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Health Care Reform and Abortion in the Times

A good story in today's NY Times laying out the various options on how to treat abortion in the health care reform plan. Here's a taste, but go read the whole thing:

At least 31 House Democrats have signed various recent letters to the House speaker, Nancy Pelosi, urging her to allow a vote on a measure to restrict use of the subsidies to pay for abortion, including 25 who joined more than 100 Republicans on a letter delivered Monday.Representative Bart Stupak of Michigan, a leading Democratic abortion opponent, said he had commitments from 40 Democrats to block the health care bill unless they have a chance to include the restrictions.After months of pushing the issue, Mr. Stupak said in an interview, Mr. Obama finally called him 10 days ago. He said: Look, try to get this thing worked out among the Democrats. We want you to work it out within the party, Mr. Stupak said, adding that Mr. Obama did not say whether he supported the segregated-money provision or a more sweeping restriction. We got his attention, which we never had before.After the president called, Mr. Stupak said, Ms. Pelosi agreed to meet with Mr. Stupak on Tuesday to discuss his proposals for the first time, her office confirmed. Her spokesman, Nadeam Elshami, said in a statement, As we have throughout the process, we are meeting with our members to listen to their concerns, consulting with the administration, and making progress.

Although I haven't looked at the actual language of his amendments, the Hatch/Stupak proposals sound very sensible as described in the story -- i.e., prohibit the use of federal subsidies to purchase policies that include abortion coverage, but allow women to purchase abortion "riders" on their own. Given the ideological tactical stance most Republicans have taken against health care reform in any shape or form (regardless of how abortion is treated), credit for more restrictions on the use of federal funds for abortion, if they become part of a successful bill, should go to the group of pro-life Democrats discussed in the story.

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This is Good news. That being said, I would rate the statement, "Given the ideological stance most Republicans have taken against health care reform in any shape or form (regardless of how abortion is treated) as somewhere between "pants on fire and a nose that is as long as a telephone wire".

I'll admit to poor word choice. There's nothing particularly "ideological" about most Republicans' opposition to health care reform. It appears to be a tactical choice to try to weaken Obama. I've changed the wording of the post to reflect that.

Indeed, I applaud the efforts of Hatch and Stupak. Pro-life Democrats are uniquely position to nudge policy in a pro-life direction, and I am happy to see they are taking advantage of it.Nancy,It wouldn't be a dotCommonweal post without a gratuitous swipe at Republicans or bishops who take a hard line on abortion. Best to ignore it and move on.

Eduardo, just remember, things are not always what they appear to be.

...without a gratuitous swipe at Republicans or bishops who take a hard line on abortion.Speaking of gratuitous swipes... Even as originally worded, the sentence Nancy objected to was directed at politicians who oppose health-care reform "regardless of how abortion is treated." I'm afraid this characterization doesn't fly.

I'd like to present an idea here so that it can be totally ignored on dotCommonweal as it has been on Vox-Nova.I must be typical of millions of people in that my company provides me with health insurance, though as the years go by, I am expected to contribute more and more of the cost (though still only a fraction). Abortion is covered in the policy. Am I (and millions like me) not contributing more directly toward paying for other people's abortions now than I would be if a government program is passed that grants low-income people a subsidy to purchase their own insurance policies, some of which may cover abortion?May a Catholic work for an insurance company that provides abortion coverage? May a Catholic buy an insurance policy from a company that sells policies that cover abortion? May a Catholic employer provide his employees with insurance that covers abortion? If these questions have ever been raised before, I am unaware of it.So I wonder how much of the debate over abortion coverage in health-care reform is just politics, rather than an honest attempt to define how Catholics must deal with the issue of abortion and insurance.

The way the Republicans have been behaving over health-care reform, it is difficult for any swipe at them to be gratuitous.

