Campus Progress has the transcript of the above video:

BOXER: There's nothing in this amendment that says if a man some days wants to buy Viagra, for example, that his pharmaceutical coverage cannot cover it, that he has to buy a rider. I wouldn't support that. And they shouldn't support going after a woman using her own private funds for her reproductive health care. Is it fair to say to a man you're going to have to buy a rider to buy Viagra and this will be public information that could be accessed? No, I don't support that. I support a man's privacy, just as I support a woman's privacy.

That was all well and good, and fitting for a Congressperson. But you know what she really wanted to say was, "It Ain't None Your Business!"

What' s the matter with your life? /Why you gotta mess with mine? /Don't keep sweatin' what I do/'Cause I'm gonna be just fine!

Can we formally vote to make this the pro-choice anthem? Just saying.

At any rate, Senator Nelson of Nebraska seems to want to make it his business to keep bringing up old stuff. The Guttmacher Institute did a comparison of Stupak-Pitts and Nelson's Amendment and confirms what we all knew going in - the bills are the same shit, different day:

"As with Stupak-Pitts, this amendment would restrict abortion coverage well beyond the status quo and could have profound implications even for coverage in the private market, paid for with private funds," emails Adam Sonfield, senior public policy associate of the Guttmacher Institute. "It also, like the Stupak-Pitts amendment, takes what had been even-handed language respecting and protecting the conscience of providers on both sides of the abortion divide and turns it into biased language that allows for discrimination against health care providers willing to provide or refer for abortions."

Amy Sullivan of Time is letting Nelson have it over at Swampland:

What is it about those Nebraska governors-turned-senators? Did they not get enough attention as children? Do they chafe at being told they hail from a "flyover" state? Does that unicameral legislature leave too few adoring supporters? Bob Kerrey was infamous for waiting until the verrrrrry last moment to make up his mind on important pieces of legislation, waiting until he'd been courted and wheedled and begged. And now it appears Ben Nelson is looking to make himself similarly indispensable to the Democratic effort to pass health reform legislation.

So what happens when the Nelson amendment fails? Last week, Nelson was threatening to filibuster health reform if his abortion language was not included, but he's since walked that back. Even a Nebraska attention-seeker can only go so far, after all. Democratic leaders have said they're working on other compromises to win Nelson's support for the final bill, but it's unclear that he was ever willing to vote for health reform, even if his amendment were to pass. And other pro-life Democrats—like Bob Casey, who is a co-sponsor of Nelson's amendment—have not said the issue will determine their vote.

Casey has talked about introducing parts of his Pregnant Women Support Act in order to insure that the bill contains measures to reduce abortion rates. But such a move would be almost entirely for his own comfort, and not to bring more pro-life senators aboard or placate the Catholic hierarchy. Richard Doerflinger, associate director of the U.S. Conference of Catholic Bishops' secretariat of pro-life activities, told the Wall Street Journal over the weekend that compromise in the wake of a defeat of the Nelson amendment was "not a negotiation we're prepared to have," adding, "I really don't know how you compromise further."

Another factor arguing against additional abortion amendments is the fact that if Reid cannot count on Nelson to get to 60 votes, he will have to pin his hopes on Olympia Snowe, a strong supporter of abortion rights. Snowe's main stated concern about health reform is the public option. But stronger abortion restrictions would only make her less likely to sign on to be that crucial last vote to pass reform. Which is why as of Monday night, Democratic leaders were much busier crafting a public option compromise than worrying about abortion negotiations.

Speaking of the public option compromise, some of the initial news is in: Senators are backing away from a public option and instead are looking at expanding the scope of existing programs.

After five days of intensive talks among five moderates and five liberals, the outlines of a compromise aimed at appeasing both ends of the Democratic political spectrum were emerging: a plan designed to expand insurance coverage without creating a new government-run program.

Under the compromise, the public option would be removed from the bill and replaced with a new government-administered national insurance plan similar to the Federal Employee Health Benefits Plan, which serves members of Congress and federal workers.

To sweeten the deal for liberals, people 55 and older would be able to "buy-in" to Medicare and purchase coverage in the popular government program for the elderly. Liberal Democrats such as Sen. Sherrod Brown of Ohio and Sen. John Rockefeller of West Virginia have been pushing the idea for years.

It's currently unclear how much this plan would help, particularly considering what passes as an increase:

The negotiating group is also looking to expand Medicaid to cover people with incomes 150 percent above the poverty line, up from 133 percent under the Senate bill, and to impose stronger regulations on private insurers.

This doesn't seem to be good enough for Republicans, who trying to throw monkey wrenches into the process however, and whenever, they can. When Harry Reid spoke on the Senate floor yesterday comparing the stalwart stance of the GOP to the opponents to abolishing slavery, desegregation, and suffrage for women, the GOP complained they were being smeared.

Then, RNC chair Michael Steele sent a message to Obama to "delay" health care reform, saying:

"Congress can't afford to throw the American people further in debt now and splurge on a risky health care bill when we may need all the resources at our disposal next year to rebuild a sagging economy," Steele wrote in a letter than will be sent to the White House on Tuesday.

"We are asking you to delay your efforts to push your health care bill through Congress by the end of the year," Steele continued. "Until we are sure job creation has begun in earnest, we should put aside our differences on health care. We should watch our spending. We've got an economy to rebuild and restore."

Funny that Steele's pronouncment comes as the health care reform process is inching toward a close. That argument may have had a shot before the townhall meetings, and before the Republicans allowed fear-mongering to define their talking points on health care reform. Now, it just seems like too little, too late.

Boxer's message to men who support abortion riders: How would you like it if we singled out Viagara? [Think Progress]
Guttmacher: Nelson Abortion Amendment Virtually Identical To Stupak [TPM]
The Health Reform Abortion Wars, Part Deux [Time]
Public option compromise takes shape [Politico]
GOP erupts over Reid slavery, segregation remarks [Politico]
Michael Steele to President Obama: Delay health care [Politico]

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]

McArdle seems to have a low opinion of the various opinions put forth against Stupak, writing:

Most of them seem to come from feminists who blithely assume away concerns about the personhood of the fetus, and the staunch political opposition to subsidized abortion from those who lean towards the "person" side. This allows them to spend 1,000 words or so having a completely irrelevant discussion of the disparate effects of the Stupak amendment on poor women, arguing that women's reproductive health care is too real health care, and similarly unrelated side points.

Memo to authors: you could prove beyond a shadow of a doubt that women's health care is important, that this has a hugely disparate impact on women, that it will result in more women carrying unplanned pregnancies to term, etc . . . and that still wouldn't make a majority of the country want to pay for other peoples' abortions out of their tax dollars.

And once again, the majority of the country doesn't want a lot of shit. People didn't want to desegregate, or have their tax dollars fund schools and public services in minority areas. I don't want to pay for wars with my tax dollars. But the government doesn't work that way - did I miss the line-item veto form on my taxes?

McArdle then busies herself misusing the 13% statistic and making some really large assumptions:

The women who genuinely can't afford $500 bucks for an abortion are the women closest to the poverty line. Those women will be covered by Medicare, and they won't get abortion coverage anyway in most states. The women who will be buying insurance on the exchanges presumably mostly do not have health insurance now, and thus are losing nothing if their new insurance doesn't cover abortions. [...]

Obviously, I am not saying that feminists shouldn't worry whether women will be denied access to abortion if this passes. But the number of people who are going to lose access that they currently have, and therefore be forced to carry a pregnancy to term, is not likely to be all that large. We're mostly talking about a modest number of women who will have to hand over several hundred dollars that they would really rather spend elsewhere. The very small number of women who currently have access to abortion services, and will lose them, and cannot get together a few hundred dollars for an abortion in time—those women can easily be taken care of if everyone who is outraged by this makes a small donation to Planned Parenthood.

Exactly, because that takes care of all the problems, shifting a public health issue onto the plates of private donors. It also makes a huge assumption - that Planned Parenthood and other like-minded organizations are able to reach all the women impacted, particularly when one considers that it can be difficult to find access to these services outside of major urban areas. A donation to Planned Parenthood won't do much good if the person in need of an abortion is more than 250 miles from the nearest provider.

