Correction Appended: Nov. 16, 2009
Republican congressional leaders have to be chuckling right now. In the end, all the tea-party town halls, Glenn Beck rallies and "death panel" rumors may have less of a hand in bringing down health care reform than an intraparty Democratic culture war.
Congressman Bart Stupak of Michigan, whose amendment restricting abortion coverage on all policies sold through the new insurance exchange paved the way for passage of health reform in the House of Representatives, vows that "there will be hell to pay" if his language gets stripped out of, or weakened in, the final legislation. Senate moderates like Ben Nelson and Kent Conrad have stopped short of demanding the exact Stupak language, but have warned that weak abortion restrictions could force them to vote no on health reform. Abortion-rights advocates, who are still stunned by the last-minute deal that House Speaker Nancy Pelosi made to allow a vote on Stupak's controversial measure, claim the provision will greatly limit the availability of abortions, especially for low-income women. They have dubbed it "the coat-hanger amendment."
Before the Nov. 7 House vote on health reform, the advocacy organization Health Care for America NOW! (HCAN) had lobbied vulnerable Democratic House members by promising to back them with ads if they supported health reform. In the wake of the vote, the group amended that pledge, saying it would not apply to those who helped pass health reform if they also voted for the Stupak amendment. NARAL Pro-Choice America president Nancy Keenan is publicly mulling going one step further and supporting primary challenges against Stupak-voting Democrats. "Nothing's off the table," she told Jill Lawrence at PoliticsDaily. "We're going to hold those accountable who voted against us."
After the House vote, President Obama, who had carefully kept his distance from the health care horse-trading, told ABC News that the Stupak language had to be altered. "There needs to be some more work before we get to the point where we're not changing the status quo," he said. But at this point whether a workable compromise can be accomplished is unclear.
At least on the level of rhetoric, all the politicians and outside groups that have weighed in on health reform seem to agree: taxpayers shouldn't pay to fund abortion. "No federal dollars will be used to fund abortions," said Barack Obama in his speech to Congress on Sept. 8. His Democratic colleagues say they agree with the same principle, as do GOP leaders. That stance mirrors public opinion as well. A 2008 Zogby poll found that 69% of Americans oppose "taxpayer funding of abortion," which is currently governed by the decades-old Hyde Amendment, the law that prohibits funding of abortions through Medicaid and federal employee health plans except in the case of rape, incest, or to save the woman's life.
The problem is that no two definitions of what constitutes "federal funding of abortion" are alike. Throughout the summer and fall, pro-choice Democrats have insisted that legislative fixes to prevent direct funding of abortion procedures had solved the problem. At the same time, however, most of their pro-life colleagues, as well as the influential U.S. Conference of Catholic Bishops (USCCB), continued to maintain that funding problems still existed because federal subsidies to help people buy health insurance on a government-managed exchange could end up going to private insurance plans that covered abortions.
Pro-Life Democrats Are Not All Alike
In mid-June, Stupak and 18 other pro-life Democrats sent a letter to Pelosi warning that they could not vote for the bill that had been introduced unless it was changed to prevent taxpayer funding of abortion. (The original health reform bill introduced in the House contained no reference to abortion, which both pro-life and pro-choice activists read as allowing coverage of abortion through the so-called public option, a government-run alternative to private insurance plans that some individuals and small businesses would have access to.) They received no response.
A month later, five other pro-life Democrats, led by Tim Ryan of Ohio, sent a letter to Pelosi expressing their concerns as well, but suggesting a compromise to the abortion quandary. This time, Pelosi was interested and she gave Ryan the green light to develop language that ended up known as the Capps amendment, because Lois Capps of California introduced it during the House Energy and Commerce Committee's markup of health reform legislation.
The provision gave authority to the Secretary of Health and Human Services to determine whether elective abortions would be covered under the public option. In addition, Capps put forward a system in which an insurance plan could segregate private funds to pay for abortions from public subsidies, which could not
Overconfidence on Both Sides
At the time, Stupak's opposition to the Capps amendment he was suspicious of it because it had been drafted without his group's input, by a pro-choice Democrat no less seemed unimportant. Democratic leaders thought their solution would allow them to cobble together enough pro-life votes, and they were convinced that the amendment had taken abortion off the table.
Indeed, up until the last week before the House vote on health reform, both Pelosi and Stupak thought they each had the votes to get their way on abortion. As a result, when Indiana Congressman Brad Ellsworth, a pro-life Democrat, tried to draft an amendment tightening the Capps language in the last weeks before the House vote, both sides attacked him. Planned Parenthood said the effort -- which attempted to strengthen the segregation of funds and ensure that no federal dollars could ever be designated to fund elective abortions in the exchange (which would include the public option) could "tip the balance away from women's access to reproductive health care." And the Catholic bishops conference issued a memo calling the amendment "not a meaningful compromise."
The one-two punch took the life out of the Ellsworth amendment and denied pro-life Democrats the opportunity to vote for something less extreme than the final Stupak amendment. According to several members who voted for the Stupak amendment, they would have supported a more moderate compromise along the lines of the Ellsworth language if they had been given the chance. As it was, 10 of the 19 Democrats who signed the initial Stupak letter to Pelosi voted against health reform even after their demands on abortion were met.
Near Silence from the White House
Obama's choice to stay out of the debate over the specifics of health reform has complicated the discussion of many issues, but particularly the question of how to handle abortion coverage. When Obama did speak publicly, his rhetoric was designed to reassure the pro-life community. But it wasn't matched by language in the bills his Democratic congressional colleagues were drafting.
In his commencement speech at the University of Notre Dame in May, Obama talked about the critical importance of doing the hard work of hammering out compromise on difficult questions. In the health reform debate, however, the President has outsourced that job to people who aren't as enthusiastic about compromise. When Obama finally reached out to Stupak in mid-September, after the White House was stunned to learn that the Capps amendment hadn't eliminated pro-life concerns, it was with an impatient message. "Look, try to get this thing worked out among the Democrats," Stupak said Obama told him, according to the New York Times. Others wish Obama had played the role of negotiator himself. "I wish the White House had stepped in," said one Catholic Democrat involved in negotiations. "The President is very good at getting people to talk to each other we really could have used his leadership on this."
The original version of story incorrectly stated that the Capps amendment extended the decades-old Hyde Amendment prohibitions against government funding of abortions to the medical care covered under the public option. In fact, the Capps amendment simply gave authority to the Secretary of Health and Human Services to determine whether elective abortions would be covered under the public option.