I find this sentence in the NYT story the most telling:"After the president called, Mr. Stupak said, Ms. Pelosi agreed to meet with Mr. Stupak on Tuesday to discuss his proposals for the first time, her office confirmed."It took a call from President Obama before (Catholic) Speaker Pelosi agreed to meet for the first time with a pro-life Democrat who had been pushing for months what seems like a sensible proposal? IMHO, that's sad.

Mollie, the sentence I objected to was, "Given the ideological "stance most Republicans have taken against health care reform in ANY SHAPE OR FORM (regardless of abortion)... because it is not grounded in truth to begin with.

The swipe was gratuitous because it had little relation to the subject of the post.It's like the period at the end of the sentence, part of the structure of any dotCommonweal post, and shouldn't be too closely examined or considered.

David,I have been very much interested in this question of Catholics paying for abortion through their health insurance plans which provide abortion coverage. Cardinal Rigali outspokeness with regard to his opposition to the Capps amendment (which set aside participant's premiums for abortion coverage so that it wasn't federal funds paying for it in a public option plan), clearly said that the Capps amendment was a lie because all the money is fungible. I have been wondering when the pro-life-concerned laity and the Church leadership were going to address Catholics paying for abortions through their private and/or employer plans. If roughly 80% of health insurance plans cover abortion, then roughly 80% of Catholics who have non-governmental health insurance are subsidizing abortions. That seems to me to be a very serious matter. Also, if the money set aside for a specific separate purpose is still fungible, then Cardinal Rigali is in effect saying that governmental funding of any Church-run institution's programs is funding the church. It's odd to me that many don't seem to see these two major contradictions. I wonder how a Catholic moralist would parse all of this.

Republicans aren't opposed to health care reform "in any shape or form." If we are to have a serious discussion of the issue, you at least have to accept that the other side has some position and that your way of looking at this issue isn't the only one.

John McG, here's my point: making claims like that seriously undermines your ability to accuse others of gratuitousness. Your judgment of relevance also seems a little wanting.

I can't help thinking that this unfairly disadvantages poor women.

Sean,It seems to me that the Republican Party in general is currently so "conservative" that they may have a position on health-care reform, but it is so unlike the Democratic plan that there is no room for compromise. How does a party that opposes Medicare compromise with Democrats on health-care reform?

Was mentioning the Republicans necessary to report this?Indeed, wouldn't a better direction for this post be to encourage us to support these pro-life Democratic Congressmen than to assign credit if the efforts are successful? Wouldn't it be better about talking about how best we can support these representatives than about whether the Republicans are Stupid and Evil or just plain Evil.--I'm over it. My whole point is it's not worth getting upset about. A better discussion will emerge if we just let the little swipes slide and address the heart of the post, which is indeed good news.

Hardly gratuitous, John. Of course it's relevant that, as yet, most Republicans seem unwilling to vote for health care reform in any form. It's because pro-life Democrats are willing to vote for the bills that they have bargaining power as to how those bills treat the issue of abortion. You can't bargain if you're not willing to give as good as you get. Republican obstructionism on health care, which appears to be based on pure political calculation that Obama's failure to deliver on health care will hurt him in 2010 and 2012, stands in the way of effective advocacy on issues like abortion insofar as they are implicated by the proposed reforms. Many Democrats appear to place a great deal of value on a "bipartisan" bill. If Republicans showed some willingness to bargain in good faith, on this issue and others, they could probably get quite a bit in exchange. If the bill is improved on the abortion front, it will be due to those who were willing to put party loyalty aside in the interest of issues of vital importance to Catholics (i.e., universal access to health care and the lives of the unborn). If you think that merely pointing this out is a gratuitous swipe, then I don't really know what wouldn't be.

