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Health-care reform and abortion services: the damage is already done to future coverage

Guest Blogger

Of the many contentious issues in the health care reform battle, abortion provisions ignite some of the hottest sparks. Carole Joffe, professor at the Bixby Center for Global Reproductive Health at the University of California, San Francisco, has followed the abortion debates for years. Whatever health care reform finally emerges, Joffe believes that access to an abortion in the United States will remain a complicated matter and that abortion services will not be normalized into the health care system any time soon. In her latest book, "Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us," Joffe explores the impediments to abortion care.

By Carole Joffe

As the health reform bill nears a pivotal vote in the House, abortion remains at the center of this long running drama. Will Rep. Bart Stupak (D-Mich.) find enough anti-abortion allies to derail the measure because the Senate bill allegedly does not contain as strong anti-abortion language as the congressman was able to insert in the original House measure?

The health reform process wasn’t supposed to go this way.

Recognizing the explosive nature of the abortion issue, President Obama and abortion rights Democrats continually said, “This is a health care bill, not an abortion bill.” Early in the process, Rep. Lois Capps (D-Calif.), a staunch supporter of abortion rights, put forward an amendment that stipulated that any health care bill should be “abortion neutral” -- neither increasing or decreasing the coverage Americans now get from private insurance plans, and not challenging the longstanding Hyde amendment which states that no federal funds can be used for abortion, except under very limited circumstances.

This amendment did not satisfy pro-life forces, and the last few months have seen a battle between different camps within that movement as to whose restrictions on abortion go farther -- Stupak’s, which demands that women wanting abortion coverage purchase a separate rider? Or Nebraska’s Democratic Senator Ben Nelson’s, which permits abortion coverage if a woman writes two separate checks to her insurance company?

It is anyone’s guess, what will happen. The bill may be defeated by opponents of abortion. It may squeak through. House Democrats who support abortion are dismayed by the abortion provisions but are not willing to let the entire bill fall.

One thing is clear, however: damage has already been done to future insurance coverage of abortion. An analysis by a leading health policy scholar concludes that many insurance plans -- which now mostly do cover abortion -- will cease to do so, because of the cumbersome requirements involved in both the Senate and House bills.

With an eye toward being attractive to as many markets as possible, some of these companies will drop abortion coverage, even if health reform does not pass at this point.

But the probable impact of health care reform politics on the insurance market is only one of a host of factors that make abortion care in the United States a remarkably complicated affair in many locations

As I was researching a book on the contemporary abortion wars, the words, from a Woody Guthrie ballad about the Great Depression, “Some will rob you with a six gun, some with a fountain pen,” frequently ran through my mind. Nothing of course is worse than the violence that periodically strikes the world of abortion provision (eight members of this community have been murdered since 1993, most recently, Dr. George Tiller of Kansas in May 2009).

But such incidents, thankfully, happen only occasionally. Yet every day those who perform abortions and those women who seek them have to deal with a host of cumbersome laws and regulations that make abortion care seem like running an endless obstacle course.

That abortion was not going to be easily normalized into the American health care system as a routine part of women’s reproductive health (as it is in many European countries) became clear almost immediately after the Roe v Wade decision in 1973. A politically powerful Right to Life movement emerged in response to this decision, and one of its first and most significant legislative victories was the passage of the Hyde amendment.

State legislatures eventually began to pass numerous laws attempting to regulate abortion provisions in various ways (over 800 such laws were introduced in 2009 alone). Among these: waiting periods of 24 or 48 hours, parental consent and notification measures, onerous reporting requirements (a recently passed Oklahoma law demands providers fill out a 37-item questionnaire on each patient), and most egregious, in my view, mandated informed consent requirements in 23 states which involve blatant mistruths about the alleged health risks of abortion, such as breast cancer, mental illness and future infertility.

How has this massive regulation of abortion affected women seeking the procedure? Here’s what we know. Regarding the Hyde amendment, a recent report from the Guttmacher Institute concluded that “approximately one-fourth of women who would obtain a Medicaid -funded abortion if given the option are instead forced to carry their pregnancy to term...”.

We also know that the number of abortion providing facilities in the United States fell from a high of 2,908 in 1982 to a low of 1,787 in 2005 (the most recent year for which data is available). We can reasonably assume that this dramatic drop is due in great part to the difficulties many clinics had in conforming to the numerous regulations mentioned above.

We know that the numbers of abortion performed in the United States have also seen a dramatic decline, from a high of 1.6 million in 1990 to 1.2 in 2005. What we don’t know is how much of this decline to attribute to improved contraceptive use, to changing cultural attitudes about abortion, or to the difficulties faced by the most vulnerable women in actually getting to a facility and affording the procedure.

Similarly, we can only speculate about how many women are kept from seeking the abortion they want because of legitimate fears of being “outed” by protesters who show up at clinics with video cameras or unfounded, but still terrifying, fears because of the misinformation they may have received from anti-abortion propaganda, including the information that providers in some states are legally bound to give.

That abortion care continues to take place in such a highly polarized environment as the contemporary United States is a testament both to women’s determination to control their fertility, and to providers’ willingness to endure conditions found no where else in health care.

