to perpetuate a status quo that coerces women to have abortions.

 

Comments

Anonymous | 9/21/2009 - 9:29pm
Re:  "It means that the health care bill should not be used by either pro-life or pro-choice groups to change the status quo on abortion."  Then it is not a good thing because the status quo on abortion is an on-going holocaust on America's most defenseless citizens.  We have to utilize every avenue to fight this institutionalized evil.
 
Anonymous | 9/21/2009 - 4:02pm
First, I question the hypothesis that fewer women will have abortions if they are insured.  There are countless crisis pregnancy centers, many if not most run by the Catholic Church, that will pay all costs associated with a pregnancy including post-natal care and/or adoption services if desired.

Second, anyone who has a passing familiarity with the way government works knows that if something is not explicitly excluded, then it is open for funding.  I support healthcare reform, but there needs to be a clear exclusion for abortion funding of all kinds.

As Catholics, we believe abortion is the taking of life and the country deserves a healthcare system in which all are covered and protected, especially our most vulnerable citizens.  We can do both, and we must.
Anonymous | 9/21/2009 - 1:09pm
Here's the data you lack, directly from the Guttmacher Institute:
 
''Approximately one-fourth of women who would obtain a Medicaid-funded abortion if given the option are instead forced to carry their pregnancy to term when state laws restrict Medicaid funding for abortion, because they lack the money to pay for the procedure themselves'' - Guttmacher Institute, July 8, 2009, “Restricting Medicaid Funding for Abortion Forces One in Four Poor Women to Carry Unwanted Pregnancies to Term” [url=http://www.guttmacher.org/media/nr/2009/07/08/index.html]http://www.guttmacher.org/media/nr/2009/07/08/index.html[/url]
 
-A little more than 2 million babies were born under Medicaid in 2003 in the 32 states and DC that restrict abortion funding (like the federal government) under Medicaid – the states that Guttmacher is referring to in their conclusion. There were 20 million Medicaid enrollees in these 32 states and DC at the time.
 
-THAT MEANS THAT 500,000 MORE BABIES WOULD BE ABORTED, leaving 1.5 million live births under Medicaid in these 32 states and DC. This data is exactly according to Guttmacher's conclusion.
 
-I am well aware that those numbers refer to Medicaid eligible and that the new healthcare proposals would federally fund insurance for those above the Medicaid line (and others). And if we bring 20 million people onto the private rolls, we may not have 500,000 more abortions. HOWEVER, no statistician could ever make a case that we wouldn't significantly increase abortions – at least a couple hundred thousand, based on Guttmacher's conclusions. And people on both sides of this issue agree that Guttmacher has the most accurate data there is. Those couple hundred thousand babies are the reason you cannot support this bill. There is no reason we can’t provide healthcare without including insurance plans that cover abortion.
 
- And another thing, many people are making it appear as if abortion coverage is common in private policies. How do you square that with this actual financial data (not a random survey) from Guttmacher (and please remember that 65% of Medicaid enrollees are on private managed care insurance plans):
 
''Providers reported that about 13% of abortions are reimbursed by Medicaid; almost all of these occur in Medicaid funding states. An estimated 13% of abortions are covered by private insurance billed directly by the facility.'' (The Accessibility of Abortion Services in the United States, 2001)
 
-The means that 13% of abortions were paid for by private insurance. Even if that was double or triple, it would still be that a minority of insurance plans cover abortion. Therefore, not providing is not going against anything. What is breaking policy is the federal government funding insurance plans that provide abortion. We don't do that for the tens of millions of Americans who we fund private plans for now - Federal Employees, Military, Native Americans or Medicaid enrollees.
Anonymous | 9/21/2009 - 10:55am
The Dallas Morning News ran a front page story yesterday about five areas in south Dallas.  One of the striking metrics used was the age and number of teenage births, level of poverty, and number of births to single moms.
To concisely summarize - these five areas are all well below the federal poverty levels.  The teenage rate of pregnancy was above 50% (wish they had also included a metric for teenagers having second births?), single moms having babies was well above 60%.
The high school graduation rate for these areas runs on average around 30%.
It appears that economics plays a significant role in high school graduation rates; teenage pregnancies; and single mothers.  These did not have abortions but the rates are alarming and indicate a vicious cycle in our society.  The article, unfortunately, does not really indicate what happens to these babies except by a remote connection to later high school graduation rates.
Not sure if they had babies because they could not afford abortions; cultural and social reasons to have babies; etc.  In many ways, the debate about health coverage misses the point.
Anonymous | 9/21/2009 - 10:30am
I forgot to mention another insurance industry anti-life "pre-existing condition": intention to adopt a child.
Anonymous | 9/21/2009 - 10:28am
Some of these Bishops should dig out there ethics texts from when they were in minor seminary.  They should also pay attention to the tax code, which subsidizes abortion services in private insurance through exemptions to the business income tax.  A federal option with abortion services would not prove much of a difference.  The impact on any taxpayer is slight enough that no one can claim that participating in the life of the state through voting or paying taxes can be considered direct involvement in any abortion.
 
