The Next Health Reform Myth

By Ruth Marcus
Wednesday, September 9, 2009

Item: "President Obama and top Democratic congressional leaders are pushing hard for health care bills that would result in federal government funding of abortion on demand!" warns the National Right to Life Committee.

Item: A television ad broadcast by the Family Research Council shows an older couple -- Harry and Louise on Medicare -- sitting at their kitchen table and worrying about how to afford a needed operation. "They won't pay for my surgery, but we're forced to pay for abortions," says the man.

Item: House Minority Leader John Boehner asserts that House Democrats' health bill "will result in federally mandated coverage of abortion on demand in virtually all of America's health plans," making it "illegal for health-care providers nationwide -- even Catholic and religious-based hospitals . . . -- to provide anything less than abortion on demand for anyone who seeks it."

You're going to be hearing more of the same. Don't believe it. These inflammatory statements do a disservice to a complex issue of public policy: how, in the context of health reform, to balance the deeply felt views of both sides in the abortion debate.

I am firmly in the camp of those who think the abortion decision should be left up to the woman. But I respect those who fervently believe that abortion is the taking of human life, so I am sensitive to concerns that their tax dollars not be used to pay for the procedure.

Actually, let's remember: Tax dollars already are used to pay for abortion. Even the Hyde amendment, which since 1976 has prohibited the use of federal Medicaid funds for abortions, makes an exception in cases of rape and incest and when the mother's life would be in danger. Americans who believe that abortion should not be permitted, even in such cases, are nonetheless required to pay, yes, tax dollars to underwrite these procedures.

On a more subtle level, the federal government offers tax credits to purchase health insurance and subsidies for people who have lost employer coverage -- without excluding plans that cover abortions. Again, tax dollars.

Still, the status quo is generally to keep federal money out of abortions. The health care given to members of the military doesn't include coverage for most elective abortions. Neither does the insurance offered to federal employees.

At the same time, most private insurance plans do offer abortion coverage. So the abortion question unavoidably arises in the context of health reform -- notwithstanding President Obama's understandable desire to "not get distracted by the abortion debate."

The controversy has two dimensions: First, if a public plan is created, should abortion be among the covered services? Second, even without a public plan, should the private insurance plans available on the exchanges be allowed or required to cover abortion -- even though government funds would go to subsidize some, but not all, of those obtaining insurance this way?

The only Senate measure produced so far is silent on the subject. In the House, an amendment offered by Rep. Lois Capps (D-Calif.) nicely threads these narrow-eyed needles.

With respect to private insurance, the Capps amendment makes clear that companies participating in the exchange cannot be required to include abortion coverage and that plans cannot -- contrary to Boehner's assertion -- discriminate against health providers that decline to provide abortions.

In addition, it requires that the exchanges include at least one plan without abortion coverage -- relieving abortion opponents from worrying that their premiums would be used to pay for abortions -- and one that offers coverage. Although private plans could include abortion coverage, they could not use federal funds for that purpose. Instead, plans that choose to include this coverage could set aside a portion of their private premiums that could then be used to pay for abortion services.

The most questionable, and politically vulnerable, aspect of the Capps amendment involves the public plan. It provides that abortion, if included among the covered services, can be financed only from a separate pool of purely private contributions -- as with the private plan. This is even more stringent than the Medicaid rules under which states can use their own money to pay for abortions.

It is hard to imagine how to craft a more sensitive approach -- other than telling women who purchase insurance through the exchanges entirely with their own money that they cannot obtain abortion coverage.

Then again, that would be perfectly fine with some of the critics. Others are happy to seize on any argument, however misleading, that might derail the larger enterprise.

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