In the new New York magazine, Jennifer Senior provides disheartening facts and figures about support for abortion. While noting that even at the time of Roe vs. Wade, the Supreme Court decision was against the popular majority, Senior points out that over the years, our nation has swung closer and closer to the anti-choice side of the pendulum. More troubling appears to be the attitudes of the neo-lifers, which fall along these lines:

NARAL's Nancy Keenan likes to say that abortion's biggest defenders right now are a "menopausal militia"-a rueful, inspired little joke. These baby-boomers, whose young adulthoods were defined by the fight over the right to choose, will soon be numerically overtaken by a generation of twentysomethings who is more pro-life than any but our senior citizens. As GOP strategists Christopher Blunt and Fred Steeper have pointed out, this group came of age during the partial-birth debate and was the first to grow up with pictures of sonograms on their refrigerators. The major development in reproductive technology during their lifetimes wasn't something that prevented pregnancies but something that created them: IVF. These kids have no idea-none-what it was like to live in a world without abortion rights. ("This generation's knowledge of Roe is like, ‘Roe vs. what?' " says Keenan.) And they feel much more strongly about personal responsibility than the generations preceding them: Didn't use birth control? The burden's on you.

These anti-choice narratives are changing how women view abortion - and leaving less and less room for stories like this one:

The woman is 28 years old and ten-and-a-half-weeks pregnant. She wears false eyelashes, blue eyeliner, and a striped shirt of black and gray. The condition is: I can sit in on her counseling session if I do not know her name.

"I can see that you are stressed," starts Claire Keyes, her counselor.

"Yeah," the woman responds. "Always look stressed."

Keyes was particularly interested in counseling this woman because of the constellation of adjectives she'd checked off on her intake form: selfish, uncertain, guilty. If you listened only to pro-life cant, you'd think that women were unconflicted-cavalier, even-about their abortions, using them fungibly with birth control. Keyes can tell you this is seldom the case, especially in such a Catholic city as Pittsburgh, and especially among African-Americans, like this woman, who on national surveys are less inclined than whites to identify themselves as pro-choice.

"I see you're going to school," says Keyes. "Is it harder doing that or working?"

"Going to school."

"Because …?"

"Because I got to cram in homework; sometimes I don't do it," says the woman. "I got three kids: 13, 11, and 8. And I got to deal with them, and the household, and phone calls from school, 'cause they're cutting out. So it's just like … a whole lot of … everything." She reaches for a tissue. "Basically, I go to school, and as soon as I come home, I go straight to sleep."

Not all abortion clinics drill down and do this kind of work. But the Allegheny Reproductive Health Center in Pittsburgh, from which Keyes stepped down as director in January but still works as a counselor, has a national reputation for being psychologically oriented. If there's any place where the complexity and ambivalence surrounding abortion plays out, it's here.

Keyes opens the woman's folder. "The first thing I saw in your chart," she says, "is you're not sure about your decision. What do you want to tell me about that?"

"I don't know," says the woman. "In a sense, I got too much going on, and I can't afford to take on another child. But in a sense, I feel pressure from my boyfriend, because he don't want the kids … so it's like, I want to. I'm not into the whole abortion thing. I did it before"-twice, according to her chart, once last year at this very clinic-"and I really didn't like it. I think some things happen for a reason."

Worst still are how all of our discussions of "choice" and "life" can still be so woefully inadequate:

Keyes gestures toward the waiting room, where the patient's boyfriend is sitting. "Is he an important part of your life?"

The woman hesitates. "I guess. For now."

"He doesn't have kids?"

"He's got kids. He just don't want any more."

Keyes pauses. "I don't feel you in this decision, and that makes me sad." She thinks. "If you had to name a percentage-pick a number-what percentage of your decision to be here today is yours?"

The woman stares into space. "Basically, 99 percent of it is him." She looks listlessly at Keyes. "So. Get it done and over with."

Keyes gently returns her look. "We have a saying around here: We don't do abortions for boyfriends."

The woman is silent for several long, drawn-out seconds. Then, she offers something. "But see, that's where it comes down to my percent. I have three kids already. So, he leaves, and now I have four children and no dads."

Often, the default pro-choice discussions shy away from these moments, while anti-choicers relish them. To some, this woman is exactly why the government should not assist anyone in paying for abortion. Her story plays neatly into existing stereotypes about black women, promiscuity, and parental responsibility that seems pulled straight out of the pages of the Moyinahan report. And yet, this woman's story is true, and it is one of the many different circumstances that lead to why women seek abortions in the first place.

What generally isn't applied to this type of analysis is a look at the larger factors surrounding choice. Race and racism loom large in various aspects of the debate, but are rarely discussed. African American children are disproportionately placed in the foster care system, and it is often difficult to find these children homes - the GAO even commissioned a study in 2007 to analyze the problem and propose solutions. Poorer women are already banned from receiving abortion coverage, but this is not a fight that has been taken up. Many mainstream feminist organizations are just concerned with maintaining what American women have, and lack the resources and support to push for more equality.

This may be partially an issue of our own making. As Kimala Price writes in Homegirls Make Some Noise:

From the 1980s to the present, women of color have continued this activist legacy in reproductive rights and justice. In the late 1980s, a group of thirty-five prominent African-American women, including political activists and members of Congress, issued the statement "We Remember." The statement connected reproductive health with other issues such as economic and social justice issues:

We understand why African American women risked their lives then, and why they seek safe legal abortion now. It's been a matter of survival. Hunger and homelessness. Inadequate housing and income to properly provide for themselves and their children. Family instability. Rape. Incest. Abuse. Too young, too old, too sick, too tired. Emotional, physical, mental, economic, social – the reason for not carrying a pregnancy to term are endless and varied, personal, urgent and private. And for all these pressing reasons, African American women once again will be among the first forced to risk their lives if abortion is made illegal (African American Women Are for Reproductive Freedom 1999, p. 39)

This re-articulation is in light of the U.S. government's ugly history of determining who can and cannot be mothers, who has the right to bear and raise children, through coercive policies. In the past, the federal government had sterilization campaigns targeting African America, Puerto Rican, Mexican American and Native American women. Today it uses more insidious ways of accomplishing the same end, such as family cap policies in the "reformed" welfare system in which mothers may lose benefits if the number of children they bear exceeds the limit set by state governments. Thanks to the 1976 Hyde Amendment, which banned federal funding of abortions, most state Medicaid programs will not cover abortions, and women who serve in our nation's armed forces cannot obtain abortions on military bases or through the military's health plan. Women in federal prisons and most state prisons don't have access to abortions as well.

The problem has been that the mainstream reproductive rights movement has not paid that much attention to these and other related issues. Out of their frustration with this, women of color activists are busy building our own movement. [...]

Drawing from human rights and social justice principles, women of color activists have re-defined "reproductive rights" into what they now call "reproductive justice." Reproductive justice is not just about the individualistic right to have an abortion (i.e., the right not to have children) but to include the right to have children and to raise them in healthy and stable families. Accordingly, these activists have broadened reproductive rights and freedom beyond abortion rights, the rights to privacy and "choice" which are normally associated with the movement. In sum, reproductive justice encompasses many other issues such as economic justice, immigration rights, housing rights, and access to health care.

This is the reason that Stupak-Pitts has become an important dividing line for the pro-choice movement. The amendment is horrid enough on its own - however, as a symbol, it continues to show the quiet erosion of women's right to choose and a painful reminder of all that progressives have failed to accomplish.

Interested in helping to Stop Stupak and expressing support for the right to choose? There are events scheduled this week that you may be interested in. There is a National Day of Action (that's this Wednesday, December 2) where coalitions from different Reproductive Rights Organizations will lobby their congresspeople as well as rally. Supporters are welcome, and Planned Parenthood is asking for people to RSVP. NOW has more details on the basic schedule for the day. There are also rallies planned in Illinois (Dec. 2) and New York (December 4) with more details here.

