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E.J. Dionne Jr. on health reform's abortion stumbling block

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Thursday, November 12, 2009

For some years, Democrats have denounced parodies that cast their party as utterly closed to the views of those who oppose abortion. Last weekend, Democrats proved conclusively that they are, indeed, a big tent -- and many in the ranks are furious.

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From the outraged comments of the abortion-rights movement, you'd think that Rep. Bart Stupak's amendment to the House version of the health-care bill would all but overturn Roe v. Wade.

No, it wouldn't. The Michigan Democrat's measure -- passed 240 to 194, with 64 Democrats voting yes -- would prohibit abortion coverage in the public option and bar any federal subsidies for plans that included abortion purchased on the new insurance exchanges.

Stupak argues that the federal government has stayed out of the business of financing abortion since passage of the Hyde Amendment in 1976 and that none of the policies available on the Federal Employees Health Benefits Program covers elective abortion. The structures that reform would create, he says, should carry the same restrictions, which do not apply in cases involving rape or incest or when a mother's life is in danger.

Supporters of abortion rights counter that, at the very least, individuals who pay part of the cost of their policies should be allowed to choose abortion coverage.

Whatever else is true, Stupak's amendment is unlikely to have a significant effect on the availability of abortion. And most abortions are not paid for through health insurance. The Guttmacher Institute, for example, reported that only 13 percent of abortions in 2001 were directly billed by providers to insurance companies -- although the institute has cautioned that the proportion of women whose abortions were covered by insurance could be higher because the figure did not include those "who obtain reimbursement from their insurance company themselves."

The odd thing is that everyone in this fight insists that the only goal is to maintain the status quo on abortion. But defining the status quo has been a legislative and negotiating nightmare.

Democratic leaders once thought they had found the middle ground with an amendment offered by Rep. Lois Capps of California. She proposed segregating the money paid in for health insurance. Abortion coverage could be purchased with the premiums paid by individuals, but not with government money.

Abortion opponents argued that this separation of funds was artificial and that all money paid to the government plan was, by definition, public. So Rep. Brad Ellsworth, a right-to-life Democrat from Indiana, suggested an alternative that became known as "Capps on steroids." It substantially strengthened the barriers between public and private funds, particularly in the public plan.

But a key group of Democrats who supported the rest of the House bill (roughly 10 by the best count I have been able to get) was still not satisfied, partly because the Roman Catholic bishops were not satisfied. These Democrats turned out to be essential on a bill that ultimately passed by five votes.

Last Friday night, Stupak put forward a final compromise to House Speaker Nancy Pelosi that would have prohibited abortion coverage in the public plan but would have allowed an annual vote on the abortion ban for the private plans. Pro-choice Democrats rejected this, and the stronger version of Stupak's proposal then passed.

What happens now? Democratic supporters of abortion rights need to accept that their House majority depends on a large cadre of antiabortion colleagues. They can denounce that reality or they can learn to live with it.

There is also a challenge for abortion's foes, above all the Catholic bishops who have a long history of supporting universal coverage but devoted most of their recent energy to the abortion battle. How much muscle will the bishops put behind the broader effort to pass health-care reform? Their credibility as advocates for social justice hangs in the balance.

And if the Senate forces a change in the Stupak language, one obvious approach would involve a ban on abortion in the public plan -- if such an option survives -- and the application of Ellsworth's rules to the private policies sold in the insurance exchange. The alternative would be Stupak's original compromise offer to Pelosi. There are not many other options.

The truth is that even with the Stupak restrictions, health-care reform would leave millions of Americans far better off than they are now -- including millions of women. This skirmish over abortion cannot be allowed to destroy the opportunity to extend coverage to 35 million Americans. Killing health-care reform would be bad for choice -- and very bad for the right to life.

ejdionne@washpost.com



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