"Poisoned Pills:" What IHS Tells Us About Health Care, The Public Option & Abortion

Sen. Russ Feingold is thrilled: a deal toward a public option is creeping forward. However, the abortion battle still threatens to derail progress on health care - and history has always shown us how this could play out.

The AP summarizes the situation thus far, and where it could potentially go:

Buoyed by a presidential pep talk and intense rounds of negotiations, Senate Democrats hope to move closer to embracing a major health care bill this week by tackling the nettlesome issue of abortion. [...]

A government-run insurance program, or "public option," is one of the bill's most contentious issues. At the urging of Senate Majority Leader Harry Reid, a group of moderate and liberal Senate Democrats met again Sunday to seek a compromise, after Obama's pep talk.

One idea calls for national nonprofit insurance plans to be administered by the Office of Personnel Management, which oversees the popular Federal Employees Health Benefits Program.

The proposal seems to appeal to a key Republican, Sen. Olympia Snowe of Maine, who met with Obama at the White House on Saturday.

On Sunday, Snowe called the possible compromise "a positive development" because it would give consumers more options for buying insurance.

Snowe's potential support for the Democratic-crafted bill is crucial. Supporters need 60 votes to overcome filibusters, and the chamber's 40 Republicans hope to draw at least one Democrat to their side.

It could be Nelson, who says he will not support final passage of a health care bill unless it includes the tight abortion restrictions he wants. If so, Democrats would have to woo moderate Republicans such as Snowe.

So what's at stake if the Dems can't overcome a filibuster? The health care bill may suffer the same fate as the bill to strengthen the options currently provided by Indian Health Services, which is responsible for providing health care and social support for the indigenous community in the United States. However, IHS is plagued with shortfalls and necessary infrastructures and equipment simply aren't available when needed. A senate bill was proposed in 2008 to strengthen IHS services and plug some of the gaps in service - but this was quickly derailed by Sen. David Vitter. Racewire reports:

While native communities have a big stake in health care reform, they're also prone to becoming a political football. Last year, a Senate bill to strengthen IHS foundered when Sen. David Vitter injected a poison pill amendment specifically aimed at restricting access to abortion for native women. Vitter's amendment could be seen as symbolic in that it replicated the language of the Hyde Amendment's broad restrictions on federal funding for abortion services. That longstanding anti-choice policy disproportionately impacts all poor women.

Still, since the proposed amendment would codify Hyde in the IHS statute—and because native women suffer from huge health disparities and barriers to care, advocates argued that Vitter's move would subject native women to an especially discriminatory, more permanent and restrictive version of Hyde. Vitter figured that in attacking abortion rights, there was no better place to start than one of the most medically disenfranchised groups of women in America.

Last Friday, Senator Byron Dorgan submitted an amendment to reauthorize the Indian Health Care Improvement Act and added an amendment to offer contract medical care to supplement IHS services. On Saturday, Senator David Vitter submitted two amendments to restrict access to abortion services for Native Americans.

Beyond the question of abortion coverage, the public option still remains as the other key issue to be resolved. As Ezra Klein puts it:

Currently, insurance plans are regulated by the states, which means they're different in every state. That makes it hard for them to achieve certain efficiencies of scale or maximize their leverage against providers. But back in September, I noticed a promising provision in Max Baucus's draft that would allow for national insurance plans, so long as they met a minimum level of federal regulation. That seemed like a potentially huge change, but I never heard another word about it, so I let it go.

The compromise being discussed is built atop that provision. The idea is that the Office of Personnel Management would choose nonprofit plans that met national standards and offer them on every state exchange (unless states opted out). These plans would be private, but the OPM would act as an aggressive purchaser, ensuring that they met high standards and conducted themselves properly. It's a private option with a public filter, essentially. But more importantly, it's a menu of national, nonprofit plans, which would be much more interesting from a competitive standpoint than state-based, pubic plans.

But the fact remains that private plans are not public options, no matter how much extra scrutiny they're subjected to. Though the liberals in the room are listening to this compromise, sources close to the discussion tell me that the conversation is opening up beyond the insurance offerings.

Today might mark the Senate's vote on abortion coverage in the health care bill, according to Majority Whip Dick Durbin. This vote will determine what is put forth in the final bill to Obama, and while abortions rights advocates are hopeful, nothing is set in stone until the final votes are in on the outstanding amendments.

Feingold: Deal on public option 'getting closer' [Politico]
Public option compromise still in the works [Politico]
Senate to confront abortion in health care debate [AP]
Indian Health and Abortion Rights: A Dose of Hope Laced with Poison Pills [Racewire]
Latest amendment list [Politico]
The not-a-public-option compromise, and beyond [Washington Post]
Abortion vote could come Monday, Durbin says [Politico]