The issue of federal funding for abortion threatens to derail final passage of a health care bill. All sides claim the same goal: Extending the logic of the Hyde Amendment, which bans federal funds from covering abortions in any current government insurance program, to the newly configured exchanges and public option. But, translating that goal into legislative language that both pro-choice and pro-life legislators can live with has proven elusive. And, unlike other potential impediments to health care reform, the abortion issue is all about principle, moral principle at that, and so it is not easily the subject of a compromise.
Pro-life groups, most especially the nation’s Catholic bishops, were thrilled when the Stupak Amendment passed the House because it really does bar federal funds from going to pay for abortion coverage. Of course, the Stupak Amendment produced a backlash among pro-choice groups, and in the Senate, pro-life senators are in the minority. The current Senate bill tries to avoid federal funding in subsidized health insurance by "segregating" the money that comes from the government from the money contributed by the individual, and only paying for abortion coverage from the individual’s contribution. The bishops have said this "segregation" of funds is only an accounting gimmick (money is fungible) and the non-partisan group Factcheck.org agrees with the bishops. Now, both sides have dug in and they are talking past each other, insisting that their way is the only way to achieve the goal both acknowledge they share. That means it is time to seek a new way forward, a different approach from that envisioned by either the Stupak Amendment or by the "segregated" funds approach of the Senate bill.
The most nettlesome difficulty is how to deal with insurance plans to be purchased with a mix of federal subsidies and private premiums in the proposed exchanges. Stupak says: If you get a federal subsidy you can’t buy a plan with abortion coverage. The Senate bill, as noted above, merely indicates that the federal funds will be segregated from the private funds. But, if the subsidies are calculated based on a person’s income, and given to the individual as a voucher to shop with in the exchange, why should we not let the individual choose whatever coverage they want? If they prefer a more expensive plan with abortion coverage, the voucher is not going to increase, so they really are making their own decision about what to do with their money and de facto as well as de jure they are buying their abortion coverage with their own funds. Additionally, the voucher is going to the individual, not the insurance company directly, so this arrangement does not constitute federal funding in any way.
Vouchers are currently used to cope with another complicated issue, helping poor parents pay for tuition at religious schools. There the difficulty arises from the First Amendment not the Hyde Amendment, but the idea is the same. In the health care debate, the difficulty arises from the profound ambivalence of many Americans about abortion: They do not want the procedure to be illegal but they really don’t want to encourage it with their tax dollars. The Hyde Amendment, after all, was never about saving money, it was about expressing this ambivalence about abortion. The idea of using vouchers was floated this summer, but not embraced. At the time, a spokesman for the U.S. bishops, Richard Doerflinger, told Beliefnet.com that the idea of using vouchers was "such a crazy idea it just might work." That is not an endorsement, but it is also not a veto. It is time to explore the "crazy idea."
The public option, already in great difficulty because the GOP succeeded in framing it as a "government take-over," is further complicated by the abortion issue. Again, Stupak is straightforward: the public option does not cover abortion, period. In the Senate, the Secretary of Health and Human Services has to jump through some hoops to get abortion in the public option, but it is not excluded. It should be. The public option should be as close as possible to the health care coverage congressmen receive. (This might also help Democrats sell the public option. There are worse tag lines than "Because you should have access to the same insurance your congressman gets!") Although the hysterics from pro-choice legislators like Cong. Diana DeGette and Sen. Barbara Boxer about the Stupak Amendment putting women back to the days of back alley abortions suggest otherwise, the fact is that DeGette and Boxer do not have abortion coverage in their health care because they are federal employees. Do either of them really want to equate their situation with that of women in the 1960s?
Finally, the last difficulty is the easiest to fix. The Stupak Amendment does not technically bar plans that are purchased in the exchanges completely with private funds from offering abortion coverage, but it has that effect because the insurance companies say the pool of people not receiving federal subsidies would be too small to offer such a plan. In this sense, pro-choice critics are correct that Stupak goes beyond Hyde. The law should require that the exchanges have at least one plan with abortion coverage and one plan without such coverage. And, because people with federal subsidies would be using vouchers, you do not have to separate those who are paying with their own money from the pool of those people receiving subsidies. The pools would be large enough to ensure both kinds of policies are offered.
Those of us who are lifelong pro-life Democrats were heartened when President Obama said he sought "common ground" on abortion and pledged that health care reform would not entail government funding of abortion. We were willing to look the other way on the Mexico City policy and we understood that the decision on embryonic stem cells would have occurred if John McCain had won the election too. As well, it is difficult to see how passing health care with abortion funding will help the Democrats: They stand to lose enough seats in next year’s midterm elections without also replacing a group of pro-life Democratic legislators with pro-life Republican congressmen. If Speaker Nancy Pelosi wants to remain Speaker, she needs to have Democrats representing more conservative districts like NC-14 and VA-5 and MI-1, currently represented by pro-life Democrats Health Shuler, Tom Perriello and Bart Stupak, respectively.
Catholic social teaching is unambiguous when it comes to the fact that health care is a right not a privilege. In today’s political climate, there is simply no alternative to the current legislation making its way to the President’s desk. It would be criminal to see this goal derailed because legislators can’t find a way to achieve what they all admit they want: health care coverage that does not include federal funding of abortion, especially when all that is needed is some creative thinking and a new approach. Instead of getting dug in, both sides need to reach out.