Abortion's Role In the Health Care Debate

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.)

This expanded federal oversight and use of federal dollars raises several thorny issues: will plans offered through a federally regulated exchange be required to include covering abortion as a standard benefit, or will they be prohibited from offering abortion coverage? Will patients in a public plan or who buy private insurance with federal subsidies have coverage for abortion, or would they have to use their own funds so taxpayers won't feel they are subsidizing abortion? Will doctors and hospitals receiving federal dollars be required or prohibited from offering abortion? And will religious organizations and individuals—from Roman Catholic hospitals to employee health plans purchased by churches to a pro-life doctor—be able to opt out of paying for or facilitating an abortion?

Both abortion-rights advocates and abortion opponents claim they are not seeking changes to the status quo. President Obama promised those who had coverage they likely would not lose it under a reform package, so abortion-rights groups claim coverage for abortion should continue to be widely available. The other side points out that federal dollars only cover abortion in limited circumstances, and they believe new federal health-care dollars should not cover abortion beyond Medicaid's restrictions.

The health-care-reform plan President Clinton put forward in 1993 did specify that services for pregnant women would be covered, which was meant to include abortion without spelling it out. The legislation also included a so-called "conscience clause" to allow doctors to opt out of performing the procedure, provided they referred patients to another provider.

Unlike the Clinton plan, the two versions of a reform bill currently on the table—one from the House and another from the Senate's Health Committee—do not list covered benefits, and that could make it easier to finesse the abortion issue. They leave coverage decisions up to an independent commission or the Department of Health and Human Services. On the other hand, this could increase pressure from pro-life groups because they believe, according to Tony Perkins of the pro-life Family Research Council, that "if a specific prohibition [on covering abortion] is not included in the health-care plan, then abortion is in this plan." While such a provision might win support from Republicans and pro-life Democrats, a survey by the National Women's Law Center found ruling out coverage for abortion and other family-planning services would be opposed by 62 percent of Americans.

Sources involved in drafting President Clinton's reform package in 1993—who were speaking on background because they currently hold politically sensitive jobs—implied they would have considered themselves lucky if abortion had been the factor that derailed their effort instead of popular revolt over the plan's very structure. "We were worried abortion would blow thing up," one said, "but we cratered before that could happen."

With Congress closer to a reform package than ever before, there's a chance lawmakers may get the chance to test how explosive these abortion questions will be. But if they get stuck tangling over an issue that the Republican negotiator says is "not compromisable," these summer's negotiations are going to be even longer than was feared.