On abortion in health-care reform, pro-lifers make two big mistakes
My colleague Michael Gerson thinks I’ve got it wrong on the differences between the House and Senate when it comes to attempting to make certain that federal funding does not go to subsidize abortions. For the record, I don’t think that this issue is “a trivial mix-up.” I think the differences between the two measures are trivial, both on paper and in practice.
As I’ve written previously, while I am firmly pro-choice, I am "respectful of the convictions of those who disagree. And, consequently, sympathetic to the notion that taxpayers should not have to pay for a procedure they believe is tantamount to murder." I think both the House and Senate language go too far in attempting to protect these convictions, but that would not prevent me from voting for them. Gerson has no basis for saying that I hope the principle that federal funds should not be used to subsidize abortion “will be casually abandoned in the confusion of health reform.” I simply believe that those who hold this principle are, first, making a mistake in balancing the equities of health reform (the undeniable benefits it would bring to the uninsured versus the risk of having federal funds end up subsidizing abortions) and, second, misreading the legislative language.
Gerson says, correctly, that federal law currently prohibits the use of federal funds to pay directly for abortions in most circumstances (the Hyde amendment) and that the federal health benefits plan (of which I happen to be a member) does not include abortion coverage. But the federal government subsidizes every federal employee (and family members) who obtain insurance through the federal employee health benefits plan. The insurance exchanges to be set up under the health-care bill would pose a more complicated situation because some people purchasing insurance on the exchanges would be spending entirely their own money. Most, however, would receive some degree of government subsidy. The House bill deals with this situation by requiring people who participate in the exchanges and want abortion coverage to purchase a separate policy. The Senate bill deals with it by requiring people who want abortion coverage to write a separate check and by requiring the insurance companies that offer such coverage to maintain strict separation of the funds between the two accounts.
Gerson considers this an enormous difference. He asserts that there will be “massive public subsidies to health-insurance plans that cover abortion” but does not mention any requirement for separate accounting. Quoting an analysis by the Catholic bishops, he says their “main objection to the Senate bill” is that:
Under the Senate bill, all but one plan in each exchange may cover abortion. Therefore many families will be forced to choose between a plan that best meets their health needs, and one that respects their conscience on abortion. The government, far from helping to protect them from this terrible dilemma, will make it worse by (a) providing federal subsidies for the plans that impose this on people, and (b) requiring any plan that covers these abortions to collect a regular extra payment, solely and specifically for elective abortions, from every enrollee in the plan regardless of their conscientious objection.
I don’t think that families should be forced into “this terrible dilemma.” I also seriously doubt that they will be. The more likely result of the cumbersome Senate restrictions will be that no plans in the exchanges will include abortion coverage. Insurers who for some reason want to offer plans that include abortion coverage could easily offer identical plans that don’t. Indeed, they would have every incentive to. They won’t make money by giving people who oppose abortions reason to choose a competing plan.
As for the likely effect of health reform on the number of abortions, my former Post colleague T.R. Reid made this argument far better than I could.
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