Healthcare Reform--at the Price of Women's Health?

You can almost see the page in the conservative playbook: When all else fails, scream "babykillers!" And so it is that a handful of abortion-related amendments may be tacked onto the Senate Finance Committee's long-awaited health reform bill as it goes through markup this week. Some would simply prohibit all private health plans involved in a government exchange from covering abortion services. Others are trickier, offering separate riders for abortion coverage and expanding the already considerable "conscience clause," so that pharmacists, healthcare providers and insurance plans could opt out of providing drugs and services they find objectionable. If Republicans don't have much hope of derailing healthcare reform at this point, they still have a shot at seriously limiting women's access to affordable reproductive healthcare.

The attacks on abortion seem designed to divide and conquer, forcing pro-choice supporters of the bill to choose a team. But as passage of the bill seems increasingly likely, the question becomes, at what cost? So far, efforts to attach anti-choice amendments have narrowly failed. In the Senate Committee on Health, Education, Labor and Pensions, which put out its own bill in July, the margin on some anti-choice amendments was a single vote. This time, advocates fear, results could be as close--or worse. In the Senate Finance Committee, as many as four Democratic senators--Blanche Lincoln, Thomas Carper, Kent Conrad and Bill Nelson--could go either way on the issue. And even if the bill emerges from the Finance Committee without these onerous add-ons, they're almost sure to resurface when the legislation comes up for debate on the Senate floor in coming weeks.

The best approach to abortion-related obstacles to health reform would seem to be neutralizing them, which is exactly what California Representative Lois Capps, a former school nurse from California, tried to do when similar anti-choice measures came up in the House over the summer. Since the law already prohibits using federal funds to pay for abortion in almost all cases, Capps clarified that health reform wouldn't affect the status quo. Now integrated into bills in both the House and the Senate, the Capps language promises not to loosen the existing ban on federal funding for abortions, proposing that insurance plans offering abortion coverage keep public and private funds separate, and use only the private funds to pay for abortions.

The Capps amendment caused "great unhappiness" among pro-choice supporters, according to Judy Waxman, vice president of health and reproductive rights at the National Women's Law Center. These advocates hadn't wanted abortion singled out at all, hoping coverage for the service would be determined by the Secretary of Health and Human Services, as would other medical services. And they worry, reasonably, that the headache of segregating premiums and co-pays from government funds could dissuade some insurance companies from covering abortion services.

Still, pro-choice groups largely held their fire, seeing that, to the extent it circumvented the issue, the Capps language could allow everyone to move past abortion and on to the larger matter at hand. Thus, abortion rights advocates have grudgingly come to see Capps as "the best in a world of bad options," as Laura MacCleery, director of government relations at the Center for Reproductive Rights, puts it.

But key anti-abortion senators didn't see Capps as a middle ground, rejecting its main premise: that segregating funds is enough to save the government from the problem of giving money to insurers that cover abortion. One amendment would specifically invalidate Capps. Another declares that if a single dollar of government funds goes to an insurance plan, it shouldn't be able to cover abortions. Another, proposed by both Senators Orrin Hatch and Mike Enzi, proposes that women obtain abortion coverage through separate riders. This last might seem a reasonable alternative until you consider that no one plans on having an unplanned pregnancy, let alone a dangerous one. And if few people buy such riders, companies are unlikely to offer them. (The idea has already been tried unsuccessfully in five states that have banned insurers from offering abortion coverage. In North Dakota, for instance, Blue Cross and Blue Shield of North Dakota, which has 91 percent of that state's market share, doesn't even offer the riders, citing a lack of demand.)

Lingering on the question of federal funding for abortion is a politically astute move for desperate reform opponents, since it not only buys time for them but can also mean dividing Congressional votes in a novel way. While there are clear majorities of both Democrats and pro-choice legislators, some who consider themselves pro-choice may draw the line at public funding. With four votes hanging in the balance, the fate of these amendments--and access to abortion care--remains in question.

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