The Abortion Wars Heat Up [The Atlantic]
The Abortion Distortion [New York Magazine]
The Moynihan Report (1965) [The Black Past]
African-American Children In Foster Care [GAO]
Quoted: Kimala Price On Hip-Hop Feminism and Choice [Racialicious]
National Day Of Action [Planned Parenthood]
National Lobby Day And Rally [NOW]

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

The New York Times's David Kirkpatrick writes that despite the relatively small role abortion played in the 2008 election and in the Sotomayor confirmation hearings, it's hugely important in the healthcare debate. On the anti-choice side, Marjorie Dannenfelser of the Susan B. Anthony List says donations are up 50% from 2007, the last non-election year. She calls abortion coverage in healthcare reform "the biggest fulcrum of activism we have ever had." Ellen Malcolm, of the pro-choice group Emily's List, echoes her observation if not her ideology, saying the Stupak Amendment has touched off the biggest groundswell of support for her group since 1989's Webster vs. Reproductive Health Services. And Cecile Richards of Planned Parenthood says, "We have seen money coming in at every level. Congressman Stupak managed to crystallize this movement in a way that is hard to replicate."

Meanwhile, the debate over abortion and healthcare continues to rage in the Senate. According to Time's Jay Newton-Small, there probably aren't enough anti-choice votes to add a Stupak-like amendment to the Senate bill. But because Nancy Pelosi is reportedly considering just passing the Senate bill rather than trying to combine it with the House version, pressure on Senators is intense. Much of it focuses on anti-choice Democrat Bob Casey of Pennsylvania. Says Joy Yearout of the Susan B. Anthony List, "He's our No. 1 target to influence others. Casey ran as a pro-life Democrat and it's time he deliver for his constituents." Casey is reportedly considering an amendment that would improve counseling for pregnant women. While this probably won't satisfy anti-choicers, he says, "I just think that there's going to be enough momentum to get a bill passed that one issue - even one very important issue - will not prevent passage."

Despite the inflammatory language used by anti-choice groups (Richard Doerflinger of the U.S. Conference of Catholic Bishops says, "We want everybody covered and nobody deliberately killed. It doesn't seem to us an unreasonable request for health care."), limiting abortion coverage may not actually be a key part of healthcare reform for most Americans. Although 46% say government benefits shouldn't cover abortion services (a position, we should note, that's compatible with less extreme restrictions than Stupak), just 3% of healthcare opponents cite abortion as their reason. It may still be true, as it was in the election, that abortion is becoming less of a wedge issue for voters. Unfortunately, it still seems like a wedge issue for lawmakers — perhaps because some feel beholden to an extremely vocal and extremely anti-choice minority. It would be a shame if the Senate, like the House, conceded to this minority by imposing abortion restrictions that, as Sen. Kirsten Gillibrand says, "will put the lives of women and girls at risk" — especially if these restrictions aren't even important to most people.

Health Bill Revives Abortion Groups [NYT]
Can Bob Casey Bridge The Abortion Divide On Health Care? [Time]
Abortion To Be New Flashpoint In Senate Bill [Wall Street Journal]

The two bills do have some common ground:

Both bills would require all Americans to carry health insurance, with government help to make premiums more affordable. They would ban insurance companies from denying coverage or charging more to people with health problems. They would set up new insurance markets for those who now have the hardest time finding and keeping coverage - self-employed people and small businesses. Americans insured through big employer plans would gain new consumer protections but wouldn't face major changes. Seniors would get better prescription coverage.

Thing is, the battles are getting increasingly more contentious as the debate continues. For Representative Patrick Kennedy, the national mud-wrestling match over abortion rights has turned personal:

A bitter dispute over abortion that prompted Rhode Island's Roman Catholic bishop to ask Rep. Patrick Kennedy not to receive Holy Communion has revealed the depth of the divide among Catholics over how politicians should reconcile their faith with their public duties.

Bishop Thomas Tobin on Sunday said he made the request because of the Democratic lawmaker's support for abortion rights. The news prompted debate among Catholics around the country and within the bishop's flock in the nation's most Catholic state about whether it was right for Tobin to publicly shame Kennedy for breaking with the church on what its leaders consider a paramount moral issue. [...]

Their dispute began in October when Kennedy criticized Catholic bishops for threatening to oppose an overhaul of the nation's health care system unless lawmakers included tighter restrictions on abortion, which have since been added to the House version of the bill. Tobin said he felt Kennedy made an unprovoked attack on the church and demanded an apology.

Since then, their feud has played out in public. Tobin, who has said he might have gone into politics were he not ordained, has written sharp public letters questioning Kennedy's faith and saying his position is scandalous and unacceptable to the church. Kennedy has said his disagreement with the church hierarchy does not make him any less of a Catholic.

This isn't the first time a question of Catholicism and politics made waves in public:

In 1984, former Democratic New York Gov. Mario Cuomo, a Catholic who supported abortion rights and was at the time a potential presidential candidate, delivered a speech at the University of Notre Dame explaining that Catholic lawmakers shouldn't be pressured by church leaders to work for anti-abortion legislation. He said Sunday it's dangerous for the church to pressure politicians because of the potential for unintended consequences.

"If you're required (by the church) to make everybody follow your Catholic role, then nobody would vote for Catholics because it's clear that when you get the authority, you're going to be guided by your faith," the former governor told The Associated Press.

Cuomo said there are two positions a politician can take: They can oppose church doctrine outright or, as he did, accept church teachings personally but refuse to carry them into the public arena where they would affect people of every faith.

"Don't ask me to make everybody live by it because they are not members of the church," Cuomo said. "If that were the operative rule, how could you get any Catholic politician in office? And would that be better for the Catholic church?"

Outside of religion, party politics are looming large over the horizon. Lawmakers are feeling major breaks between the Dems and the GOP, as well as splintering within their own parties:

A leading Senate Democrat said Monday his party is determined to push through a health care overhaul bill with or without Republican support because the "system is broken."

"We prefer to go at it with Republicans if we can reach compromises in some areas," said Sen. Charles Schumer, D-N.Y. "But we're not going to not pass a bill."

Schumer dueled with Republican Sen. Kay Bailey Hutchison on a network morning news show in the wake of a key Senate vote Saturday night that advanced a 10-year, $959 billion health bill to full debate. Hutchison argued that "you're going to put taxes and mandates on business" that would be a drag on an economy still struggling to recover from recession.

Accusations around the political use of the task force recommendations on breast cancer screening have also become a dividing line between Democrats and Republicans:

Rep. Debbie Wasserman Schultz (D-Fla.), a breast cancer survivor, slammed Republicans on Sunday for trying to use controversial new mammogram guidelines as an argument against Democrats' health care legislation.

"The Republicans, and Ms. [Marsha] Blackburn, have for the first time politicized breast cancer," Wasserman Schultz said on ABC's "This Week," where Blackburn (R-Tenn.) was also a guest.

Obviously, an orderly fight ensued.

Health Care Hurdles [ABC News]
Schumer: Dems ready to go-it-alone on health care [AP]
Kennedy Abortion Flap Shows Catholic Rift [CBS News]
Dem: GOP has 'politicized breast cancer' [Politico]

Earlier: New Breast Cancer Screening Guidelines Spark Confusion, Criticism

Update: Senator Blanche Lincoln of Arkansas has also stated that she, too, will vote to push the bill forward, which gives the Democrats the 60 votes they need to avoid a Republican filibuster. [CNN]

Things to watch out for during the Saturday vote which will determine if the health care debate moves forward:

Major Differences

The Politico summarizes:

Senate Majority Leader Harry Reid introduced his health care reform bill yesterday and moved the debate into its final stage. After a year of multiple plans, proposals and programs we're down to two final, and very different, versions of reform. The House bill costs just over $1 trillion. The Senate bill weighs in at $848 billion. The Senate cuts Medicare spending by $491 billion and the House slashes it $571 billion. The Senate's public insurance option allows states to opt out of the program while the House has a more robust plan. And to fund reform, the Senate relies primarily on taxing high-end health plans while the House taxes the rich. And the gulf between the two bills is not likely to shrink as the bill moves through the Senate. If anything, the gap may widen if Senate moderates force Reid to make the bill more conservative. Besides the daily speculation about whether Reid has 60 votes to move a bill forward, which has been going on for weeks, the next power play to watch will be how Reid, Pelosi and the White House begin to move toward a bill that can pass both chambers and land with a victorious thud on the president's desk. Getting a bill passed through the Senate is difficult, but many insiders think reconciling the differences between the two bills could be hellacious.

