Abortion Under Fire

Will health reform limit access to abortion? Pro-choicers are worried, while pro-lifers say the Pelosi bill doesn’t go far enough. Dana Goldstein reports on the religious right's influence—and how Obama dropped the ball.

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Is the House health-care bill pro-life?

That’s what at least one prominent abortion-rights leader is saying in the wake of the bill’s long-awaited release last week. “We would say the bill leans toward the pro-life position,” said Judy Waxman, vice president of health and women’s rights at the National Women’s Law Center, which has been lobbying and advertising on expanding reproductive health-care coverage for women.

“I wish I was counting ways to improve women’s access to abortion. But right now, we’re counting ways to keep women from losing the coverage they already have.”

The Pelosi bill contains a number of provisions that would improve women’s access to affordable health care, including ending “gender rating”—in which insurers charge women more for coverage—and making it illegal to classify C-sections, domestic violence, and even pregnancy as pre-existing conditions that disqualify women for health insurance. It includes new funding for comprehensive sex education, supplanting some of the abstinence-only programs favored by the Bush administration. The bill also aggressively expands Medicaid, the existing federal health-insurance program for low-income women and their children, which includes generous birth-control coverage.

But on the narrower issue of abortion access and affordability, the major pro-choice organizations aren’t shy about expressing their disappointment: The legislation references abortion more than 25 times, mostly in an effort to restrict access to the procedure.

“We think all reproductive health care should be treated just like other health-care services,” said Cecile Richards, the president of Planned Parenthood. “Unfortunately, in this bill, it isn’t. All the versions we’re seeing of the health bill single out abortion.”

Nancy Keenan, president of NARAL Pro-Choice America, told The Daily Beast: “It’s a disappointment there isn’t more in the bill to proactively further women’s rights. I wish I was counting ways to improve women’s access to abortion. But right now, we’re counting ways to keep women from losing the coverage they already have.”

Dana Goldstein: The Health-Care Gender GapThe tenor of the debate reflects the extent to which, even under a pro-choice president and pro-choice congressional leadership, the religious right and abortion-rights opponents wield serious political power. The House bill requires the public-insurance option, expected to cover some 6 million people, to provide abortion primarily in cases of rape, incest, or threats to a woman’s physical health.

That limited language echoes the Hyde Amendment, a rider to the appropriations bill that has passed each year since 1976 and currently prevents federal funding of most abortions for Medicaid patients, government employees, Peace Corps workers, and women in prison. But because the House health bill actually cements the restriction in law—as opposed to in a rider—some pro-choicers see the provision as a step backward. “It establishes a different baseline,” Waxman said.

The bill also prevents affordability credits from being used to pay for abortion coverage; the credits would help middle-class and working-class Americans purchase insurance coverage on the private market. Eighty-seven percent of existing private insurance plans cover abortion, which is significantly cheaper and less medically risky than pregnancy and childbirth. After reform, if insurers want to continue to provide such care, the House bill would require them to segregate all government funding from the co-pays individuals pay into the plans. Abortions could only be paid for out of the “private” side of the ledger.

In addition, in each state, the health-insurance market would have to include one plan that does cover abortion, and one plan that does not. But because the vast majority of insurers currently do cover the procedure, pro-choicers view the provision as a step forward for the opposition. “That kind of leans toward the pro-life position,” Waxman said.

Pro-life Democrats have been especially influential in the health reform process because so many of them are considered swing voters on the overall package. Rep. Bart Stupak, a Michigan Democrat with strong ties to the religious right, has emerged as a spokesman for antiabortion sentiments in both parties. He continues to push forward in an attempt to amend the Pelosi bill to restrict abortion even further. Stupak’s goal is to outlaw all abortion coverage within the health-insurance exchanges, requiring women to purchase a special “rider” for abortion services. But according to health-care experts, few women anticipate needing an abortion and thus would be unlikely to pay extra for the coverage—even though about half of American women experience an unintended pregnancy in their lifetimes, and one-third of American women have had an abortion.

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Adam Sonfield, senior public policy associate at the Guttmacher Institute, which researches reproductive health issues, told The Daily Beast, “Currently, it’s not that we can’t pay for coverage that includes abortions. It’s that we can’t cover abortions. The [Stupak] standard is stricter than the standard in Hyde.”

Abortion-rights activists regard Stupak as “obsessed,” motivated by religious beliefs, and unwilling to compromise. They allege that he may not truly support the president’s effort to overhaul the health-care system, pointing out his ties to groups like Focus on the Family and the National Right to Life Committee, which opposed the expansion of S-CHIP, the state program that provides health care to poor children.

Counting votes “has been unbelievably painstaking because we don’t know if Stupak is bluffing or not,” said NARAL’s Keenan.

Stupak, though, says he is a supporter of health-care reform. “I believe we need comprehensive health-care reform and I am excited that we are closer than we have ever been to passing a health-care reform bill in Congress,” he wrote in an Oct. 29 letter to the Washington newspaper The Hill. “But any reform must address legitimate concerns, including using public funding for abortions, even if party leaders disagree.”

Pro-choice leaders disagree about whether more support from the White House could have strengthened their hand in the health-reform battle. In addition to the failed efforts to include comprehensive abortion coverage in the public plan, efforts to require private health insurance coverage of birth control also fell flat. In 1993, Hillary Clinton explicitly told Congress that she expected pregnancy and abortion to be treated in health reform like any other medical service. This year, though, Obama sent a different message, telling Katie Couric in July, “I think we also have a tradition of, in this town, historically, of not financing abortions as part of government-funded health care. Rather than wade into that issue at this point, I think that it’s appropriate for us to figure out how to just deliver on the cost savings, and not get distracted by the abortion debate at this station.”

A different tone from the White House might have helped pro-choice groups, Waxman said. “We would like significant support from the administration on women exercising their constitutional rights,” she said.

But Sonfield, of Guttmacher, maintains that Congress is the culprit: “Just because there are a lot more Democrats than Republicans doesn’t mean there are a lot more pro-choice people,” he said.

Along with immigration, abortion is one of the few remaining sticking points for legislators still on the fence about health reform. The debate is likely to continue unabated over the next two weeks, as Senate Majority Leader Harry Reid presents his final health bill and the House version comes to a vote. “We’re not going to give up,” Waxman said—but there’s little doubt that abortion-rights groups are now on the defensive.

Dana Goldstein is an associate editor and writer at The Daily Beast. Her work on politics, women’s issues, and education has appeared in The American Prospect, Slate, BusinessWeek, The New Republic, and The Nation.