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Missing from Healthcare Bills: Coverage for Reproductive Health | The Nation

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Missing from Healthcare Bills: Coverage for Reproductive Health

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In his address to Congress, President Obama recently debunked three myths about his proposed healthcare reform. He refuted claims that access to health insurance would be extended to undocumented immigrants and that "death panels" would limit care for the elderly. He also made it clear that under his proposal, when it comes to the current ban on using federal funding for abortions, nothing will change.

About the Author

Sylvia Law
Sylvia Law is the Elizabeth K. Dollard Professor of Law, Medicine and Psychiatry at New York University Law School and...

What does it mean for nothing to change? Here is a picture of the state of funding for abortion care.

Abortion is one of the most common surgical procedures in the United States. Nearly half of pregnancies among American women are unintended, and four in ten of these are terminated by abortion. Most women seeking abortions say that they do so because of their understanding of the responsibilities of parenthood and family life and their inability to meet those demands under their present circumstances. Abortion rates are much higher in the United States than in any other developed country because the antiabortion movement has successfully opposed fact-based sexuality education and access to contraception.

Since Roe v. Wade was decided in 1973, the vast majority of employer-based private insurance plans--87 percent today--include coverage for abortion. Private insurers and employers appreciate that by paying for abortions for women who want them, they respect patient choice, promote the health of women and children, and conserve resources.

By contrast, Congress has sharply limited the use of federal funds for abortion. Medicaid, which otherwise funds comprehensive health services for the poorest people, has banned funding for abortion since 1976, with narrow, virtually irrelevant exceptions for women whose life is threatened or who are pregnant as a result of "reported" rape or incest. Congress has extended the ban on federal funding for abortion for other groups, including military personnel and their dependents, federal employees and their dependents, teenagers participating in the State Children's Health Insurance Program, low-income residents of the District of Columbia, members of the Peace Corps, disabled recipients of Medicare, federal prison inmates and Native Americans.

Women serving in the military cannot obtain a federally funded abortion even when the pregnancy results from rape or incest. Military doctors and healthcare facilities cannot provide abortions even if the woman is able to pay out of pocket. These restrictions apply to women with pregnancies that threaten their health as well as women carrying fetuses that are unlikely to survive after birth.

Health reform promises support for comprehensive care that makes financial sense and promotes health. That promise plainly does not extend to the many women who depend on public funds and seek abortions.

Healthcare reform also contemplates expanding health insurance coverage. The debate now centers on whether the discriminatory exclusion of abortion will extend to women who purchase private insurance, or to the new public option or health co-ops, if those are created. On July 30 the House Energy and Commerce Committee adopted a compromise, requiring that tax dollars used to subsidize private health insurance be kept separate from private funds to avoid any public subsidy for abortion, and that there should be one plan in each region that covers abortion and one that does not (Senator Max Baucus modeled his treatment of abortion coverage on this amendment). This "compromise" did not satisfy antichoice activists, despite unmistakably extending segregation requirements into the private insurance sector, which has only rarely been asked, by a few states, to treat abortion as distinct from other aspects of women's reproductive healthcare.

Healthcare reform is monumentally important, both for the uninsured and because we need to develop a fair and rational means to constrain wasteful spending. Compromise is inevitable. But no compromise will satisfy the opposition forces--they are unlikely to support healthcare reform in any circumstance, and many are using the abortion issue to whip up opposition when the real agenda is merely to block reform.

More important, excluding abortion from health insurance is irrational and unjust. The 2008 Democratic platform affirmed that the party "strongly and unequivocally supports Roe v. Wade and a woman's right to choose a safe and legal abortion, regardless of ability to pay, and we oppose any and all efforts to weaken or undermine that right." Healthcare reform should extend to one of the most common surgical procedures and should cover the women who need it most.

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