Abortion

Now that Pelosi has reversed her stance on Stupak-Pitts, saying the amendment goes too far and embracing Reid's version, Catholic leaders and the GOP have come out swinging.

Catholic bishops are displeased:

A top Obama administration official on Thursday praised the new Senate health care bill's attempt to find a compromise on abortion coverage - even as an official of the U.S. Conference of Catholic Bishops said Sen. Harry Reid's bill is the worst he's seen so far on the divisive issue.

The bishops were instrumental in getting tough anti-abortion language adopted by the House, forcing Speaker Nancy Pelosi, D-Calif., to accept restrictions that outraged liberals as the price for passing the Democratic health care bill. [...]

Richard Doerflinger, associate director of the bishops' conference Secretariat of Pro-Life Activities, said Reid's "is actually the worst bill we've seen so far on the life issues."

He called it "completely unacceptable," adding that "to say this reflects current law is ridiculous."

Meanwhile, the Republicans found a new talking point:

House Minority Leader John Boehner's office has posted a long statement blasting the Senate health care plan, specifically targeting the abortion provisions with an accusation it levies an "abortion premium fee."

A Senate Democratic aide came back with the facts, pointing out that the prevision that Boehner refers to is for something else, and points to all the language in the bill that prohibits the use of public funds for abortion.

But Melissa over at Shakesville points out that Reid's additions are more of a Pyrrhic victory than anything else.

When Boxer's petition against the Stupak Amendment noted it "discriminates against women by taking away health coverage they already have-and tells women who participate in the new health insurance exchange that they can't even use their own funds to buy a policy that includes abortion coverage," I didn't imagine "let them use their own funds!" was going to be regarded as the best solution.

Silly me.

Meanwhile, D-Day notes that this compromise depends heavily on decisions made by the Secretary of Health and Human Services, as s/he "determines whether or not abortion services are being paid for with federal dollars" and "can choose whether or not abortion services are covered in the public option."

Not only are those wildly enormous decisions to leave in the hands of one person, but, as D-Day points out, "the executive branch may indeed be controlled by a Republican at some point in the future."

Cost

One of the major differences in the two plans is how it will be funded. The House wants to tax millionaires - the Senate bill wants to tax "Cadillac plans." However, taxing these so called plans may not be a good strategy. Politifact delves into the details of the Senate plan:

Under the Senate Finance proposal from Sen. Max Baucus, insurance companies would have to pay a 40 percent excise tax on health insurance policies that exceed $8,000 for individuals and $21,000 for families; they would pay taxes on the amount that exceeds those thresholds. We spoke with three economists on both the left and the right, and they all agreed that insurance companies will not simply absorb the new tax; they will pass it along in the form of even higher premiums. Employers will then try to avoid the new higher costs by buying cheaper health plans.

Finally, the economists agreed that if employers have to scale back on health plans, they will eventually pay higher wages as they seek to retain workers. At this point, disgruntled workers may say "Yeah, right," but the economists were adamant that it is the case. There are data that we won't get into now that back up their point.

Here's where the analysis that Palin mentioned by the Joint Committee, which is nonpartisan and advises Congress on tax policy, comes in: At the Senate's request, it tried to figure out the effect of the excise tax on federal taxes collected. Like the economists we talked to, the Joint Committee also believes that wages will rise if employers select lower-priced health insurance, and the government gets to tax those higher wages. So the Joint Committee created a series of tables projecting how much additional income tax would be collected over the next 10 years. By 2019, about 87 percent of those people paying higher taxes would make less than $200,000, according to an analysis of the preliminary Senate Finance proposal.

So here's what that means: If workers end up getting paid more, they'll also be taxed more.

Communications Workers of America also ran a separate analysis on what the 'Cadillac' plan tax would mean for workers:

"The Senate Finance Committee excise tax is not a tax on 'Cadillac' plans; it's a pick-up truck tax. It taxes plans that are of great utility to millions of working Americans, but it is bad policy based on wrong assumptions," said CWA President Larry Cohen. "Health care reform should be paid for by making employers who don't pay, pay. The House bill does it with an 8 percent payroll tax on employers who don't provide coverage."

CWA recommends the following strategies to avoid penalizing people who fought for better coverage, but are being lumped in with CEO packages:

Rather than impose a new tax on the middle class, CWA supports other revenue sources:

* Require most employers to provide coverage or pay an 8 percent penalty if they do not, as proposed under H.R. 3200 in the House of Representatives. This would raise $163 billion over ten years, according to the Congressional Budget Office (CBO). The Senate Finance Committee bill has no employer mandate.
* Levy a modest surtax on the wealthiest Americans – 1.2 percent of U.S. taxpayers – as proposed in H.R. 3200, raising $544 billion over ten years according to JCT.
* Limit the charitable deductions for individuals earning more than $250,000 and families earning more than $500,000, as proposed by President Obama, which would raise $318 billion over ten years.
* Enact a strong public health insurance plan option to compete with private insurers, as proposed under H.R. 3200, which would lower costs by about $110 billion. The Senate Finance Committee bill has no public option.

Of course, the real party starts Saturday night. Seeing that the last Saturday evening health care announcement brought us Stupak-Pitts, let's hope nothing new comes out of left field.

Live Pulse [Politico]
Pelosi Says Stupak 'Goes Beyond Status Quo', 'Optimistic' It Won't Stop Reform [TPM]
White House at odds with bishops over abortion [AP]
GOP Claims Senate Bill Forces Taxpayers To Pay 'Abortion Fee' [TPM]
Senate Health Bill Answer to Stupak [Shakesville]
Sarah Palin says health care reform will raise taxes on the middle class [Politifact]
CWA Excise Tax Study Finds that One-Third of Health Care Plans Still Will Be Affected By Senate Finance Committee Approach [CWA]

Related: Why the Health Insurance Excise Tax Is a Bad Idea [The Nation]

In the past, cervical cancer screening has been recommended starting at age 21 or within three years of a female's first sexual experience, whichever comes first. Now, the American College of Obstetricians and Gynecologists (ACOG) says women can start getting screened at the age of 21, regardless of when they began having sex, and that women older than 30 who have three consecutive normal Paps can get screened every three years instead of every year. ACOG also says some women can put screening on hold between ages 65 and 70, and that women with no history of abnormalities who have their cervix removed through hysterectomy can stop screening entirely.

Like the mammogram guidelines, these new Pap smear recommendations are meant to reduce the harm caused by false positives. But doctors say the risks of Pap smears are greater than those of mammograms — they often detect cervical lesions in young women that would go away on their own without ever progressing to cancer. Removing these lesions can damage the cervix and increase the chances of premature birth.

Dr. Cheryl B. Iglesia, chairwoman of the panel that developed the new Pap smear recommendations, calls their timing — coinciding with debates on mammograms and on healthcare reform overall — "an unfortunate perfect storm." And cervical cancer survivor Patricia Juirc told the Washington Post,

It seems a little bit of a week where women's health is taking a beating, considering the suggested guideline changes for mammography and all. Like they no longer want to be proactive and only see or treat us when we get sick.

But Cindy Pearson of the National Women's Health Network says,

There's something about health reform and guidelines that makes people think they're telling women to do less screening to save money. But we don't have any concerns that women are being asked to give up something that is helpful. These recommendations are sound.

And Thomas Herzog, a gynecological oncologist and spokesman for ACOG, adds, "in this case, if anything, we're taking money out of our own pockets." Part of the skepticism about screening guidelines is no doubt caused by fears surrounding the health care debate. But in part, these guidelines have been so controversial because they go against the prevailing medical culture. The Times's Kevin Sack writes,

For decades, the medical establishment, the government and the news media have preached the mantra of early detection, spending untold millions of dollars to spread the word. Now, the hypothesis that screening is vital to health and longevity is being turned on its head, with researchers asserting that mammograms and Pap smears can cause more harm than good for women of certain ages.

