Dropping the ‘A’ Bomb

When asked whether compromise was possible on hard health-reform issues like the creation of a public health insurance plan, the lead Republican negotiator, Sen. Charles Grassley of Iowa, has long been optimistic that common ground can be found. "I take a view that there is almost anything compromisable in public affairs," he said in March, adding the counterexample he often employs for rhetorical effect when discussing difficult negotiations: "Abortion is about the only issue I know of that's not compromisable." With negotiations between Grassley and Senate Finance Committee Chairman Max Baucus, the Montana Democrat, seemingly deadlocked over the fundamental structure and financing of reform, NEWSWEEK has learned that Grassley has also been pushing for the inclusion of measures that would prevent reform from leading to "taxpayer-subsidized abortion."

"Senator Grassley is opposed to mandating abortion coverage in health-care legislation," said Jill Kozeny, the spokesperson for this staunchly pro-life lawmaker. Groups supporting abortion rights—including NARAL Pro-Choice America and Raising Women's Voices—mobilized earlier this month because negotiations on the subject between Grassley and Baucus had intensified. Grassley's office appeared to confirm fears among some abortion-rights advocates that Baucus was weighing at least some concessions on abortion coverage, adding, "At one point during the recent negotiations, there was a [compromise] solution that didn't work out."

Senator Baucus's office would not comment, citing "longstanding Finance Committee policy not to discuss the specifics of ongoing negotiations." But in e-mail messages, his press secretary, Erin Shields, noted Baucus has a 100 percent approval rating from NARAL and stressed, "He has always fought for a woman's right to choose and will continue to do so."

Abortion policy has not been discussed much during the health-reform process—though a group of 19 pro-life Democrats recently sent a public missive to House Speaker Nancy Pelosi insisting a "government-defined or subsidized health insurance plan should not be used to fund abortion." The issue has been far overshadowed by the political disputes over the fundamental questions of how to structure and pay for overhauling our health-care system. Though Baucus's office insists any differences on abortion coverage will be worked out, the issue is a volatile one and, if not handled carefully, could be yet another stumbling block for reform.

Though usually publicly debated in the language of personal liberty and morality, abortion is a medical procedure performed by a doctor. It's currently covered by most private insurance plans and existing government programs, at least under some circumstances. According to a 2002 study by the Guttmacher Institute, roughly 87 percent of employer-offered plans cover abortion, though five states only allow private insurers to offer coverage when a woman's life is in danger or in cases of rape or incest. Federal dollars in the program for low-income families, Medicaid, will cover abortion in cases of rape, incest, or when pregnancy is life-threatening for the mother but not in other situations, including when a mother's health is in danger or when a fetus is nonviable or grossly deformed. But Medicaid is partly funded by the states, too, 17 of which use state funds to provide expanded abortion services.

The plans under consideration in Congress would, speaking generally, create a marketplace—called an "exchange"—in which people and businesses could select coverage from several different plans offering standardized benefit packages, with subsidies for individuals who could not afford premiums. (There might also be a public plan competing with private insurers.)