Nelson vs. Stupak: abortion and health care (Part I)
Though the battle over health care reform has covered some very contentious ground, it is safe to say that the biggest sticking point thus far has been abortion, specifically the question of how to maintain the current prohibition against federal funding of abortion in the final bill. As is usually the case in matters related to both abortion and health care policy, the debate has been extremely emotional and often extremely confusing. This post represents my humble attempt to make sense of the question as a Catholic who is both pro-life and relatively liberal on the general issue of health care reform. Because I want to be fairly comprehensive, I’m actually going to divide this into two posts. In this first one, I will start by outlining the political and moral background behind the question of abortion funding; provide some general information on the bills currently under consideration by the House and Senate; and describe the provisions on abortion funding in each bill. In the second post, I will perform a comparative analysis of each bill’s abortion provisions and come to a final conclusion as to whether the relevant language in the Senate bill (which will probably end up in the final bill) is acceptable from a pro-life perspective.
First off, the background. Politically, the debate is taking place out of a desire to maintain the current federal standards on taxpayer funding of abortion. At present, a provision known as the Hyde Amendment prohibits the Medicaid program (currently the only federal health insurance program available to citizens of all ages) from offering coverage of elective abortion, unless a pregnancy threatens the life of the mother or is the result of rape or incest. In principle, everyone agrees (or at least claims to agree) that this same standard should apply to any federal program created under the currently pending health care reform. In an interview with CBS in July 2009, President Obama said, “I’m pro-choice, but I think we also have the tradition in this town, historically, of not financing abortions as part of government-funded health care.” Later, in his September address to a joint session of Congress, the President again made a very explicit promise: “One more misunderstanding I want to clear up — under our plan, no federal dollars will be used to fund abortions.”
So, from a political standpoint, the principle behind this debate is that any health care reform bill should be “abortion-neutral,” meaning that it should not change the status quo on abortion funding in either a pro-choice or a pro-life direction. More importantly, however, the moral impetus behind the efforts of pro-life legislators on this issue is the principle that federal funding of abortion would be inimical to the primary moral justification for health care reform, which is the necessity to protect the poor and vulnerable. The pro-life Democrats in the House and Senate who pushed for tougher restrictions on abortion funding did so out of a belief that we as a society have a moral obligation to ensure that all Americans have affordable access to basic medical care, without victimizing the unborn. Obviously, in a more general sense we believe that the unborn should be entitled to the same protections under law as all other human beings; however, barring the possibility of that happening any time soon, we seek to ensure that efforts to aid other vulnerable members of society do not lead to an increase in the number of unborn children victimized by abortion. In the words of Archbishop Timothy Dolan of New York City, “All we ask is that [universal health care] be just that—universal—meaning that it includes the helpless baby in the womb, the immigrant, and grandma in a hospice, and that it protects a healthcare provider’s right to follow his/her own conscience.” This is my position, and it is also the position of the United States Conference of Catholic Bishops (USCCB), which has pushed hard for stricter abortion restrictions.[i] I realize that many reading this may disagree with the basic premise—opposition to abortion—but as I’m assuming a pro-life perspective in this post, I’m going to save those more general moral arguments for a later post.
So, having established both the political and moral reasons—the “why”—for ensuring that health care reform does not result in increased federal funding of abortion, the question now turns to the “how,” and it is here that we will begin to compare the House and Senate bills on that issue. But first, we must review the general provisions of the different plans. Each bill creates what is called an “exchange” to enable individuals and families who do not have employer-based health insurance to purchase coverage. Essentially, an exchange is a marketplace of private insurance plans among which costumers can choose. In the House bill, the exchange would also include a plan that is owned by the federal government but funded, just like any private plan, by customers’ insurance premiums. The goal of this so-called “public option” is to provide competition to the private insurers in the exchange and therefore keep prices low. The Senate bill does not include a public option, but would allow the federal government to contract with private entities to create a nationwide, privately owned, nonprofit plan, similar to the option that is offered to federal employees. In addition, the Senate bill differs from the House bill in that it creates a separate exchange for each state, whereas the House bill creates a single national exchange (though states could choose to create their own.) Both bills provide federal subsidies to insurance companies so that individuals and families below a certain income level will be able to purchase plans at lower premiums.
Confused yet? Stay with me. Under this framework, there are essentially two means through which the federal could end up funding abortion: the inclusion of abortion as a “medical” service covered by a public plan, and federal subsidization of private insurance plans that cover abortion. In an effort to address both of these areas, Representative Bart Stupak (D-MI) introduced an amendment that eventually passed with the support of 64 Democrats and every Republican in the House. The Stupak Amendment specifically prohibits the Department of Health and Human Services from offering abortion coverage as part of the public plan. In addition, it stipulates that no private plan receiving federal subsidies can cover abortion. However, insurance companies would be allowed to offer a “rider,” essentially a separate, supplemental plan that provides abortion coverage on top of whatever subsidized plan the customer purchased. Consumers would be required to purchase the rider separately and without federal subsidies.
Immediately after it passed, the Stupak Amendment created a firestorm. Organizations such as Planned Parenthood and NARAL announced that they would oppose the final bill if the amendment remained in place, while every major pro-life organization, including the USCCB, reacted enthusiastically. Attention then shifted to the Senate, where Ben Nelson (D-NE) introduced an identical amendment. However, because of the heavy opposition provoked by the Stupak language, the Senate rejected the amendment by a wide margin. With Nelson threatening to filibuster the bill if it did not contain strict abortion funding restrictions, the Democratic leadership frantically tried to come up with a compromise. In the end, Majority Leader Harry Reid introduced an amendment with the following provisions: each state’s exchange would be required to include at least one private plan that specifically excludes abortion coverage. In addition, for private plans that do cover abortion, consumers would be required to make two premium payments rather than one. For example, if a plan had a monthly premium of $1000, a consumer might be required to write one check for $980, and another for $20. The $20 would go into a company account that would be used only to pay for abortions, while the remaining $980 would go into an account specifically prohibited from being used to pay for abortions (note that $20 is just an example; the actual number would be based on the insurance company’s estimate of what percent of each premium is normally used to pay for abortions.) No federal subsidies could go into the “abortion account.” Furthermore, individual states would have the option of completely banning abortion coverage from any plan within their exchange.[ii]
Coming soon: in Part II, I will analyze and compare the possible effects of each bill’s abortion language, and come to a final conclusion as to whether the Senate bill is indeed acceptable from a pro-life perspective.
[i] I tend to assign a lot of credibility to the USCCB on this issue, because they are the only nonpartisan organization that has endorsed the basic principles of health care reform while remaining true to its uncompromising pro-life stance on abortion. Indeed, the Catholic bishops have supported universal health care since the beginning of the twentieth century, long before it became a pet issue of the Democratic Party. In a nutshell, their position on the current reform is as follows: it must provide what Catholic social teaching calls “a preferential option for the poor,” meaning that it must guarantee access to basic medical care for everyone, regardless of ability to pay; it must treat legal immigrants in the same way that it treats U.S. citizens, and must not deny emergency lifesaving treatment even to illegal immigrants; and it must not fund abortion or force doctors who oppose the procedure to perform it. For more information, see http://www.usccb.org/healthcare.
[ii] Source for both House and Senate provisions: http://www.cbsnews.com/stories/2009/12/20/ap/business/main6002083.shtml