Reproductive Rights Left Behind After Health Care Bill Passes House

Saturday night, Congress threw a party, jubilant that its members had passed a version of a health care bill. Which version? That would be the one that traded the right to choose for a majority vote.

The reports from Washington are unambiguous. Health care reform was actually war on Roe:

The House passed its version of health-care legislation Saturday night by a vote of 220 to 215 after the approval of an amendment that would sharply restrict the availability of coverage for abortions, which many insurance plans now offer. The amendment goes beyond long-standing prohibitions against public funding for abortions, limiting abortion coverage even for women paying for it without government subsidies.

Wow. I suppose advocating for smaller, less intrusive government ends at womens' wombs.

Obama left the abortion issue unmentioned Sunday when he appeared in the White House Rose Garden to give brief remarks congratulating the House on its "courageous" passage of the bill. "Now it falls on the United States Senate to take the baton and bring this effort to the finish line on behalf of the American people," he said. "And I'm absolutely confident that they will."

Other issues remain unresolved. The House bill's primary new revenue source to pay for the bill is an income tax surcharge on families earning more than $1 million; the Senate bill will probably rely on a proposed new excise tax on costly insurance plans. The House and Senate also differ on a government-run insurance plan to be offered on the new marketplace where small businesses and people without employer-provided coverage — about 30 million in all — would buy coverage. [...]

The bills also differ in their requirements for employers to provide coverage — the House's language is tougher — and in the subsidies for those who cannot afford coverage, which are larger in the House version. Both bills deny subsidies to illegal immigrants, but the Senate version goes further by also barring them from buying coverage on the new marketplace with their own money.

So, let's recap:

1. No public option
2. We have an exchange that assumes a relative definition of "affordable"
3. Somehow, they managed to work this so that even women who were paying for their own care got conned out of abortion coverage
4. Undocumented workers can't access this plan, even without subsidies, though they - like other human beings - get sick and need treatment like everyone else.

Ladies and gentlemen, we got hosed.

The Stupak-Pitts amendment (which I am highly tempted to rename Stupid-Shits) was considered to be the way to compromise and move the bill forward. Senator Claire McCaskill is trying to hedge on behalf of the allegedly pro-choice Dems who voted for the bill, saying:

the amendment in the House health care reform bill is narrow, barring any insurance plan that is purchased with governments subsidies from covering abortion. The vast majority of Americans would not fall into that category, she said.

Nope. Poor people, you get what you get and you will be grateful.

The right-leaning Wall Street Journal, on the other hand, doesn't mince words:

The House's 11th-hour change to its health bill removes abortion coverage from millions of insurance policies that consumers would get under the legislation, including from private insurers.

Anyone who receives a new government tax credit to buy health insurance couldn't enroll in an insurance plan that covers abortion. A proposed government insurance plan also wouldn't cover the procedure. That's a sharp reversal from the original bill, which included abortion coverage in the public plan and allowed those with a tax credit to enroll in a plan that covers the procedure.

Abortion-rights supporters say the change would likely prevent any insurer who sells policies on the new government insurance exchanges from covering abortions, regardless of whether the purchaser is using a tax credit. [...]

Private plans inside the exchange would still be able to sell policies that cover abortion to anyone who isn't getting a tax credit. But they would have to create a special policy for that group. Insurers may be reluctant to do so because it could complicate how they pool risk and force them to label policies in a way that could draw attention from abortion opponents.

Those who receive an insurance subsidy and want coverage for abortion would need to buy a separate rider policy. "What woman would buy a plan for an unplanned pregnancy?" said Ms. Rubiner of Planned Parenthood. She said only a handful of states currently allow for such a policy.

In addition, NARAL Pro-Choice America is convinced that this amendment doesn't pass the sniff test:

  • The Stupak-Pitts amendment forbids any plan offering abortion coverage in the new system from accepting even one subsidized customer. Since more than 80 percent of the participants in the exchange will be subsidized, it seems certain that all health plans will seek and accept these individuals. In other words, the Stupak-Pitts amendment forces plans in the exchange to make a difficult choice: either offer their product to 80 percent of consumers in the marketplace or offer abortion services in their benefits package. It seems clear which choice they will make.
  • Stupak-Pitts supporters claim that women who require subsidies to help pay for their insurance plan will have abortion access through the option of purchasing a "rider," but this is a false promise. According to the respected National Women's Law Center, the five states that require a separate rider for abortion coverage, there is no evidence that plans offer these riders. In fact, in North Dakota, which has this policy, the private plan that holds the state's overwhelming share of the health-insurance market (91 percent) does not offer such a rider. Furthermore, the state insurance department has no record of abortion riders from any of the five leading individual insurance plans from at least the past decade. Nothing in this amendment would ensure that rider policies are available or affordable to the more than 80 percent of individuals who will receive federal subsidies in order to help purchase coverage in the new exchange.

On November 6th, before the announcement of Stupak-Pitts, Kathleen Kennedy Townsend published an op-ed in Newsweek, urging Catholic leaders to re-examine their push to end access to abortion through health care reform:

The current House health-care bill expressly prohibits federal funding of abortion and excludes the procedure from the minimum benefits package. It includes provisions that existing state laws and conscience laws will be respected. The House bill makes buying private health coverage affordable by offering tax credits to families with modest incomes. Moreover, the bill proposes a common-sense solution to ensuring that federal funds are not used for paying for abortion. The bill creates a mechanism for segregating private dollars from public funds to ensure that only private dollars go toward abortion coverage. This is a common practice in negotiating the role of religion in the public square. Similarly, Catholic schools receive federal funding for nonreligious services as long as those funds are separated from the school's religious work. If this solution is good enough for Catholic schools, then it is certainly good enough for health-care reform, and it reflects well on the tolerant and pluralistic society we have created. Most importantly, the bill does what the president promised health-care reform would do-it ensures that no one loses benefits they currently have.

