How Abortion Could Imperil Health-Care Reform

The Commander in Chief has, of late, become something of a fact checker in chief. In town halls, interviews and meetings with interest groups, President Barack Obama repeatedly harps on what he calls the "myths" and "fabrications" about health-care reform.

The list runs from "death panels," which have not been proposed by Congress, to illegal immigrants, who would not get coverage under the current proposals, even though 55% of Americans believe otherwise, according to a recent poll. The President also routinely mentions the issue of abortion. "You've heard that this is all going to mean government funding of abortion," Obama said recently in a call to religious leaders. "Not true."

But this last statement, while technically correct, does not tell the whole story. The health-care reform proposed by House Democrats, if enacted, would in fact mark a significant change in the Federal Government's role in the financing of abortions. "It would be a dramatic shift," says Representative Bart Stupak, a Michigan Democrat who has vowed to oppose the bill because of how it would affect abortion. Stupak says dozens of House Democrats may join him in opposing a final health-care compromise unless the abortion language is changed, presenting a clear challenge to Democratic vote counters that could imperil a party-line vote.

To understand the change, one must first look at the strictly hands-off role the Federal Government has historically taken toward abortion services. Since 1976, Congress has mandated through the so-called Hyde Amendment that no federal funds will be used for abortion, effectively preventing Medicaid dollars from being used for the procedure, except in cases of rape or incest, or when the life of the mother is at risk. Private health plans offered to government employees, including members of Congress, have also been barred from offering abortion coverage, as has the military.

The health-care-reform bill proposed by House Democrats does not actually override those restrictions. But it does find a way for the Federal Government to expand the coverage of abortion services through a government-run program — the so-called public option — without spending what it defines as federal dollars on abortion. Instead, the only money the public insurance option could spend on abortion that does not involve rape, incest or the life of the mother would be money collected from members dues; or, in the words of supporters like Elizabeth Shipp, of NARAL Pro-Choice America, the plan "could only use private funds to pay for abortion services."

The member dues, or premiums, to pay for expanded abortion coverage would be segregated from the federal tax dollars by keeping the money in separate internal accounts. The problem is that all those who sign up for the public option would have to pay into the account for abortion coverage, an amount "not less than $1 per month," according to the legislation. So in effect, anyone who wanted to sign up for the public option, a federally funded and administered program, would find themselves paying for abortion coverage. "You are spreading the cost of the procedure over a public plan," explains Stupak. Under the legislation, the Executive Branch would have to make a determination that abortion is a basic medical service for the service to be provided, something the Obama Administration is expected to do.

Meanwhile, private insurance companies, which could receive taxpayer subsidies to cover low-income individuals, would continue to choose for themselves whether or not to offer abortion coverage. If they did offer the coverage, they would also need to segregate the funds to pay for the procedure, to ensure that direct taxpayer subsidies were not involved. And no consumer would be forced to choose a health-care plan that covered abortion. By using a new federally managed marketplace for purchasing health insurance — the so-called exchange — uninsured consumers would be able to choose not to join the public plan in favor of a plan that does not cover abortion services. Opponents of abortion, including Stupak, want language that would prohibit any private insurance company that accepts federal funds from offering to policyholders abortions other than those already eligible under Medicaid.