The dispute over abortion financing in the health care reform bills has been a sticking point since the very beginning of the legislative debate, and as this long drama finally approaches its denouement, the question of abortion financing once again appears to be the deal breaker -- or game changer.
So far, pro-life forces have largely carried the day, arguing with conviction that the Senate bill -- which will be the version of health care reform that will be adopted if the reconciliation process works -- amounts to a huge, multibillion-dollar taxpayer subsidy for abortion. The House version, they say, would be preferable, though that bill cannot get past a promised Republican filibuster in the Senate and so has been rendered moot.
A close reading of the two bills, however, informed by analyses from a range of experts, reveals that the pro-life claims about the Senate bill and its abortion financing provisions are, in fact, mistaken. Indeed, the Senate bill is in some respects arguably stronger in barring abortion financing and in promoting abortion reduction.
Speaker Nancy Pelosi, echoed by President Obama, has forcefully and repeatedly asserted that the legislation provides no federal financing of abortion. But she and her allies have largely been drowned out by even more forceful, and often exaggerated, claims by pro-lifers that the Senate bill would be "the single greatest expansion of abortion since the 1973 Roe v. Wade decision," as Charmaine Yoest, head of Americans United for Life, put it in a recent Wall Street Journal essay
The question of which view is correct is no small matter. Democratic Rep. Bart Stupak of Michigan, the author of language in the House bill that bars any taxpayer financing for abortion, has said he and at least a dozen fellow pro-life Democrats will vote against the Senate version because he says funding language in that bill inserted by Democratic Sen. Ben Nelson of Nebraska, also an abortion opponent, does not go as far as his amendment and would force taxpayers to underwrite abortions.
Without Stupak and his allies on board there are serious questions as to whether Pelosi can wrangle the 216 votes necessary for passage. Stupak, a Roman Catholic, has formulated his position in close consultation with officials of the Catholic bishops conference, which is a major force in opposing the Senate bill because of the Nelson amendment.
The evident sincerity and periodic stridency (not to mention the obvious manipulations) of claims about the Senate bill's abortion-related provisions have, however, obscured many of the facts of the matter.
What follows is an analysis of each disputed point:
Perhaps the most eye-catching claim by anti-abortion forces
is that upwards of $7 billion designated in the Senate bill ($11 billion in the president's amended version) would be funneled directly to Community Health Centers (CHCs) which, as Yoest wrote, "include Planned Parenthood clinics that provide abortions." The National Right to Life Committee (NRLC) has made the same point, arguing that
"There is no restriction in the current laws authorizing CHCs that prevents these centers from performing abortions."
This meme has become the unchallenged talking point for pro-life opponents of the health care reform bill. But it is mistaken on several points.
Most obviously, none of the 1,250 Federally Qualified Health Centers, or FQHCs, that would receive the billions in money through the reform bill offer abortion services. These federally regulated community health care centers were started as part of the War on Poverty in the 1960s to provide primary and preventative care to poor communities across the country. The Senate health care bill would provide money to allow them to serve an estimated 15 million more people who do not have adequate health care.
As the National Association of Community Health Centers
said in a statement this week, none of the health centers receiving money under the Senate bill "provide abortions to any of their patients, and we are not aware of any that have ever done so." In addition, the statement said that "Health centers do not plan to, nor are they seeking to, become providers of abortion. On the contrary, last year health centers provided prenatal, perinatal, and post-natal/post-partum care to 1 of every 8 children born in the U.S."
The federal Department of Health and Human Services (HHS) has also said that none of the health centers are abortion providers, and none of them are operated by Planned Parenthood.
Moreover, it is unlikely that Planned Parenthood or any other provider of reproductive health services could qualify as a Community Health Center because these centers by law have to provide all-around care for both men and women, and for children -- "from an earache and runny nose to high blood pressure and diabetes," Dan Hawkins, policy director of the National Association of Community Health Centers, told me. "It is acute and chronic care." Planned Parenthood clinics and the like are simply not equipped to do that. Besides, a majority of the board of each Community Health Center must be made up of current or registered patients, a standard no abortion clinic could meet.
And contrary to claims by many pro-life groups, any money from a new health care law would be subject to the same Hyde amendment restrictions as money from the Stupak version of the House bill (which allocates $12 billion to community health centers).
The Hyde amendment has been attached to HHS appropriations each year for three decades to ensure that any taxpayer money HHS disburses will not go to paying for abortions except in cases of rape, incest or a threat to the life of the mother. The language in the Senate bill is not as explicit as the House bill about the path of the money, but the health care center money can only go through HHS and thus must be subject to Hyde restrictions.
"The Senate bill...provides that this funding is to be transferred to HHS accounts to increase funding for community health centers and does not provide for segregating these funds," said Timothy Stoltzfus Jost, a law professor at Washington and Lee University and a top health care expert who has done an extensive analysis
of the abortion financing question. "Since all other HHS funding, including expenditures from trust funds, is subject to the Hyde Amendment, these funds cannot be used to pay for abortions."