Are we about to see a shift in the way we think about our health, in which the benefits of early detection are weighed against the risks of detecting and treating something that never would have harmed us? This shift might be beneficial — especially if we believe ACOG — but it's not going to happen overnight. And a healthcare debate in which phrases like "death panel" get thrown around isn't going to make it happen any faster. In addition, the new Pap smear recommendations may seem strange to women who take birth control, given that doctors often require yearly Pap smears as a condition for such prescriptions. Girls and young women who want the Pill have long had to submit to screening before even the more conservative three-year recommendation, and the new guidelines are unlikely to change this practice. Beneficial as screening can be, using birth control as a carrot to lure women into the stirrups is a little paternalistic, and reflects an approach to women's health in which the women themselves don't have much power. This approach is evident in the debate over reproductive rights as well — over the years, so many people have tried to exert control over women's bodies that it's no wonder we've become a bit suspicious.

Cervical Cancer Screening Can Wait Till 21, Group Says [Washington Post]
Medical Science And Practice In Conflict [NYT]
Guidelines Push Back Age For Cervical Cancer Tests [NYT]

The report made waves by advising against home screening for breast cancer and against annual mammograms:

The task force, a federal advisory board, said this week that women should not begin routine mammograms until age 50, contradicting the well-established advice that women 40 and older should be screened.

Groups such as the American Cancer Society and Susan G. Komen for the Cure have opposed the new guidance.

The backlash was swift and merciless, forcing Health and Human Services Secretary Kathleen Sebelius to issue a statement saying that the recommendations of the task force are not guaranteeing a change in government policy:

In a written statement, Sebelius said the guidelines had "caused a great deal of confusion and worry among women and their families across this country" and stressed that they were issued by "an outside independent panel of doctors and scientists who . . . do not set federal policy and . . . don't determine what services are covered by the federal government." [...]

The task force on Monday recommended that women in their 40s stop having routine mammograms and instead individually discuss whether to get the exams with their doctors.

The panel also recommended that women in their 50s get mammograms routinely every two years, instead of annually. The panel argued that the benefits of more frequent exams were outweighed by the harms caused by false alarms, which can lead to anxiety and unneeded treatment.

While hailed by many patient advocates and breast cancer experts, the new guidelines have been harshly criticized by the American Cancer Society, the American College of Radiology and others, including some members of Congress.

Two of the women over at Time's Swampland blog are up in arms, noting that the recommendation seems more like a cost-saving measure rather than anything that will benefit women. Kate Pickert points out the numbers:

The panel also said a review of clinical data showed that yearly mammograms for women 40-49 reduced the risk of breast cancer death by 15%, but under a section titled "Balance of Harms and Benefits," said this:

• Harms of screening include psychological harms, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure. Harms seem moderate for each age group.

  False-positive results are a greater concern for younger women; treatment of cancer that would not become clinically apparent during a woman's life (overdiagnosis) is an increasing problem as women age.

These new guidelines - which while influential, are not binding - have caused no small amount of consternation. Women are incensed that some faraway task force has decided a 15% risk reduction – i.e. actual lives saved – is not enough to warrant mass screenings. I asked a number of female colleagues here at TIME what they thought of the new guidelines and all said they found the new recommendations to be disturbing. One even said the news set off "a giant pink bell ringing in my head."

After pointing out how Congresswoman Debbie Wasserman-Schultz, a breast cancer survivor, freaked out at the proposal, Pickert concludes:

For instance, a small number of women get diagnosed with breast cancer in their 20s and 30s. Does this mean mammograms should be routine during these years too? At what point do lives saved outweigh "psychological harms, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure." Will private insurance companies, which pay close attention to guidelines from the U.S. Preventive Task Force and other groups, stop covering mammograms for women under 50? Wouldn't insurers rather catch cancers early when they are easy (and cheap) to treat? And what about the oft-touted U.S. breast cancer five-year survival rate, which is 83.9%, compared to England, where it's 69.7%?

Time's Karen Tumulty doesn't pull any punches - she thinks the task force is composed of "pinheads:"

[A]t age 19, when I discovered lumps in both my breasts that didn't go away after a couple of menstrual cycles.

That's when I had my first mammogram. Back in those days, the technology wasn't what it is today, and it was inconclusive. My doctor decided he wanted to do a biopsy. That wasn't what it is today, either. A simple breast biopsy in 1975 required me to check in for an overnight stay in a hospital, and to sign forms before the surgery authorizing a mastectomy on the spot if it turned out to be cancer. I remember vividly waking up from the general anesthesia terrified, feeling the heavy layers of bandages trying to figure out what they had done. It was benign—thank God—but it turned out to be the first of several times I would go through this drill, because I have lumpy breasts. The fancy name for that is fibrocystic disease.

At the time of my first breast biopsy, I had no family history of the disease. I subsequently developed one. Over the years, my mom was diagnosed with breast cancer (and survived it); my aunt was too (and didn't). I've had a number of scares, but none, thus far, has turned out to be cancer.

So it would seem I'm the perfect example of a person who shouldn't have had mammograms, or even examined my own breasts. But am I sorry I've had the information I've had through mammograms and self-exams? Not for a second.

That's why I think these scientists are pinheads. Pink ribbons are lovely, but women who want information should have it. And I would remind Swampland readers of the important lesson we all learned from Carly Fiorina. Information is power, ladies, and don't let some scientific panel tell you it isn't.

But the NY Times' Gail Collins begs to differ:

Somewhere between the reports that Pap smears and tests for prostate cancer aren't all they were cracked up to be and the news that a high fiber diet doesn't do anything to prevent cancer, the health establishment began looking decidedly nonomniscient. Then this week, a federal task force reported that most women don't need annual mammograms.

Even more fascinating, they suggested that doctors stop telling their female patients to self-examine their breasts for lumps. [...]

The report triggered two immediate and inevitable responses. Doctors and patients began an animated discussion. And Republicans declared it was all a Democratic plot.

"I mean, let the rationing begin. This is what happens when bureaucrats make your health care decisions," said Representative David Camp, the ranking Republican on the House Ways and Means Committee.

Representative Camp is definitely on to something. Whatever happens, we do not want the government conducting any studies on whether current health practices actually do any good. Let this continue and soon you will not be able to get your hands on a good leech when you need one.

There is no possible political advantage in coming out against medical testing, so the Obama administration scurried away from the report. The task force did not consider the matter of cost, but, of course, people like Representative Camp depicted it as the first step toward rationing. The current position of the Republican Party seems to be that it is not possible to spend too much money on medicine. Party on.

(Has anybody noticed that the people who darkly warn about government bureaucrats forcing insurance companies to cut back our coverage appear to be the same ones who just voted to force insurance companies to stop covering abortions? Where's the sanctity of the marketplace when we really need it?)

Collins, also a breast cancer survivor, is remarkably glib about the whole business, explaining:

I had mammograms every year like clockwork, and I had just gotten a clean bill of health from my latest one when I found a lump on my left breast while watching a rerun of "Buffy the Vampire Slayer," multitasker that I am.

It turned out to be cancer, of a fairly low-grade variety. My oncologist felt strongly that it never would have developed if I hadn't taken estrogen replacement therapy - another one of the medical marvels that has now been consigned to the Seemed Like a Good Idea at the Time category.

So, in summary, the cutting-edge of medical thinking of the 1990s may have induced my cancer, and then the universally recommended testing protocol failed to detect it.

So who's correct? Only time will tell, but in terms of personal health, most of us would prefer to side with the old adage "an ounce of prevention is worth a pound of cure."

Who decides about mammograms? Inside the task force [CNN]
Sebelius distances herself from new mammogram guidelines [LA Times]
Are Mammograms the New Political Football? [Time]
A Word About My Breasts [Time]
The Breast Brouhaha [NY Times]

Earlier: New Breast Cancer Screening Guidelines Spark Confusion, Criticism

Senator Reid unveiled his plan last night with both fanfare and steely resolve:

Reid's plan would expand coverage to 94 percent of Americans through a government-run health insurance option - allowing states to opt out - and other features, all while reducing future federal deficits by $130 billion over the next 10 years, according to a Congressional Budget Office report released late Wednesday. [...]