The raison d'etre of the Republican party as currently structured is this. All else is frosting on the tainted cake -----As a matter of history, the bottom line of Conservatism with a capital C turned out to be not conservatism with a small c but preservation of wealth and inequality. With fierce international competition, conserving old ways is too costly to the maintenance of wealth. And with historical working class gains in place, small-c conservatism becomes a buffer against inequality. For the sake of protecting and extending the powers of wealth, big-C Conservatives regularly sacrifice the small c-conservatism that many of them genuinely cherish. They blather on about warm beer and old maids cycling to church and then they hand Wal-Mart the keys to the kingdom. They are thereby in tune with the propensity of capitalism, which is to maximize a certain kind of value, in sovereign disregard of the value of any things.http://politicaltheoryworkshop.googlepages.com/GACohenConservatism.pdf

"Of course its relevant that, as yet, most Republicans seem unwilling to vote for health care reform in any form. "Wyden-Bennett was said to have broad bipartisan support. Maybe the Democratic leaders aren't as interested in bipartisanship as we'd wish them to be."Republican obstructionism on health care, which appears to be based on pure political calculation that Obamas failure to deliver on health care will hurt him in 2010 and 2012"Sure, some of it is stick-it-to-the-opposition politics. And I hope you were equally outraged when Democratic obstructionism derailed President Bush's initiative to reform Social Security, another current entitlement that dovetails nicely with Catholic social teaching and that we soon won't be able to afford.Some of it is politics in the sense of party solidarity - something that Republicans always do better than Democrats.Some of it, too, is politics in the good sense - in the sense of of listening to constituents back home. And a good deal of it is principled opposition to the legislation being advanced through the process. It's entirely possible to want to reform health care and yet think that the cures currently on offer are worse than the disease.

"...credit for more restrictions on the use of federal funds for abortion, if they become part of a successful bill, should go to the group of pro-life Democrats discussed in the story."Are you being facetious? Why would someone who puts restrictions on the use of federal funds for abortion be deserving of credit? I am certain you are familiar with the writings of Ambassador Kmiec and other Catholic legal scholars employed by The Party so are you disagreeing with them?

John, I understand what you are saying. Eduardo, universal access to Health Care and the Lives of the Unborn are of vital importance to everyone, not just Catholics.

Democrats have got themselves in an interesting position.Having won the election, they now control the House, Senate, and the White House. They do not need Republican votes for this.However having pushed from their own left such economic measures that to most Americans smack of socialism, having pushed likewise (i.e. from their left) so hard to reform health care, and having basically called Republicans and others who disagree with them (at best) Neanderthals and (at worst) racists or Nazis, the Democrats are now beginning to realize that they will have to do this alone and will thus be held solely accountable for the results.It is a risk, and of course most politicians, regardless of party affiliation, do not like risks. If Democrats do things correctly, they will gain big time. If they foul it up, they will lose big time.If Democrats do not pass some version of health care reform, their left wing will be furious with their center. If they pass health care reform without Republican cover (the real politic meaning of bi-partisanship), the average American voter will hold Democrats fully responsible for the mess, and that sort of thing will dog the party for many years.Certainly Republican apparatchiks are delighted at all this. Any Democrat politico would be tickled silly if the Republicans had inadvertently worked themselves in a similar situation. Indeed that sort of thing is a relatively fun (at least interesting) part of the game of American politics.However as has correctly been pointed out here, the game of politics has its limits. There is a time and place for everything, and there always comes a point where we all need to seriously try to realize our Christian duty, pay attention to the better angels of our nature, and put the common good of the country first.While I am a moderate Republican and am not fond of socialistic projects, the fact of the matter is that two socialistic projects have turned out quite well; Social Security and Medicare. Moreover I accept that it is our Christian duty to provide medical care for all, and in fact, we at least try to do that now, but in a very inefficient and expensive manner. To me then, it seems mainly a matter of how we can best pay for universal health care. As a Catholic, the guidance of the US Catholic Bishops really helps clarify this for me. My main concerns are that we specifically exclude abortion and euthanasia from whatever plan we adopt, and that we include all people living here i.e., the (mostly Mexican) indocumentados (they have complicated situations and they work very hard in our land).To say the least, this will be interesting.

