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.