But Reid's plan contains considerable differences from House legislation passed earlier this month - with a more limited public option and different ways to pay for the bill. Reid included an excise tax on insurers who offer "Cadillac" health plans, not the "millionaire's tax" that's in the House bill.

And one of the biggest differences between the bills – on language restricting federal funding for abortion – could prove problematic for Reid. His bill doesn't include as many limits as the House bill and already is drawing fire from anti-abortion activists.

On the issue of abortion, the bill makes the following provisions:

The bill grants the secretary of Health and Human Services the authority to determine whether federal money is being used to fund abortions under the public plans, but doesn't ban those plans from offering the coverage. Reid's bill also explicitly requires insurers to separate private premiums from any public subsidies used to pay for that coverage to assure taxpayer dollars aren't used to fund the procedure - which is prohibited by the Hyde Amendment. [...]

There is a conscience clause that makes it perfectly acceptable for insurance companies to deny that coverage or health care providers to refuse carrying out the procedure. But the bill also requires each exchange to offer one plan that provides abortion coverage and one that doesn't - a major sticking point for critics of the original House language.

California Rep. Lois Capps, who tried to hatch a compromise on the Energy and Commerce Committee, commended Reid's language, saying, "I am pleased that the Senate has adopted a reasonable, common ground approach on this difficult question. It appears that their approach closely mirrors my language which was originally included in the House bill."

In a statement, she went on to point out that the bill "ensures that federal funds do not pay for abortions but allows continued access to this legal medical procedure."

We also have a date: Reid's version of the bill would start exchanges in 2014.

Reid, it should be noted, isn't fucking around with party holdouts.

At a special evening meeting of the Democratic caucus tonight, Senate Majority Leader Harry Reid outlined, in broad strokes, the details of his health care bill, which the CBO has found, in a preliminary analysis, will expand coverage to 94 percent of Americans while reducing the deficit. And earlier in the day, during a separate meeting about floor procedure, Reid let three of his party's key skeptics know that if they join Republicans at any stage of the process to block the bill, he still retains the option of passing major parts of it through the filibuster proof budget reconciliation process.

In response to a question from TPMDC Nelson told reporters that, at a meeting this afternoon with Sens. Mary Landrieu (D-LA) and Blanche Lincoln (D-AR), Reid "talked about process, procedure, discussion about reconciliation and a whole host of issues of that sort."

"Nobody's really jumping up and down to push for reconciliation," Nelson said, "he's not threatening that, but anybody can conclude that if you don't move something on to the floor, that is one of the possibilities."

National Right to Life-rs are, of course, talking shit, but I'm going to ignore them in favor of reason and sanity. The real battle begins on Saturday.

Reid plan ups pressure on moderates [Politico]
Reid's restrictions on abortion [Politico]
Reid Outlines Bill For Caucus, Warns Conservative Dems That Reconciliation Is Still An Option [TPM]
National Right to Life blasts the Reid bill [Politico]

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]

We have no idea if we can get riders, or what they will cost.

Abortion-rights activists say the option of buying additional coverage for abortion - a so-called rider - is a false promise. They cite the examples of Oklahoma and North Dakota, where riders have had negligible use even though allowed under state laws that otherwise ban insurance coverage of elective abortions.

"Abortion coverage should be part of the regular package," Crane said. "Women don't expect unplanned pregnancies and don't expect their wanted pregnancies to go wrong. ... They don't anticipate needing abortion coverage so they wouldn't buy a rider."

Kristin Binns of WellPoint, Inc., which oversees health plans serving 35 million Americans, said it's impossible for the insurance industry at this stage to estimate how much such riders would cost and the extent to which they might be offered.

"We don't have a clue," she said.

The Republicans' crap-ass plan still covers abortion...by accident.

The Republican National Committee's health insurance plan covers elective abortion – a procedure the party's own platform calls "a fundamental assault on innocent human life."

Federal Election Commission Records show the RNC purchases its insurance from Cigna. Two sales agents for the company said that the RNC's policy covers elective abortion.

Informed of the coverage, RNC spokeswoman Gail Gitcho told POLITICO that the policy pre-dates the tenure of current RNC Chairman Michael Steele.

"The current policy has been in effect since 1991, and we are taking steps to address the issue," Gitcho said.

While many women do opt to pay cash for their abortions, that is not the end of the story.

Stupak says one reason his amendment's impact would be limited is because only a small fraction of abortions - 13 percent by Guttmacher Institute estimates - are paid for directly by private insurance. The vast majority are paid for in cash, even by women with abortion coverage who do so out of privacy concerns.

However, Dr. Willie Parker, an abortion provider in Washington, D.C., noted that insurance coverage could be vital for women with health problems who need hospital abortions costing many thousands of dollars, compared to roughly $400 to $800 for a first-trimester abortion in a clinic.

"The cash option was a challenge for many women even in more reasonable economic times," Parker said. "I see that becoming worse as people have to make hard decisions because abortion is not considered part of health care."

There are issues trying to play to both sides.

Other lawmakers said, in effect, that they voted for the Stupak amendment but didn't really mean it, because they expected the amendment to be stripped out later, either in the Senate or in a conference committee.

As a result, Democratic leaders are in some danger of having the worst of both worlds: letting a compromise pass, thereby angering their liberal wing, while appearing cynical in suggesting that they now intend to drive it out of the bill, thereby angering the party's moderates and the bishops. That's a problem with consequences: The simple math in the House suggests the health bill wouldn't have passed without the votes of the moderates who came to the "yes" side after the Stupak amendment.

If we become apathetic about our right to choose, we will lose that right.

The pro-choice, pro-health reform advocates I spoke with this week remained confident that they would be able to nudge Congress to soften the Stupak-Pitts restraints in a final health care reform compromise. They took heart from the fact that a vigorous public insurance option - an idea pronounced a dead letter not so many months ago - did at last make it into the House's legislation. But there's one key difference: the American public widely supported the public option, polls showed this fall. The support for abortion rights now isn't so solid.

A Pew Research Center survey released last month showed Americans' support for abortion rights is at a striking low - down to 47 percent - after hovering consistently just above 50 percent since at least the mid-1990s. And despite the passionate outrage expressed by high-profile abortion rights supporters this week, most of the pro-choice public just doesn't appear to be all that fired up about fighting for the freedom to choose anymore. According to the Pew poll, only 15 percent of people overall say abortion is a "critical" issue today, and even among those described as liberal Democrats, that proportion has dropped 26 points, from 34 percent to 8 percent, since 2006.

Stupak-Pitts passed not just because a group of Catholic bishops bore down on Democratic lawmakers. It passed because it could.

Tough choices for women on abortion coverage [MSNBC]
RNC insurance plan covers abortion [Politico]
Abortion Upends Health-Bill Alliance [WSJ]
‘Mad Men,' Maddening Times [NY Times]

But is the bill good?

Mr. Clinton spoke to a closed-door meeting of Senate Democrats as party leaders were struggling to contain a growing number of conflicting demands and ultimatums from senators.

"It's not important to be perfect here. It's important to act, to move, to start the ball rolling," Mr. Clinton said afterward. "And whatever they can get the votes for, I'm going to support."

Which, at this moment in time, includes the Stupak-Pitts amendment.

Luckily, there's Representative Linda Sanchez, who puts the fight in a pop culture context:

Has Congress become like an episode of Mad Men? The Stupak Amendment slams women back to a time of stenographs and unsafe abortions. It represents an unprecedented and unacceptable restriction on women's ability to access the full range of reproductive health services to which they are lawfully entitled.

It is truly disappointing to see women's reproductive rights on the table as a bargaining chip for health care reform. It is equally disappointing that the United States Council of Catholic Bishops (USCCB) was let in the room to bargain, then ended up writing the law.