By Steven E. Levingston  |  March 16, 2010; 5:30 AM ET
Categories:  Guest Blogger  | Tags: health care reform and abortion; abortion rights; abortion debate in health care bill  
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Posted by: siankirsten | March 16, 2010 5:39 AM | Report abuse

Will you call a Democrat today and help us preserve our country and our futures? I am calling - but I need help!

5 Democrats who voted yes in November that are in the pro-life Stupak bloc:

Bart Stupak

Marion Berry

Dan Lipinski

Kathy Dahlkemper

Joe Donnelly

17 potential Democratic No-Yes flip votes:

6 lean yes:

Jason Altmire
202-225- 2565

Bart Gordon

Brian Baird

John Boccieri

Scott Murphy

Betsy Markey

7 possible:

Glenn Nye

John Tanner

Suzanne Kosmas

John Adler
202-225- 4765

Lincoln Davis
202-225- 6831

Jim Matheson

Harry Teague

4 less possible:

Travis Childers

John Barrow

Allen Boyd

Rick Boucher

20 potential Yes-No flip votes:

5 possible members of the Stupak bloc (Stupak-curious):

Steve Driehaus (Obama is attending an event in Ohio for Driehaus on Monday, March 15)

Brad Ellsworth

Marcy Kaptur

Jerry Costello

Henry Cuellar

15 other wary Democrats:

Mike Arcuri

Zack Space

Chris Carney

Mike Doyle

Paul Kanjorski

Ann Kirkpatrick

Alan Mollohan

Nick Rahall

Dan Maffei

Bill Owens

Baron Hill

Solomon Ortiz

Gabrielle Giffords

Earl Pomeroy

Tim Bishop

Posted by: easttxisfreaky | March 16, 2010 10:36 AM | Report abuse


This is absolutely false. Since an abortion expert like Joffe must know better, I can only presume she is deliberately being misleading. Many European countries have much more restrictive policies regarding abortions than the U.S. Many prohibit 2nd trimester abortion except for health reasons. If the supposition is that Europe is more "civilized" regarding abortion, then perhaps it is worth considering why it generally follows a much more restrictive policy on abortion at or near fetal viability. Our abortion on demand culture is a barbarity in comparison. You would be arrested animal abuse if you treated a dog the way we treat sensate human fetuses.

Posted by: kclairch | March 16, 2010 10:52 AM | Report abuse

If Congressman Slupak's intention is to advance the Pro-Life agenda he can do it be opposing any legislation at all that does not include his anti-abortion amendment. His tactics are merely an extension of the Nebraska Senator's selling his vote.

Posted by: llnstoner | March 16, 2010 10:54 AM | Report abuse

Sorry, Joffe's quote got lopped off. Here it is:

Posted by: kclairch | March 16, 2010 10:54 AM | Report abuse

OK, here it is again:

That abortion was not going to be easily normalized into the American health care system as a routine part of women’s reproductive health (as it is in many European countries)

Posted by: kclairch | March 16, 2010 10:54 AM | Report abuse

I am sick of republicans ,I will never vote for them again .
They are so crazy people .The health care reform bill now is similar to their bill back in 1993 ,so why they oppose It ???
according to Republican party Sarah Palin is the smartest one in group and here is what She said " We used to hustle on over the border for health care ....and I think,isn't that kind of ironic now ? " She admitting that her family used to go to Canada for medical treatment when she was a child , Canada has a single -payer system , which Palin oppose ! (Too bad for Canadian tax payers )
Limbaugh the second smart one in the group also said " I'll just tell you this, if this passes and it's five years from now and all that stuff gets implemented -- I am leaving the country. I'll go to Costa Rica." .well too bad ,Costa Rica has had health care for all in 60 years already.( should Costa Rica taxpayers cover health care for this mad man ? )
Republicans :
Don't You learn any thing from housing crisis ? like housing cost in the past ,health care cost is out of control .the next crisis will be health care crisis if health care reform failed ,millions of people may die .
please forget about Republicans ,pass health care reform NOW.

Posted by: reformss | March 16, 2010 2:21 PM | Report abuse

Pro-Life is pretty compelling if YOU ARE the infant. It's easy for some to right off the innocent lives of others, but consider that each of us born into this nation passed a 20% chance of being aborted.

That's right, that's a 20% chance of dying right out the gate. Add that to the infant mortality statistics and you'll find we come in somewhere behind Botswana in infant mortality (although for different reasons).

Posted by: RealTexan1 | March 16, 2010 4:01 PM | Report abuse

I hate to tell you folks this, but I work in a medical laboratory where I see dead fetuses all the time. They weren't aborted, they just died. Most of them don't have anything obviously wrong with them. If your God likes fetuses so much he has a funny way of showing it. In fact, he would have to be the biggest abortionist of all. It gets even worse when they aren't normal, things that you are glad were never born. Just a little joke, I suppose. Hope I didn't offend anybody, but this is a fact.

Posted by: DaveHarris | March 16, 2010 4:42 PM | Report abuse

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