If there’s an issue big enough to stall health-care reform, surely it’s abortion policy. Unlike other obstacles to reform (distrust of big government, new taxes, or anything that looks vaguely European), the abortion debate, like the debate over health care itself, involves fundamental questions of justice. What are our obligations to two vulnerable groups, the sick and the unborn? And what do we do when these obligations seem to conflict?
Unfortunately, much prolife opposition to health-care reform has never gotten past its own rhetoric to a careful examination of policy. Some prolifers suggest that a prochoice president must be trying to use health-care reform to increase funding for abortion—no matter what he or the legislation says. Better, therefore, to try to kill his proposals, just to be safe. This is single-issue politics with a vengeance, and without excuse.
It is not the politics of the United States Conference of Catholic Bishops, which has been among the strongest supporters of health-care reform for decades. The conference seems to recognize that both the House and the Senate bills, now being reconciled by members of Congress and the administration, would improve the country’s health-care system in several important ways.
To begin with, both bills would provide coverage to millions of uninsured Americans (by giving employers new incentives to insure their workers, by subsidizing individual policies for those who lack employer-based insurance, and by expanding Medicaid). The bills would prevent insurance companies from denying coverage to people with “preexisting conditions,” and from canceling the insurance of those who require expensive treatment. Although the House bill’s public option is probably doomed, both bills would tightly regulate private health insurance, and treat the companies that sell it more like public utilities than purveyors of a consumer good. Serious defects in our country’s legislative process (above all, the impossibility of the Senate’s doing anything useful without a supermajority) have weakened the legislation considerably, but it nevertheless remains what President Barack Obama recently called it: “the most important reform of our health-care system since Medicare passed in the 1960s.”
Despite all this, statements from the bishops’ conference have expressed serious reservations about the legislation. The conference points out that it would exclude noncitizens from programs like Medicaid, while preventing undocumented immigrants from buying health insurance with their own money. The bishops are right to lament this meanness, but they should also acknowledge that most immigrants will probably be better off with this legislation than they have been without it. Thanks to Senator Bernie Sanders (I-Vt.), the Senate bill increases funding for community health clinics throughout the country, so that at least some of those who lack access to insurance will not also lack access to basic care.
That leaves abortion. The bishops’ conference has endorsed the House bill’s Stupak Amendment—which keeps federal money from being used to subsidize any health plan that covers abortion—and rejected the compromise in the Senate bill, which would allow the government to subsidize insurance policies that cover abortion without allowing it to subsidize abortion coverage itself. Policyholders who get help from the federal government would have to pay a separate, unsubsidized premium for the part of their insurance that covers abortion.
Critics call the Senate bill’s two-payment system an accounting trick; they insist all the money, no matter what pocket it comes from, will eventually get mixed up in the same big corporate coffers. But it is the critics who seem to be mixed up on this point. According to the Senate bill, the separate premium for abortion coverage must go to an account used exclusively to pay for abortions, while the main premium, along with whatever subsidy a policyholder may receive, must go to another account that is used exclusively to pay for services other than abortion. The bookkeeping may be tricky, but it is not a trick. What’s more, the Senate bill, unlike the Stupak Amendment, allows states to keep plans that cover abortion off their health-insurance exchanges. It also requires that states make available at least one plan that does not cover abortion, and stipulates that abortion coverage may not make any plan cheaper than it would be otherwise. Taken together, these measures should ensure that no one will be forced to buy abortion coverage or to pay federal taxes that subsidize it.
In fact, the longer one looks at the Stupak Amendment and the Senate compromise, the less different they seem. Insofar as there is a difference, the Stupak Amendment may be better—it’s certainly clearer and simpler. But the difference is technical, not moral. It should not keep Catholics who are both prolife and pro-reform from supporting this important legislation.