Speaking of Catholics, Nancy Keenan (president of NARAL Pro-Choice America) and Jon O'Brien (president of Catholics for Choice) teamed up for an opinion piece in the Politico. Their goal? To shame the Catholic Bishops for employing a double standard concerning government funding:

[T]he U.S. Conference of Catholic Bishops and its allies in the House distorted the facts about the health reform proposal by claiming that the proposed system would have used federal dollars to cover abortion care. They're wrong.

The original House bill included a compromise that required all plans to separate public and private dollars in the new system - ensuring that no tax dollars would ever cover abortion services.

In fact, the bishops should be familiar with this arrangement because it reflects the same principle of separation that guides their financial interaction with the federal government. The bishops have a long history of almost unlimited access to enormous quantities of federal funding. When it comes to funding for Catholic schools and hospitals or programs run by Catholic Charities, they accept federal funding with open arms. The bishops never question their own ability to lawfully manage funds from separate sources to ensure that tax dollars don't finance religious practices.

Yet they reject the idea that others could do the same. This is the very definition of hypocrisy.

However, there may be some small hope here - Majority Whip James Clyburn mentions that the Stupak-Pitts amendment may not be as influential as it seems. He claims the bill provided ten needed votes, not the 40 that were estimated.

The Politico explains:

If that is the case, it could change the dynamic of the debate and give progressives a stronger hand than many thought they had. It's easier to reverse a provision that only wins 10 votes — and angers a good chunk of the Democratic caucus — than one that makes or breaks the bill. In other words, it's easier to win four or six votes than it is to grab 38.

Reid Says Health Bill Will Be Done by Christmas [NY Times]
Bill Clinton Presses Senators to Pass Health Bill [Wall Street Journal]
The Arena [Politico]
The Catholic Bishops' Double Standard [Politico]
Clyburn Says Stupak Amendment Won 10 Votes [Politico]

In a new interview with ABC News, Obama explains that the wedge issues currently receiving so much attention weren't really the point of the bill:

You know, I laid out a very simple principle, which is this is a health care bill, not an abortion bill. And we're not looking to change what is the principle that has been in place for a very long time, which is federal dollars are not used to subsidize abortions.

And I want to make sure that the provision that emerges meets that test — that we are not in some way sneaking in funding for abortions, but, on the other hand, that we're not restricting women's insurance choices, because one of the pledges I made in that same speech was to say that if you're happy and satisfied with the insurance that you have, that it's not going to change.

So, you know, this is going to be a complex set of negotiations. I'm confident that we can actually arrive at this place where neither side feels that it's being betrayed. But it's going to take some time.

I still hate that "sneaking in funding for abortions" line: It's like the lawmakers heard the cries for affordable premiums and comprehensive coverage, and thought Yeah, but what about all those unscrupulous whores scheming to use their health care coverage to go to abortion parties and make fetus-necklaces? WTF? Doesn't the Hyde Amendment go far enough?

Melissa McEwan at Shakesville thinks Obama's milquetoast cry for unity is a crock:

There is no fucking "common ground" between people who believe in women's right to autonomy over their own bodies and people who believe that women's bodies are property of the government, or their doctors, or their husbands, or anyone else who gets a vote on whether they have to be pregnant even if they don't want to be. Either you stand on the side of women's equality and independence or you don't.

It is fucking ludicrous that our DEMOCRATIC PRESIDENT refuses to take a stand on this issue.

And this mealy-mouthed bullshit-"I laid out a very simple principle, which is this is a health care bill, not an abortion bill"-is contemptibly craven. I'm absolutely fucking livid that a man who had the audacity to claim to be a champion of women's right to choose would abandon women in this way.

Nancy Pelosi is cool with her decision, saying:

U.S. House Speaker Nancy Pelosi said Monday that while she opposes an anti-abortion amendment to the House version of the health care bill, it was necessary for the measure to pass.

The California Democrat said the language to prohibit the new government insurance plan from covering abortions "would have been in the bill one way or another." She said backers of the far-reaching legislation to overhaul the U.S. health care system thought it was better to have the language included as an amendment to be voted on than as a provision "that could take down the whole bill."

Pelosi, please. Why didn't you launch a counter-attack explaining that certain factions want to use health care reform as a weapon for their pet issue? Put some pressure on people! They had no problem making issues out of non issues, as is made clear by these comments from Senator Kent Conrad:

"I think all of us have recognized throughout that there are three things" - abortion, illegal immigration and the public option - "that could really bring this down," said Conrad, the only Democrat on the Senate Finance Committee to vote with Republicans on amendments restricting abortion rights.

The only thing that should have conceivably been on that list is the public option. But abortion and the issues of undocumented workers and resources? It's trumped up bullshit, preventing people from paying attention to little asides like this one:

Summarizing her study of the bill over the past 10 weeks, [Senator Susan] Collins said it was "too timid" in revamping the health care system to reward high-quality care. She said the bill included "billions of dollars in new taxes and fees that will drive up the cost of health insurance premiums."

And she noted that many of the taxes would take effect before the government started providing subsidies to low- and middle-income people to help them buy insurance.

Thus, Ms. Collins said, "there will be a gap for even low-income people where the effect of these fees will be passed on to consumers and increase premiums before any subsidies are available to offset those costs."

The bill sets standards for the value of insurance policies, stipulating that they must cover at least 65 percent of medical costs, on average.

Most policies sold in the individual insurance market in Maine do not meet those standards, Ms. Collins said, so many insurers would have to raise premiums to comply with the requirements. As a result, she said, the premium for a 40-year-old buying the most popular individual insurance policy in Maine would more than double, to $455 a month.

Wait, wait, wait - what? Fuck this, let's call Angie from Politifact on this one.

In the meantime, NPR published a quick guide to the language, noting:

Government Money: In general, government money cannot be used to pay for abortion. The government-administered health plan - often called the public option - will not cover abortion, unless a doctor certifies that a woman is in danger of death without one, or the pregnancy is the result of rape or incest.

If you get your health insurance through the government, or with help from the government in the form of a tax subsidy, your plan will not cover abortion. In this case, you would have the right to buy extra coverage - with your own money.

If you get your health insurance through your state, as in Medicaid, your state could buy supplemental abortion coverage for everyone it insures. And 17 states already do this under Medicaid.

The Exchange: The next section of the abortion amendment deals with the exchange. That's the government-administered service where people can buy insurance and join a risk pool. One of the reasons health care is so expensive for people who don't get it through their work is that they're not in a large risk pool. The bill tries to group them together and cut costs for everyone.

Private insurance companies that offer a health plan through the exchange are allowed to cover abortion. But if they're going to, the companies must also offer another plan that is identical in every way, except that it does not cover abortion.

So, say you're buying insurance with your own money, and you get it through the exchange. You can choose a policy that covers abortion, or one that doesn't. But if you're getting help from the government to buy that insurance - in the form of a tax subsidy - you may not choose a plan that covers abortion. You are still allowed to buy a supplemental policy with your own money.

Private Insurance: The Stupak amendment does not apply to private insurance bought with private money. It is also not close to becoming law. The Senate bill does not have similar language, though lawmakers on both sides of the debate are now looking at it.

Politifact goes a bit further, denying a lot of the pro-choice rhetoric surrounding Stupid-Shits, saying that there is no proof that doomsday is on the way. Taking on Representative Nita Lowey's comments, Politifact writes:

But Lowey said the amendment "puts new restrictions on women's access to abortion coverage in the private health insurance market even when they would pay premiums with their own money." We believe that Lowey's formulation is, at best, misleading. The people who would truly pay all of the premium with their own money — and who would not use federal subsidies at all — are not barred in any way from obtaining abortion coverage, even if they obtain their insurance from the federally administered health exchange.

Lowey's office counters that exchange participants who get the subsidies do indeed pay a share of their premiums with their own money, maybe even a majority of the cost. But if that's what Lowey meant, she should have said abortion coverage would be prohibited "even when they pay part, or most, of their premiums with their own money." Not making that distinction, combined with her failure to specify that she was discussing only people who use the exchange, suggests that the restrictions are more severe and widespread than they actually are.

Some in the abortion-rights community do actually make a stronger case that the amendment would harm individuals who pay for their coverage without subsidies. This line of argument involves what insurance companies might do from a business perspective in response to the amendment.