One final point: These Community Health Centers currently receive $2.2 billion in federal money annually and have nearly doubled in number since 2000, from 650 to 1,250 today. Most of that growth came under President George W. Bush, who in 2001 launched the Health Center Growth Initiative. The centers, and the billions they receive each year, have never before been subjected to pro-life scrutiny or criticism.
"There's no question in my mind that he [Bush] was both fervently and faithfully pro-life, and I can't believe he would have both called for that growth and then held faithful to it during the eight years of his presidency if he thought for a minute that any of it was going to provide abortions," Hawkins said. "Anybody who claims that health centers could perform abortions or could fund abortion mills or anything like that really doesn't know much of anything about community health centers."
But does the Senate reform bill finance abortion insurance coverage?
The answer is no, and it is there in the bill, on page 2072: "If a qualified plan provides [abortion] coverage...the issuer of the plan shall not use any amount attributable to [health reform's government-funding mechanisms] for purposes of paying for such services." As Slate's
Timothy Noah put it, "That seems pretty straightforward. No government funding for abortions."
What concerns critics is the different ways the House and Senate bills go about barring taxpayer financing of abortion coverage.
Both bills would create health insurance exchanges, basically a new marketplace for small businesses and individuals to buy affordable coverage with government subsidies if necessary. But the House bill with the Stupak language stipulates that women who want abortion coverage and a government subsidized health plan must buy a separate rider for the abortion coverage. The Senate bill with the Nelson language says an insurance plan in the exchange can offer abortion coverage, but a woman who wants it must pay for that element of the coverage by a separate check that goes into a separate account.
As Jost writes: "Concern has been expressed that plans might use accounting practices that, despite this oversight, allow them to subsidize abortion coverage from federal funds, but if they want to do this for some reason, they could also do it under the House bill. Requiring a separate abortion policy rather than a separate premium is an administrative technicality. It merely requires one more piece of paper."
(In every exchange there must always be at least one plan that does not offer abortion coverage so those with moral objections, or the vast majority of Americans who are not women of child-bearing age, do not have to pay for abortion coverage they won't use, or to effectively subsidize someone else's abortion coverage. Health care economists expect such abortion-free plans will predominate because they are the most attractive to most customers.)
Isn't there a compulsory "abortion tax"
in the Senate plan for all who get subsidized coverage in the exchanges? No -- even though many critics, including Stupak himself, have alleged that there is such a mandatory fee. ABC's Jonathan Karl recently debunked
this claim, though it still makes the rounds. The reality is only those who elect to choose a policy that includes abortion would have to pay the separate fee, and that is designed to keep federal dollars from potentially paying for abortions.
Other frequently heard objections
to the Senate bill are that it does not preserve conscience protections for individuals or health care institutions (such as Catholic hospitals) that oppose providing abortions, but even the Catholic bishops acknowledge that charge is not true and those protections are the same as they always have been, and are equal in both the House and Senate versions.
In addition, the Senate bill includes a number of provisions pleasing to pro-lifers that the House bill does not.
For example, it includes key elements of the Pregnant Women's Support Act that have long been sought by abortion foes: One is to appropriate $250 million over 10 years to create a federal Pregnancy Assistance Fund, which will provide assistance to pregnant and parenting teenagers and college students, as well as pregnant victims of domestic violence; another Senate provision not in the House bill would increase federal financing for adoption by $1.2 billion over the next two years.
The Senate bill also explicitly allows states to bar any policies in the federally created insurance exchanges from providing abortion coverage. So Utah or Mississippi or any other state could simply pass a law barring all plans in the exchanges from covering abortion. The House bill does not allow states to do that.
So the final verdict is that the Senate health care reform bill
does not pay for or promote abortion, and it will arguably reduce abortions as well as providing good, affordable health care to millions of women and children who now go without -- and suffer for it.
"The bottom line is that health care reform is pro-life," Jost said. "We're going to save an awful lot of lives with this bill ... I identify as a Christian, strongly, and I identify as someone who believes in the sacredness of life. I just think this is a pro-life bill. I'm really discouraged that people not only don't want it but also are spreading erroneous information about it. Because I don't think that's something that Christians should do."
Whether Jost's view, and the true story of the Senate bill's approach to abortion and health coverage, can shift the debate before the looming deadline for congressional action is one aspect of this argument that can't be decided by consulting a text. Those who have laid down a marker against the Senate bill have a lot invested in seeing it fail, or having it changed, if only to save face given all they have invested in portraying the bill as "pro-abortion."
Still, movement is possible. Bart Stupak has signaled in recent days that there may be some progress toward finding a way to tweak the Senate language so that he and his allies can get on board. Some suggest he could be won over simply by making some of the prohibitions in the Senate bill more explicit -- which would be a small price to pay for Democrats who want to claim a major legislative victory.