Is Health Care Reform Covering Abortion or Not?

It's very hard to make sense of what's going on related to abortion and health care. Conservative pro-lifers claim the health care plan recently passed by the House Energy and Commerce Committee would increase the government's support for abortion. "They wont pay for my surgery but we're forced to pay for abortions," says a frightened senior in a new Family Research Council Ad. Pro-choice people look at the exact same legislation and say, no, it just preserves the status quo.

Here's my best whack at figuring this out.

The current legal reality is this: the government is now not allowed to pay directly for abortions, except in the cases of rape and incest, thanks to the Hyde Amendment (and its cousins).

It does, however, provide support for organizations that might do abortions. For instance, the government gives Planned Parenthood money to help promote family planning. By law, none of that money is allowed to go to abortion. But in an indirect way, it might help Planned Parenthood do abortions, since the family planning funds help sustain the organization.

In addition, though federal dollars aren't allowed to go to abortions, state governments are free to subsidize abortions. The Medicaid program, which provides health care for the poor, is financed by both the federal and state governments. So the federal government doesn't pay directly for Medicaid abortions but a "Medicaid recipient" might be able to get state-goverment-funded abortion if they happen to live in one of the states that provides the subsidy. Direct subsidies, no; indirect support, yes.

In theory, both pro choice and pro life groups have said they want health care reform to preserve the status quo.

The problem is that the new health care legislation introduces two new funding schemes. They can't preserve the status quo because some of these features don't currently exist.

One key component is the "public option." Under the House bill, people without insurance will have the option of buying a government plan. The government plan could cover abortion. ("Nothing in this Act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage"). Pro-choicers say that this neither-this-nor-that language is self-evidently neutral. Pro-life activists have argued that since it "could" be covered, it will be covered, a not unreasonable assumption given that, as written, it would be up to the Obama administration to make the determination.

The second key new feature is a health insurance subsidy. Congress would require everyone to have health insurance but provide assistance, in the form of tax credits, to people who don't have enough income. The House bill doesn't really subsidize plans, it subsidizes people. But the effect is that some people will get financial help from the government for health care, and then go and buy a plan that covers abortion.

In short...

On the health insurance subsidy, the pro-lifers have a weak case. Providing someone with a tax credit that they then use to buy a health insurance plan that covers abortion is not a direct subsidy of abortion, any more than it would be under Republican plans to subsidize health care through tax credits.

On the public plan, pro-lifers have a slightly stronger case. The house bill does not mandate taxpayer funded abortions, as the Family Research Council claims, but as written it does seem to leave the door open to that possibility down the road. Whether that becomes a direct subsidy or a paltry indirect subsidy would depend on how the program is structured. If consumers paid premiums that basically bore the whole cost of the insurance, it would be at most an indirect subsidy for abortion; if the government ends up charging unrealistically low premium levels, then they would, in effect, be providing a bigger subsidy for abortion (and every other type of health procedure).

I'm not arguing whether abortion should or shouldn't be in health care reform. But if one believes that health care reform ought to be "neutral" -- i.e. pretty much apply the terms of the current legislative stalemate -- then there's another way of doing it that makes things much less ambiguous.

Congress could decree that the basic public insurance option doesn't include abortion but then offer consumers the ability to buy, with their own money, a rider to the policy that would cover abortions. Then the full direct cost of abortion coverage would carried by the consumer who chooses it.