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
Federal funds for abortions are now restricted to cases involving
rape, incest or danger to the health 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
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.
"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
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
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.
But 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
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
In the Senate, the plan passed by the health committee is still
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.
Under both the House and Senate approaches, 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 rejected by the
House Energy and Commerce Committee, the same panel that approved
But abortion opponents say they can't accept a public plan that would
cover abortion. And they say private plans in the insurance exchange
should offer abortion coverage separately, as an option.
"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."