Nancy Pelosi: "This Is Not A Bill About Abortion"

...And yet, here we are. Pelosi was asked if "pro-abortion rights advocates were 'right in saying [the Stupak Amendment] will actually diminish' access to abortions?" Pelosi shot back with 'Yes, they are.'" Well, at least we're kind of pro-truth!

Time magazine summarizes this dynamic beautifully: "In the end, all of 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."

The battle over abortion rights is more than a cultural conflict. While politicians choose to position the impact of the amendment differently, it still amounts to a frighteningly blatant assault on women's autonomy. The Time piece sheds some light onto the political wheeling and dealing that led to Stupak:

In mid-June, Stupak and 18 other pro-life Democrats sent a letter to Nancy 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 another 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 extended the decades-old Hyde Amendment prohibitions against funding of abortions through Medicaid and federal employee health plans except in the case of rape, incest, or to save the woman's life to the medical care 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.

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 abortions in the exchange, 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.

While I am shaking my fist at my computer screen, Politico lobs this bomb:

Taxpayers currently provide deep subsidies for health insurance plans that cover abortion - a little-recognized fact responsible for much of the angst over an anti-abortion amendment attached to the House health care bill.

Stupak and his allies, including every House Republican, a quarter of the chamber's Democrats and the Vatican, say that it simply extends an existing prohibition on federal funding for abortion - an annually renewed policy called the Hyde amendment - to the health care exchange that would be established for the uninsured under the health care bill making its way through Congress.

But lawmakers who support abortion rights contend that, if the Stupak amendment's logic is extended to the $250 billion in tax breaks Americans get to buy coverage through employer-based plans, it could strip abortion coverage from tens of millions of women who already have it.

Rep. Diana DeGette (D-Colo.), co-chairwoman of the Congressional Pro-Choice Caucus, said that the next step beyond Stupak for the anti-abortion movement will be to make sure that "if that federal wand has been waved over your insurance, then you don't get to get abortion coverage.

All of this calls Obama's motives into question - how does one "maintain the status quo" when we are obviously upending the status quo in favor of this craptacular amendment? Still, there are some who believe that this type of trade would have little impact on the day to day lives of women in America.

The New Republic calculates how many women would be heavily impacted by the amendment:

How many women would the Stupak amendment affect? It wouldn't immediately impinge on the roughly 60 million women ages 18-64 who presently get health insurance through their jobs or their spouses' jobs rather than Medicare. At least in the short term, nothing would change for these women because they wouldn't receive any federal funds. But most of them aren't reimbursed for abortion coverage under the current system. There's a debate about how many private health care plans cover abortion—estimates have ranged from 46 percent to nearly 87 percent. But, regardless of the number, the Guttmacher Institute found that only 13 percent of all abortions in 2001 were directly billed to private insurance companies. Some women may have filed for reimbursement on their own; others may have been reluctant to file claims because they didn't want their employers or spouses to know they had abortions; and other women were uninsured. Nevertheless, 74 percent of women who had abortions paid for them out of pocket.

That doesn't mean the Stupak amendment would maintain the status quo on abortion funding. It would restrict the choices of women who buy private health insurance on the new health-insurance exchange designed to provide affordable coverage. The Congressional Budget Office estimates that, under the House bill, 21 million Americans will buy insurance through the exchange by 2019. This group will include some of the 17 million women, ages 18-64, who are currently uninsured (and, obviously, don't receive any abortion coverage) and some of the 5.7 million women currently purchasing coverage through the market rather than through employers—including self-employed and unemployed women, and those whose jobs don't offer benefits.

It's some subset of this last group—the women who switch from private plans that now cover abortion to private plans on the federal exchange—who would be most affected by the changes. The overwhelming majority of people who buy private insurance on the exchange will be receiving federal affordability credits, and the Stupak amendment says that, if you receive a federal subsidy, you can't buy insurance that covers abortion. (The amendment allows women who are farsighted enough to plan for unplanned pregnancies to buy a single-service abortion-insurance "rider," but, in practice, past experience suggests these riders won't be readily available.) "The bottom line seems to be that abortion coverage, if it exists at all on the exchange, will be rare," says Adam Sonfield of the Guttmacher Institute. This may not be a great financial burden for the majority of women who have first-trimester abortions, which are relatively cheap—in 2006, the average cost of a first-trimester abortion was $413—but it could represent a more serious burden for women who have later-term abortions, which are more expensive.