Some critics say that the amendment throws up enough obstacles against offering abortion coverage on the health exchange — particularly the requirement to offer two separate plans, one of them without abortion provisions — that insurers will simply take the path of least resistance and offer a single plan that leaves out abortion coverage. Some also argue that companies will be reluctant to offer riders for abortion coverage, or that there won't be much demand for them. This could indirectly diminish the abortion coverage options for people on the exchange who don't take subsidies, even though the law doesn't limit their options directly.

There's plenty of room for debate about how the Stupak-Pitts amendment will eventually shape the availability of abortion coverage.

There is tons of room for debate, especially when the assumption is that women are the unscrupulous whores, and not the "profits over patients" philosophy of insurance companies. They're supposed to trust the same people that classified domestic violence as a pre-existing condition and denied a four month old coverage for being fat? And they're supposed to trust that what they produce won't amount to an abortion penalty? Not happening. Even if insurance companies still offer the same coverage they always have, it would amount to the middle class facing what poor women have since the 70s - when you accept government funds, you are giving the government the right to dictate the decisions you make about your life and your well being. Planned Parenthood is calling it "the middle class abortion ban," but any way you slice it, the ramifications of this amendment are far reaching.

Still, the debate promises to get more interesting. There are rumors swirling about former President Bill Clinton getting involved with health care reform, and one of the staunchest Roe foes, Senator Bob Casey, has stated "health care reform should not be used to change longstanding policies regarding federal financing of abortion which has been in place since 1976."

Curiouser and Curiouser.

TRANSCRIPT: ABC News Exclusive Interview with President Barack Obama [ABC News]
Pelosi discusses health care bill on Seattle tour [AP]
Senate faces abortion rights rift [Politico]
Obama Seeks Revision of Plan's Abortion Limits [NY Times]
Official Site [Politifact]
Breaking Down Abortion Language In Health Bill [NPR]
Lowey says Stupak amendment restricts abortion coverage even for those who pay for their own plan [Politifact]
Too Fat for Health Insurance? At Four Months? [ABC News]
"Middle-class abortion ban" [Politico]
Bill Clinton Tackles Senate Abortion Rift [CBS News]
Casey: No new abortion restrictions in bill [Politico]

Earlier:

Reproductive Rights Left Behind After Health Care Bill Passes House
Democrats Vow To Eliminate Domestic Violence As Pre-Existing Condition

Greg Sargent reports at least 41 pro-choice Democrats have signed a letter to Nancy Pelosi stating the following:

As Members of Congress we believe that women should have access to a full range of reproductive health care. Health care reform must not be misused as an opportunity to restrict women's access to reproductive health services.

The Stupak-Pitts amendment to H.R. 3962, The Affordable Healthcare for America Act, represents an unprecedented and unacceptable restriction on women's ability to access the full range of reproductive health services to which they are lawfully entitled. We will not vote for a conference report that contains language that restricts women's right to choose any further than current law.

For those of you who (like me, initially) are confused about how this extremely complicated and at times disheartening process works, what happens now is that the Senate needs to pass its own version of the healthcare bill, and then the two houses of Congress must hash out a single version in conference committee. That version needs to be approved by the House and Senate — and 41 House Dems say they won't vote for it unless what Latoya aptly calls the Stupid-Shits Amendment, which would prohibit women who receive government subsidies from buying abortion coverage even with their own money, is removed. As Sargent points out, their language is "unequivocal, with no wiggle room." And Debbie Wasserman-Schultz (video above) pledges that the Stupak Amendment will be gone from the bill when it comes back from committee. Sargent says it will be difficult for the letter's signatories to back away from their position now. He explains,

It will be much tougher for pro-choice Dems to cave and support the bill with Stupak than it was for House progressives to cave and back the bill despite its lack of a robust public option.

Here's why: Because the public option had initially been written off for dead, the version liberals did secure allowed them to claim they had won something. By contrast, Stupak is a significant step backward for advocates of abortion rights and women's health issues. So it will be much tougher for pro-choice House Dems to back a final bill with Stupak in the end.

According to Stephanie Condon of CBS, Pelosi can only afford to lose 40 Democratic votes if she wants the health-care bill to pass, so the 41 signatories to the letter constitute a serious threat. Will that threat be enough to convince the conference committee to soften its line on abortion? Will the 41 Democrats actually kill a healthcare reform bill that would — again, as Latoya pointed out — do many good things, if it fails in this one key area? If Stupak stays in, and the Dems cave, would Obama even sign a bill with such severe abortion restrictions? White House Press Secretary Robert Gibbs was vague on this point, saying only that "I am not going to become a negotiator on Capitol Hill from the podium" and "We will wait to see what health care reform brings." His failure to denounce the amendment does make it seem like Obama might compromise on abortion to push healthcare reform through. The fate of the final bill is still so uncertain, however, that it's hard to begin the upsetting calculus of whether the compromise would be worth it. Only one thing's for sure — as Sargent says, "This will intensify."

Obtained: In Letter To Pelosi, 41 House Dems Pledge To Vote Against Bill With Anti-Abortion Amendment [The Plum Line]
Wasserman-Schultz: We Will Kill Stupak Amendment [The Plum Line]
Health Care Progress Report: November 9 [CBS]
White House Not Opposing Stupak Amendment [Politico]

Earlier: Reproductive Rights Left Behind After Health Care Bill Passes House

Reports the Times:

[Wann's] has been an oft-repeated message this summer and fall by members of the "fat pride" community, given that the nation is in the midst of a debate about health care. That debate has, sometimes awkwardly, focused its attention on the growing population of overweight and obese Americans with unambiguous overtones: fat people should lose weight, for the good of us all.

Heavier Americans are pushing back now with newfound vigor in the policy debate, lobbying legislators and trying to move public opinion to recognize their point of view: that thin does not necessarily equal fit, and that people can be healthy at any size.

It's kind of thrilling that the concept of HAES (Health at Every Size) actually got covered in the New York Times. However, much of the article revolves around the basic arguments for and against fat acceptance, and only devotes a slim paragraph to some of the political ramifications involved with these types of size based mandates:

Extra weight brings with it an increased risk of chronic disease, medical experts say, and heavier people tend to have medical costs that are substantially higher than their leaner counterparts. As a result, Congress is considering proposals in the effort to overhaul health care that would make it easier for employers to use financial rewards or penalties to promote healthy behavior by employees, like weight loss.

That says clusterfuck all over it. So now my employer gets to help police my weight? Nice. I mean, it would be cool to have my gym memberships and yoga class passes comped, but I'm not sure how they would measure progress. Are they going to start calling studios to see if I attended class twice that week? Or tie my performance evaluation or benefits package to the number on the scale?

Japan started a nationwide health program back in 2008, with the dramatic imposition of government recommended limits on weight:

Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.

Those exceeding government limits - 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks - and having a weight-related ailment will be given dieting guidance if after three months they do not lose weight. If necessary, those people will be steered toward further re-education after six more months.

To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. The country's Ministry of Health argues that the campaign will keep the spread of diseases like diabetes and strokes in check.

Think about the ramifications of these ideas for a moment. I've already felt some of this personally, when my former insurer sent me a letter, notifying me that I was over the maximum acceptable BMI for my height and weight, and, as a result they were raising my premiums by $45 a month. They did all this before they consulted my primary care physician about my blood pressure (which is on the low end of normal), my exercise routine (adopted under recommendation of said physician) or asking for her prognosis (that I have a clean bill of health, and have always been on the higher end of the acceptable BMI.) When I sent letters about this, I was informed that they would reconsider after my weight levels dropped and I provided proof from my physician. Thinking of how this type of corporate/bureaucratic override of a doctor's assessment could be applied on a wider scale is frightening. Regardless of patients' actual health, they can be charged a higher premium for being over a pre-determined average. And if they can charge higher premiums for weight without any proof of impact on a patient's health, what's next?

Heavier Americans Push Back on Health Debate [NY Times]
Health at Every Size [Wikipedia]
Japan, Seeking Trim Waists, Measures Millions [NY Times]

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