If women really want abortions, they will find funding, especially if they have no other health insurance or feel financially insecure about not only the pregnancy, but in raising the child.  There are plenty of ways to get one without federal medicaid funding - usually because state medicaid funding and the medical charities fund in most areas picks up the cost.  I suspect that the waitress who had the abortion had as much to fear from first year of live doctor visits than the visits in the pregnancy intself.  While the various efforts to make pregancy easier - like Project Gabriel - are all well and good - they are not enough.  Passing health care will actually make abortion less likely, even if abortion were covered.  A living wage, including for Church employees, would also decrease abortions.
Anonymous | 9/21/2009 - 10:23am
Congratulations, Archbishop Burke, for having your nonsensical Republican Party taking point (abortion "mandate") down pat.  Sadly, the archbishop further cheapened his message by delivering this tired distortion on lunatic-fringe-feeding FOX.
So, the archbishop prefers that predatory private insurance companies continue to exclude women who are pregnant, women who have had caesareans, and women (many with children) who are victims of domestic violence from obtaining healthcare insurance coverage due to their "pre-existing conditions."  How "pro-life" of him.
But then, the highly partisan pro-life movement has been busy cutting its nose to spite its face for decades to the detriment of its cause.  Shrilling and shilling.       
The archbishop's and the pro-life movement's all-or-nothing stances do nothing but perpetuate the status quo.  Some suggest that's exactly what the Republican Party wants.
Anonymous | 9/21/2009 - 9:32am
Thank you for your news and analysis. It amazes me how far Catholics can sometime stretch the idea of cooperation with evil to where they can just about do anything. Amarillo Bishop L.T. Matthiesen once told a meeting of ecclesial health care ministers that although most nuclear bombs were assembled at Pantex in his diocese, and he had consistantly spoke about the evil of such weapons of mass destruction, only one person he knew of had actually quit her job of making these bombs which at that time were targeting mainly the people of the Soviet Union and China.
Then there was the case of the Bishop of San Diego who had the gall to excommunicate a Catholic nurse who ran an abortion clinic and who was a politician running for office; as I recall, the bishop caught the flak and the woman was propelled into office. I think this whole incident added to the bishop's later resignation.
So, I tend to side with Archbishop Burke; supporting the buying of health insurance that also offers abortion is cooperating in evil, and mandating such insurance is a sort of making a fiction of the idea that a federal health care program doesn't support abortion. That most Catholics won't buy this is evidenced that apparently most Catholics wouldn't have any trouble in selling such insurance! Where are the good members of the Knights of Columbus on this issue? It seems to me that when the pocket is affected, then the problem is too easily resolved towards a very liberal stance that doesn't see the cooperation with evil.
At the same time, as Sean Winters points out, cooperation with the forces that oppose good health care for all are cooperating in the evil of setting up a situation where abortion is almost the only choice. But, not only that abortion is the almost the only choice, but also that anguish and despair also become the lot of those and their families so deprived of access to medical care.
Anonymous | 9/22/2009 - 10:13pm
     Giving the poor health insurance whereby they still have to come up with the money for co-pays or cover their medical expenses until they reach their deductibles is as good as not giving them health insurance at all.  I am often put off from going to the doctor just because the prospect of the aggravation that usually comes from dealing with the claim being rejected and having to be appealed is worse than living with whatever ails me.  (Probably why the insurers reject perfectly valid claims)  I imagine that someone who has even less to spare than I would be inclined not to take the chance of having to come up with money should a claim be denied and might not even bother because copays do not fit into the household budget. 
 
     Therefore, changing the way health insurance works has to go a lot further than just making it both mandatory and affordable to have insurance.  Unless the cost of medical care becomes a regular, predictable part of the budget - as it would if it were taken out of one's pay the way Medicare and Social Security are - and unless the total cost of whatever is needed in the way of medical care is totally covered, it is unlikely that merely having health insurance will result in measurably fewer abortions. 
Anonymous | 9/22/2009 - 5:43pm
1. The other Michael wrote that “Using Guttmacher statistics, 75% of abortions happen because there is not enough money to care for the child after birth”.
 
