Reclaiming Our Children: A Blog About Healing After Abortion

WASHINGTON — Health care legislation before Congress would allow
a new government-sponsored insurance plan to cover abortions, a decision that
would affect millions of women and recast federal policy on the divisive
issue.

Federal funds for abortions are now restricted to cases involving
rape, incest or danger to the life of the mother. Abortion opponents say those
restrictions should carry over to any health insurance sold through a new
marketplace envisioned under the legislation, an exchange where people would
choose private coverage or the public plan.

Abortion rights supporters
say that would have the effect of denying coverage for abortion to millions of
women who now have it through workplace insurance and are expected to join the
exchange.

Advocates on both sides are preparing for a renewed battle over
abortion, which could jeopardize political support for President Barack Obama's
health care initiative aimed at covering nearly 50 million uninsured and
restraining medical costs. The dispute could come to a head with House and
Senate floor votes on abortion this fall, a prospect that many lawmakers would
like to avoid.

"We want to see people who have no health insurance get
it, but this is a sticking point," said Richard Doerflinger, associate director
of pro-life activities for the U.S. Conference of Catholic Bishops. "We don't
want health care reform to be the vehicle for mandating abortion." The church
can't accept a public plan that covers abortion, he said.

Donna Crane,
policy director for NARAL Pro-Choice America, said abortion opponents "want an
abortion ban in private insurance, and that's not neutrality at all — that's a
radical departure from current law. They want something far more extreme than
where I think the American public is."

A compromise approved by a House
committee last week attempted to balance questions of federal funding, personal
choice and the conscience rights of clinicians. It would allow the public plan
to cover abortion but without using federal funds, only dollars from beneficiary
premiums. Likewise, private plans in the new insurance exchange could opt to
cover abortion, but no federal subsidies would be used to pay for the
procedure.

"It's a sham," said Douglas Johnson, legislative director for
National Right to Life. "It's a bookkeeping scheme. The plan pays for abortion,
and the government subsidizes the plan."

Rep. Lois Capps, D-Calif.,
author of the compromise, said she was trying to craft a solution that would
accommodate both sides. Her amendment also would allow plans that covered no
abortions whatsoever — not even in cases of rape, incest or to save the life of
the mother — to be offered through the insurance exchange.

"With all due
respect, not everyone adheres to what the Catholic bishops believe," said Capps,
who supports abortion rights. "Our country allows for both sides, and our health
plan should reflect that as well."

But Senate staffers said Capps'
compromise is unacceptable to Republican senators.

For years, abortion
rights supporters and abortion opponents have waged the equivalent of trench
warfare over restrictions on federal funding. Abortion opponents have largely
prevailed, instituting restrictions that bar federal funding for abortion,
except in cases of rape and incest or if the mother's life would be
endangered.

A law called the Hyde amendment applies the restrictions to
Medicaid, forcing states that cover abortion for low-income women to do so with
their own money. Separate laws apply the restrictions to the federal employee
health plan and military and other programs.

The health overhaul would
create a stream of federal funding not covered by the restrictions.

The
new federal funds would take the form of subsidies for low- and middle-income
people buying coverage through the health insurance exchange. Subsidies would be
available for people to buy the public plan or private coverage. Making things
more complicated, the federal subsidies would be mixed in with contributions
from individuals and employers. Eventually, most Americans could end up getting
their coverage through the exchange.

The Democratic health care
legislation as originally introduced in the House and Senate did not mention
abortion. That rang alarm bells for abortion opponents.

Since abortion is
a legal medical procedure, experts on both sides say not mentioning it would
allow health care plans in the new insurance exchange to provide unrestricted
coverage.

It would mirror the private insurance market, where abortion
coverage is widely available. A Guttmacher Institute study found that 87 percent
of typical employer plans covered abortion in 2002, while a Kaiser Family
Foundation survey in 2003 found that 46 percent of workers in employer plans had
coverage for abortions. The studies asked different questions, which might help
explain the disparity in the results.

In the Senate, the plan passed by
the health committee is largely silent on the abortion issue. Staff aides
confirmed that the public plan — and private insurance offered in the exchange —
would be allowed to cover abortion, without funding restrictions. However, a
bipartisan group of Finance Committee senators is discussing the issue and may
take a different approach.

As the House and Senate bills stand now, the
decision to offer abortion coverage in the public plan would be made by the
health and human services secretary.

Abortion opponents are seeking a
prohibition against using any federal subsidies to pay for abortions or for any
part of any costs of a health plan that offers abortion. Such a proposal was
voted down by the House Energy and Commerce Committee, the same panel that
approved Capps' amendment. It's not likely to be the end of the
story.

Aides to Reps. Bart Stupak, D-Mich., and Joseph Pitts, R-Pa., who
sponsored the restrictive proposal that lost in committee, said the pair will
press for a separate vote on abortion funding when the health care bill comes
before the full House this fall.

Abortion opponents say private plans in
the insurance exchange could be allowed to cover abortion, but only if it's
offered under a separate, supplemental policy that individuals would have to buy
on their own.

"You can have a result where nobody has to pay for other
people's abortions," said Doerflinger.

Heidi Hartmann, president of the
Institute for Women's Policy Research, said applying the current restrictions
for federal employees and low-income women to a program intended for the middle
class will provoke a backlash.

"There is a difference between picking off
one group of women here and one group there and something that would affect a
very large group," Hartmann said. "Everyone would like to avoid that
fight."