Catholic social teaching, as the U.S. Conference of Catholic Bishops has tirelessly reminded our elected officials, has long regarded access to decent health care to be a basic human right, not just the privilege of the wealthy or those lucky enough to be employed.

“It is a fundamental issue of human life and dignity,” Bishop William F. Murphy, chair of the bishops' Committee on Domestic Justice and Human Development, wrote to Congress in July. Murphy urged lawmakers to pass a health-care reform bill that extends medical coverage to all Americans, regardless of ability to pay. At the same time, Murphy reminded Congress that the church would oppose any bill that allowed taxpayer money to pay for abortions.

President Barack Obama has repeatedly promised that health-care reform will be “abortion neutral,” but as with many other aspects of the health-care effort, he has left the details up to Congress. Currently, the Hyde Amendment prohibits the use of federal money to pay for abortions, except in cases of rape or incest, or when the mother's life is in danger. Yet how this policy can be extended to private health-insurance plans that might receive government subsidies to cover those now uninsured, or to a government-run health plan (the so-called public option) in a nation where access to abortion is a constitutional right, is far from clear. Abortion opponents say they will not tolerate direct government subsidies to insurance plans that cover abortion. Much will depend on how the word “direct” is interpreted. (Millions of Americans, many of them prolife, currently “subsidize” abortion through the premiums they pay to private health-insurance companies that do cover the procedure.) At the same time, abortion-rights advocates will not support a bill that takes away coverage from those whose insurance now provides for the procedure.

This is a Gordian knot that cannot be cut without painstaking legislative and political work. Some measure of good will is needed from those on both sides of the conflict, for there is a larger good at stake here. It would be a great tragedy for the nation, and a calamity for the tens of millions of uninsured and inadequately insured Americans, if it proved impossible to bracket the abortion stalemate in order to bring basic medical services to all Americans. The details of any solution to the funding problem will be devilishly complicated, but one possible approach is to separate abortion coverage from the rest of a client's health-care package. Those who choose insurance that covers abortion would then pay for that component either out-of-pocket or—for low- and moderate-income persons—possibly through some sort of voucher system. The aim should be to keep the government from directly funding abortions it doesn't already fund.

Predictably, proposed amendments to the House's health-care reform bill dealing with abortion have been read in wildly different ways; and, truth be told, it is hard to know exactly what the language in those amendments might mean when interpreted by the courts and future administrations. But as Cardinal Justin Rigali noted in a letter to Congress last month, the Capps amendment, which narrowly passed in committee, does appear to leave room for direct government funding of abortion. As a consequence, a handful of bishops have begun to speak out against the entire health-care effort, claiming it is a Trojan horse designed to usher in federal funding of all elective abortions. That charge is hyperbole, and clearly not a view shared by the vast majority of bishops. Like the intemperate response of some bishops to the results of last year's election, the call to reject health-care reform owes more to the partisan logic of the GOP than to the bishops' legitimate concerns about abortion.

Any direct funding of abortion by the federal government would be a catastrophic political mistake. There is every reason to think Obama knows that, even if certain Democrats in Congress don't. Certainly, hard questions should be raised about all language regarding abortion in the health-care bill. But in a nation as deeply divided on the question as this one, no bill that is not “abortion neutral” will become law. If those on either side of this conflict insist on using health-care reform to further their own agenda—either to expand access to abortion or to further restrict it—they will not only damage the health of the nation as a whole, they will discredit their own cause as well.   

September 1, 2009

Related: The Editors, "Prolife, Yes, & Pro-reform"

The Editors, "What Now?"

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