That 75% figure is not from anything I've read from Guttmacher and it is not from anything I wrote. Guttmacher freely admits that abortions go up 25% under Medicaid-eligible when funded by the government. The 32 states and DC that don’t fund abortions have 2 million births under Medicaid per year, so funding abortion would reduce the births to 1.5 million and increase the abortions by 500,000. If you read the research, based on 38 studies over 3 decades, affording the abortion, which increases in cost over time, has a lot more to do with the cost of the abortion than the cost of the child. You can assume otherwise, but this is the data.
 
2. The other Michael wrote “All you conclude is that people without insurance get abortion more than their share of the general population”
 
I do not conclude that at all. You conclude that insurance policies include abortion. The majority of those who have abortions may very well have insurance, just not abortion coverage. People have to understand that most insurance companies offer plans with abortion coverage among the many other plans they offer, BUT most employers do not select the plans with abortion coverage, which leaves most employees and thus most of the insured with insurance but without abortion coverage. See below:
 
-''Most private plans do not cover abortion services except in limited instances.'' - Kathleen Sebelius, Secretary of the Department of Health and Human Services, April 2009 (Also the former Insurance Commissioner for the State of Kansas).
 
-''Most insurers offer plans that include this coverage, but most employers choose not to offer it as part of their benefits package'' Robert Zirkelbach, America’s Health Insurance Plans, the insurance industry’s trade association.
 
And healthcare is a right - health insurance helps us deliver that right.
Anonymous | 9/22/2009 - 12:15pm
Using Guttmacher statistics, 75% of abortions happen because there is not enough money to care for the child after birth.  Women don't have abortions just because of their short term situation, but because of their long term prospects.
 
I am not saying that we should not restrict abortion funding, however, what I am saying is that the losses due to people will being worse off without health insurance are likely greater than the number lost if abortion were allowed under the plan.
 
The 13% figure of abortions covered by private insurance means that most people pay cash (probably because they have no insurance at all or their insurance does not cover abortion).  That implies nothing about whether most private plans cover abortion.  All you conclude is that people without insurance get abortion more than their share of the general population, which kind of proves my point about how not having a living wage or insurance makes abortion more likely.  The lesson of Veritas in Caritate is that if we are concerned about this issue, we need to work for better standards of living for the poor (health insurance and a living wage).
 
I will agree that abortion should not be funded in the bill if you will agree that health care is a right.
Anonymous | 9/21/2009 - 4:10pm
If the Capps amendment crosses your line, the Baucus plan does the same.
''Insurers participating in any state-based exchange that offer coverage for abortion beyond those permitted by the most recent appropriation for the Department of Health and Human Services must segregate from any premium and cost-sharing credits an amount of each enrollee‘s private premium dollars that is determined to be sufficient to cover the provision of those services.''
[url=http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf]http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf[/url]
Anonymous | 9/26/2009 - 2:12pm
Abortion is not a part of the Public Option Insurance. This has been explained time and time again. Many will suffer and die without this Option. Do we want to be, in part, responsible for this suffering and deaths because some look at every issue thrught the prism of abortion? As long as this Public Option does not pay for abortions we should be allowed to support it. It seems that the frustion of Pro-life Leaders with the lack of action to stop abortions has turned to hate. Jesus said hate the sin, love the sinner. Can we do anything less? President Bush had a so called Pro-life Congress for 6 of his 8 years in office. No legislation was introducted to over turn Abortion during these 6 years. The last person to introduction legislation to over turn Abortion was the late Senator Thomas Eagleton (D) from Missouri. It failed.
Anonymous | 9/23/2009 - 11:14am
It matters not how many private plans offer abortion coverage, what matters is how many people are in those plans.  If only one offered abortion services, the fact of the matter is still that because there is a tax credit supporting its purchase, some amount of your tax money is going to fund the abortions under that plan.  The amounts are as irrelevant as far as taxpayer responsibility as they are for public option or Medicaid abortion funding.  Now, should we try to minimize abortion funding - of course.  However, it is not a matter of conscience that it be a deal breaker - it is a matter of Catholic identity and the desire for a win. 
If people want an abortion, funding won't stop them.  The lack of availability of abortion funding won't cause people to suddenly think they can afford to have a child.  People think longer term than that.  The Guttmacher figure is actually 73% (my bad) regarding why women abort and it comes from their cite, not from anything Michael III has cited.