Unfortunately, this reasonable approach is under attack from some Roman Catholic bishops who object even to the use of private dollars for women to exercise their conscience. They are determined to make abortion illegal, even if it derails health-care reform entirely-no matter the cost to women and children-and regardless of whether it would actually have any impact on the number of abortions in this country. (In fact, comprehensive health care could well reduce the number of unintended pregnancies and subsequent abortions.) In politics, this is called using abortion as a "wedge" issue. And it's simply not right. It is not right to jeopardize health care for the millions of women and children who need it most by inserting abortion politics into the debate. As a Catholic, I admire the bishops for their dedication to social justice, but cannot understand why they would put the health of so many women and children at risk when there is not a single federal dollar being spent on abortion services. It's a view I believe many of my fellow Catholics share. I urge the bishops to recognize that the House bill contains a familiar and genuinely American solution to the challenge of weighing differing religious beliefs in the realm of public policy.

As I've said before, I consider myself "pro-conscience." Women do not make the decision to have an abortion lightly, but it is absolutely critical that they have the means to make this decision and access to the care they need, no matter what their choice. Anything less would be turning the clock back on the progress we have made on advancing women's health.

It isn't just the Catholics on this one, but I'll heartily cosign Kennedy Townsend's pragmatic, women-focused take on health care. Reducing or removing access to abortion is not an effective strategy because it doesn't work - as we've written about before, it just makes the stakes higher.

While I'm sucking on the bitter pomegranate seeds of disappointment, I will try to look on the health care bright side. For one thing, the Republicans from Louisiana are an interesting bunch to watch:

So on Saturday, [Republican Anh "Joseph"] Cao, the first Vietnamese American elected to Congress, surprised Democrats and Republicans by becoming the only one of the 177 House Republicans to support the health-care bill.

"I felt last night's decision was the right decision for my district, even though it was not the popular decision for my party," Cao told CNN on Sunday.

The decision, he said, was a lifeline to the poor and uninsured in his district, rejecting the idea that it had anything to do with reelection hopes. Members of both parties privately said, however, that Cao's prospects are doomed unless a large number of Democrats in his district embrace him. [...]

"I know that voting against the health-care bill will probably be the death of my political career," Cao told the Times-Picayune this year. But he added: "I have to live with myself, and I always reflect on the phrase of the New Testament, 'How does it profit a man's life to gain the world but to lose his soul?' ''

(The bitter seeds also compel me to mention that Cao waited until the Dems had a majority and then decided to cast his vote. He also made abortion restrictions a provision of his aisle crossing.)

Bipartisanship doesn't seem like so much fun anymore. As Paul Begala points out at the Daily Beast:

Obviously, passing major laws with bipartisan support is preferable. But not always. Twenty-eight House Democrats and 12 Senate Democrats voted for the Bush tax cut in 2001. Coupled with the 2003 Bush tax cuts, which also had some Democratic support, that vote ran up $2.5 trillion in debt. And for what? They didn't create jobs or reduce poverty or raise incomes for the middle class. In fact, median income fell by about $2,000 per family. Sure, the Bush tax cuts were bipartisan. But they were disastrous policy.

So, a good thing is that bipartisanship will hopefully be used in service of the greater good for all, instead of just a nice term to trot out at press conferences.

And Ann at Feministing points out things we should love about the bill, once we finish seething over the amendment:

*Expands Medicaid "to reach a wider range of poor households up to 150% of the federal poverty level.
36M additional Americans will now be eligible for Medicaid."

*Bars discrimination in health care on the basis of gender identity or sexual orientation.

*Acknowledges LGBTQ Americans are a population likely to "experience significant gaps in disease, health outcomes, or access to health care." This will hopefully ensure that LGBTQ people are included in future data collection, and that grant programs will focus on their specific health needs.

*Ends the "unfair practice of taxing employer-provided domestic partner health benefits, allowing thousands upon thousands of LGBT people to obtain domestic partner health benefits for their partners and families without having to pay a tax penalty through the nose."

*Allows states to cover early HIV treatment under their Medicaid programs. (Currently, states are only allowed to use Medicaid money for patients with full-blown AIDS.)

*Funds comprehensive sex-ed programs.

So there are some silver linings to this storm cloud but I'm beginning to wonder - even with the good additions - if we should have left fucked up enough alone.

Abortion an obstacle to health-care bill [Washington Post]
McCaskill: Abortion amendment no poison pill [Politico]
Late Change Drops Abortion Coverage [Wall Street Journal]
House: Yes to Extreme Anti-Choice Politics, No to Women's Health and Privacy [NARAL]
A Call to Catholics [Newsweek]
A vote to make or break a career [Washington Post]
Forget Bipartisanship [The Daily Beast]
Good news in the health care bill [Feministing]
39 Democrats voted against the Affordable Health Care for America Act #HCR [Culture Kitchen]

Earlier:

NYT: Filipinos Fight For Reproductive Justice