(While much has been made of the 13% statistic, it is important to note that the Guttmacher institute disagrees with any framing of the statistic that would result in reducing the availability of abortion services and coverage. In a press release, they said: "Guttmacher's 13% statistic, therefore, should not be cited as evidence that insurance coverage for abortion is not widespread or to suggest that restricting such coverage would have an impact on only a small minority of women." While the TNR piece above states some of the Guttmacher caveats, the statistic is still what gets the most play.)

The most sensible take on the whole debate comes from this week's New Yorker, where Jeffrey Toobin puts our current bout of conservative hysterics into historical context:

Abortion is almost as old as childbirth. There has always been a need for some women to end their pregnancies. In modern times, the law's attitude toward that need has varied. In the United States, at the time the Constitution was adopted, abortions before "quickening" were both legal and commonplace, often performed by midwives. In the nineteenth century, under the influence of the ascendant medical profession, which opposed abortion (and wanted to control health care), states began to outlaw the procedure, and by the turn of the twentieth century it was all but uniformly illegal. The rise of the feminist movement led to widespread efforts to decriminalize abortion, and in 1973 the Supreme Court found, in Roe v. Wade, that the Constitution prohibited the states from outlawing it.

Throughout this long legal history, the one constant has been that women have continued to have abortions. The rate has declined slightly in recent years, but, according to the Guttmacher Institute, thirty-five per cent of all women of reproductive age in America today will have had an abortion by the time they are forty-five. It might be assumed that such a common procedure would be included in a nation's plan to protect the health of its citizens. In fact, the story of abortion during the past decade has been its separation from other medical services available to women. Abortion, as the academics like to say, is being marginalized.

It is being marginalized, and the sad part is that the effort is working - instead of looking at abortion as a part of medical coverage, we have allowed all kinds of political and religious posturing that do not contribute to the ultimate goal of health care reform: to improve access to care and coverage, not to create new restrictions. Toobin continues:

Yet it's not only with regard to insurance that abortion services are being treated like a second-class form of medicine. There is, for instance, the proliferation of "conscience clauses," which allow medical professionals to refuse to conduct procedures that they disapprove of. Shortly after Roe, Congress passed the first major conscience clause, which stated that medical professionals and hospitals that receive certain federal funds did not have to provide abortions or sterilizations if they objected on "the basis of religious beliefs or moral convictions." The Bush Administration sought to dramatically expand the clauses to cover not only doctors and nurses but anyone who works in a hospital, including pharmacists, and to increase the range of practices that might be rejected-a step that could potentially include such services as the dispensing of birth control. President Obama has said that he will revise or overturn the policy.

The President is pro-choice, and he has signaled some misgivings about the Stupak amendment. But, like many modern pro-choice Democrats, he has worked so hard to be respectful of his opponents on this issue that he sometimes seems to cede them the moral high ground. In his book "The Audacity of Hope," he describes the "undeniably difficult issue of abortion" and ponders "the middle-aged feminist who still mourns her abortion." Elsewhere, he announces, "Abortion vexes." The opponents of abortion aren't vexed-they are mobilized, focused, and driven to succeed.

Toobin's conclusion is one we would all do well to remember:

Every diminished of that right diminishes women. With stakes of such magnitude, it is wise to weigh carefully the difference between compromise and surrender.

Abortion fight is excuse to kill reform, Pelosi says [Politico]
Can the Dems Overcome Their Abortion Split on Health Care? [Time]
Abortion deal spins a very tangled web [Politico]
Stupak is as Stupak Does [The New Republic]
Misuse of Guttmacher Statistic on Insurance Coverage of Abortion [Guttmacher Institute]