I must be typical of millions of people in that my company provides me with health insurance, though as the years go by, I am expected to contribute more and more of the cost (though still only a fraction). Abortion is covered in the policy.Really? What kinds of abortion? Health/life related? Abortions that do not involve a live baby, but that are removing the remains of a miscarriage (yes, doctors do call that an "abortion")? I ask because I've never heard of or seen an actual insurance policy that covered elective abortions. Is there such a thing? What are we even talking about when we talk about the possibility that a federal plan would somehow include "abortion" coverage . . . what types of abortions?

Without playing games with words or trying to make exceptions seem like the norm; unless one is trying to put the entire matter on its head, without diving into a discussion of how many aborted babies can dance on the head of a pin, it is safe to say that obviously, abortion is an elective procedure.I do not like speaking in such a bland technical manner about something so terrible, but because - sad as it is in our land today abortion is like a nose-job, facelift, hair transplants, or other types of cosmetic surgery; abortion is an elective surgery. As such, I imagine most insurance would probably not cover abortions. From both the financial and ethical standpoints, abortion is no more worthy of being covered under a health insurance plan than any other non-critical surgery.And so in addition to abortion being the moral outrage that it is, in fact a cold financial case can be made for not covering abortions under any medical insurance plan.

I ask because Ive never heard of or seen an actual insurance policy that covered elective abortions. Is there such a thing?Stuart,My health insurance, from UnitedHealthcare, covers elective abortions. The documents outlining benefits say so quite explicitly, using the words elective abortion. The figure I keep running into is that two-thirds of insurance companies provide coverage for elective abortions.

As such, I imagine most insurance would probably not cover abortions. Ken, You are apparently incorrect, although I am finding it difficult to cite an authoritative source. I have found a lot of things like this.

Q. Does insurance cover the cost of an abortion?A. Almost two-thirds of insurance companies cover elective abortion to some degree. Contact your insurance company to find out if you are covered.Q. Does military insurance cover the cost of an abortion?A. At this time, military health plans cover abortion only in cases of life endangerment.Q. Does Medicaid or other state-assisted health insurance cover the cost of an abortion?A. Medicaid is only required to cover abortion in cases of rape, incest, or life endangerment. However, some states do cover abortion as part of their Medicaid policies.

And so in addition to abortion being the moral outrage that it is, in fact a cold financial case can be made for not covering abortions under any medical insurance plan.One source I have found says that the average cost of having a baby is $6,378 for a normal delivery, $10,638 for a cesarean. Another source says low birthweight babies cost an average of about $16,000, and very low birthweight babies an average of $95,000. Now, I am not suggesting that insurance companies pay for elective abortions for this reason, but an abortion costing $350 to $500 is much, much cheaper than even the most uneventful delivery. So there is not a good economic case to be made against insurance companies paying for elective abortions. It saves them lots of money.

"So there is not a good economic case to be made against insurance companies paying for elective abortions. It saves them lots of money."You are focusing only on the expense and ignoring the other half of the equation which is income. The economics of it is based on the premiums collected from the policies in question as well as the opportunity cost of the future premiums both from the dependant and the parent. I don't know what the profitabiliy of it is, but just saying you cannot determine it from the cost alone.

Good point, MAT; in my personal experience, premiums for family coverage are usually a multiple (e.g. 2x, 3x) of individual coverage.

I don't know if anyone here is interested in how people who are pro-choice (like me) feel about all this stuff - perhaps I'm the only existing pro-choice Catholic on the planet - but if they were, I saw a post today that gives that pov ....http://community.feministing.com/2009/10/women-could-actually-lose-cove....

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About the Author

Eduardo Moisés Peñalver is the John P. Wilson Professor of Law at the University of Chicago Law School. He is the author of numerous books and articles on the subjects of property and land use law.