A Pro-Life Victory?
Try this for a thought experiment: place yourself back in the heady months of the 2008 presidential campaign, a time when Catholics bitterly argued with one another about whether it was morally licit to vote for what some called “the most pro-abortion presidential candidate in history.”
Imagine that I had told you at the time that this (future) president and a strong Democratic majority in both houses of Congress would pass comprehensive health care reform legislation with the following features:
–Coverage for abortion would be specifically excluded from the standard package of benefits that all insurers would be required by law to offer.
–That existing restrictions on the use of federal funds appropriated via the HHS appropriations bill (a.k.a the Hyde Amendment) would be maintained.
–That the federal government, acting in its capacity as both a civilian and military employer, would continue to exclude abortion coverage from the policies it offers to its employees.
–That the new health exchanges would be required to offer at least one policy that did not cover abortion, something not available in the individual policy market in many places.
–That states would have the option of preventing insurers in their state from offering plans through the exchange that cover abortion.
–That federal premium subsidies could not be used to purchase insurance coverage for abortion.
–That while individuals purchasing coverage through the exchange would have the option to use their own funds to purchase abortion coverage, they would have to make a separate premium payment to do so.
–That all of these elements would not only be contained in the legislation, but would be reaffirmed by the President of the United States in a high profile executive order issued hours before the legislation’s passage.
I suspect that if I had laid this out as a likely scenario under a Democratic administration and Democratic Congress, I would have been laughed out of the room and seen as carrying water for the “Party of Death.”
By any reasonable standard, the pro-life movement ran the table this year. The pro-choice movement was soundly defeated on issue after issue. These folks had actually hoped at one point that health care reform would be a vehicle to expand health insurance coverage for abortion by including it in the standard package of benefits that all insurers would be required to offer.
Instead, the pro-choice movement is facing the likelihood of further erosion of insurance coverage for abortion, particularly in the individual market. First of all, I deem it likely that a number of states in the South, Midwest, and Inter-Mountain West will exercise their option to prevent insurers in their exchanges from offering abortion coverage.
Secondly, even in those states that do not exercise that option—and thus require at least one plan to provide abortion coverage—individuals will have the choice of forgoing that coverage. I suspect that people who see themselves at low-risk of needing abortion coverage will opt out. That kind of risk selection may raise the cost of the rider, discouraging buyers who may be on the fence about whether to opt in.
As an aside, I think this will play out differently in states with different social and political cultures. In states my like home state of California, where support for abortion rights runs strong, I expect some insurers to differentiate themselves by how easy and seamless they make it for women to obtain supplemental abortion coverage. They might even be willing to use it as a loss leader. (see comment below) I think this is much less likely in states like Missouri or Alabama.
On a more fundamental level, the pro-choice movement has suffered a significant philosophical defeat. Since its inception, the movement has argued that “abortion is health care,” i.e. that abortion is part of the spectrum of reproductive health care services and should not be treated any differently from other medical procedures.
The health care reform bill approved yesterday–which will shape the nation’s health care marketplace for decades to come–does not embrace this position. Abortion is treated differently from all other health care services. It is not considered part of the basic package and there are moderate obstacles placed in the path of obtaining coverage. To the extent that a key aim of the pro-choice movement has been to “normalize” the practice of abortion, yesterday’s bill must be considered a significant setback.
None of this would have happened without the leadership and tenacity of pro-life Democrats like Rep. Bart Stupak (D-MI) and Sen. Ben Nelson (D-NE). Pro-life Democrats have exercised more influence within the party over the past two years than they have in the previous twenty.
There is a risk, though, that the pro-life movement’s anger at the outcome of health care reform could lead it to actively oppose Democratic members who have historically been staunch allies. Punishing people who vote with you only 90 percent of the time is generally not the way to build a successful social movement.
In the end the question is simple: can the pro-life movement take “yes” for an answer?