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HC Reform: a Blessing in Disguise Print E-mail
By Peter Brown   
Thursday, 25 March 2010

Just how crushing a defeat was the passage of health reform for pro-lifers? Admittedly things look bad at first glance. We saw the effective circumvention of the Hyde Amendment, which banned federal funding for abortion. Now federal subsidies will indirectly pay for abortions when the health exchanges become operational in 2014. To make matters worse, some $8 billion have been appropriated for Community Health Centers. These monies are not subject to the Hyde Amendment restriction so in theory CHC’s may now provide abortions at taxpayer expense. (CHC’s do not seem to have done this yet in practice!) As for Bart Stupak, it seems that he was bluffing all along, in the hopes that the reform bill might just go away. It didn’t and Catholics, especially the USCCB which lobbied very hard for the inclusion of Stupak language, have every right to feel betrayed when Pelosi et al. called Stupak’s bluff.

Yet things are not nearly as bad as they seem. And once pro-lifers take a deep breath and take stock of where we are now, some favorable developments are possible. It is true that the Stupak language was stricken from the bill, language which would have placed an outright ban on the sale of abortion coverage on the exchange. Instead, pro-lifers got the watered down “Nelson” language (so named for its author, Sen. Ben Nelson), which only permits the sale of abortion coverage in a separate rider paid for exclusively with the insured person’s funds. Of course, money is fungible and pro-lifers rightly objected that federal monies would still be subsidizing abortions since the insurance companies don’t earmark funds, but pay all claims out of premiums received.

Yet even under the Nelson language, abortion is now bracketed as something other than part of a standard health package. Carriers have to be willing to go to the expense of writing separate “abortion” plans just as customers now have to go to the trouble of specifically asking and paying for them out of pocket. Already a number of pro-abortion activists and left-wing blogs are concerned that this will mean the gradual demise of private health coverage for abortion, especially as more and more people and businesses shop for coverage on the exchanges in the coming decades. Abortion coverage, even if not banned outright, will now effectively be stigmatized.

Abortion advocates believe quite rightly that they have lost the battle to have abortion included in the federally regulated standard package of benefits. And yet it will be this standard that over time shapes what constitutes health care in America. If abortion rights supporters could not convince this Congress of the proposition that “abortion is health care, it is hard to see them doing so in the future. The official marginalization of abortion, even though it has come at the cost of this fiscal train wreck becoming law, is a hidden victory for Catholics who care about the sanctity of life.

And this does not even consider the likelihood that pro-lifers will be able to win even tighter Stupak-type restrictions as their strength is certain to increase in Congress in the coming few cycles. Remember that some sixty-four Democrats supported the Stupak Amendment. The fact that a goodly number of these members had high ratings with abortion advocacy groups suggests that many were not pro-life but considered federal abortion subsidies to be a losing issue in their districts. This fact, too, should cause pro-lifers to take heart.

But the Stupak Amendment only concerned the insurance exchanges, and these don’t become fully operational for several years. The real action in broadening health care access right away is by expanding Medicaid, which is funded by a federal/state partnership. Yet under the Hyde Amendment, federal Medicaid dollars cannot fund abortion except in the case of rape or incest. It is true that seventeen states currently pay for abortions in some cases with their own Medicaid funds. Under Obamacare, however, most of the expansion of Medicaid is scheduled to be picked up by Uncle Sam, and there is already a strong push for the federal government to underwrite the whole expansion, as states continue to be crippled with their own massive budget shortfalls. This is terrible news for small government advocates, but it is wonderful news for defenders of the sanctity of life.

Healthcare access will be expanded but without any significant expansion – and indeed probably a net drop – in abortion coverage. Most of the newly Medicaid eligible enrollees will be the under thirty-five crowd, who are too old to be on their parents’ policies. They will get health insurance now with pre-natal care, but largely without abortion coverage. The Hyde Amendment will still work to block any direct abortion funding especially in the first few years of Obamacare.

Best of all, the passage of healthcare reform has already united fiscal and social conservatives with a common cause not seen since the 1980s. Both tea-partiers and pro-lifers are angry, energized, and highly motivated to storm the ballot boxes in November to take out their wrath on elected representatives who betrayed their trust. We may not succeed in repealing healthcare reform and indeed we may not want to repeal it entirely. Yet even if we don’t, we stand an excellent chance of making the expansion of the federal role in health care even more hostile to abortion than it already is. Pro-abortion rights liberals won a big victory by passing universal health care. But the price of doing so has been accepting a standard of health care without abortion access.


Peter Brown is completing a doctorate in Biblical Studies at the Catholic University of America.
(c) 2010 The Catholic Thing. All rights reserved. For reprint rights, write to: info at thecatholicthingdotorg

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