I would like to update CLF readers on the status of the abortion provision in the U.S. health care debate.  President Obama and high ranking Democrats in both Houses (e.g., Rep. Nancy Pelosi [D-CA], Sen. Claire McCaskill [D-MO], Rep. Ron Klein [D-FL], Sen. Arlin Specter [D-PA]) have been recently quoted as stating that no federal tax dollars will be used to fund abortion under universal healthcare.  The most highly publicized statement came from the President in his address to the joint session of congress on Sept. 9th: “One more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions.”  I felt genuinely optimistic when I heard these words.  It seemed implausible to me that despite the President’s proclivities to stretch the truth he would bold-facedly lie to the American people during an internationally televised speech.  It shortly became clear that the President’s statement was false.  Its falsity however is cleverly disguised.  To remove the disguise, I need to review a couple provisions from the health care bill being debated in the House of Representatives.

My comments refer specifically to HR 3200: “America’s Affordable Health Choices Act of 2009”.  But the abortion provisions of the Senate “Baucus Bill” (“America’s Healthy Future Act of 2009”), not yet a formally proposed bill, are, as far as I can tell, identical to HR 3200.  My discussion is somewhat technical, but I ask that you stick with me.  The technicalities are necessary to adequately explain the intent of the bill despite its misleading presentation.
 
HR 3200 includes right now a provision called the Capps Amendment, added back in July (amended to section 122 of the House bill).  The amendment both excludes certain abortion provisions from the bill and includes others, making it possible for partisan lawmakers to draw ad hoc attention to the provisions most agreeable to their constituency. 

     Here are two examples.  The first prevents the federal government from mandating that all participating health care providers participate in abortions.  In a section titled, Prohibition of Required [Abortion] Coverage, the amendment reads:

“The Health Benefits Advisory Committee may not recommend […] and the Secretary may not adopt […] the services described in paragraph (4)(A) or (4)(B) as part of the essential benefits package and the Commissioner may not require such services for qualified health benefits plans to participate in the Health Insurance Exchange.” 

The services “described in paragraph (4)(A) or (4)(B)” include both all types of abortions presently excluded from federal funding under the Hyde Amendment (which prohibits Medicaid funded abortions), and all types presently permitted to be funded with federal money (e.g., if a pregnancy results from rape or incest, or where a woman suffers from a physical disorder, physical injury, or physical illness that would place the woman in danger of death unless an abortion is performed).  So saying that these multiple types of abortion cannot be made “essential benefits” of U.S. health care is a good thing.  It means the government cannot require health care providers, including faith-based providers, who cooperate with the government plan to provide abortions.  If the government was permitted to designate abortion as an “essential service,” something pro-lifers originally feared, then all health care and insurance providers, including Catholic hospitals, who participate in the government’s plan would be forced to cooperate wrongfully in abortion, or go out of business.  As I said, this provision is good.  But before you get too encouraged, consider the next provision. 

    In a section titled: Coverage Under Public Health Insurance Option, the Capps Amendment reads:

“The public health insurance option shall provide coverage for services described in paragraph (4)(B).  Nothing in this Act [i.e., HR 3200] shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of services described in paragraph (4)(A).” 

For those confused by the jargon, “public health option” refers to a government established health insurance company, created pursuant HR 3200, which will compete with private insurers and offer insurance to any citizen at (allegedly) highly competitive premiums.  This “public option” is the centerpiece of a government sponsored health care plan, but it does not exhaust the plan. 

This paragraph of the Capps Amendment mandates that every type of abortion service presently prohibited and permitted under federal funding laws will be available under the federal government’s own “public plan.”  How will these abortions be funded?  The next paragraph states that the government “shall estimate the basic per enrollee, per month cost [of abortion services]” and distribute the total cost over all those enrolled in the public option.  In other words, all enrollees in the public option will pay for abortions through their premiums. 

The next point is obscure, so follow closely.  Strictly speaking—i.e., according to the government’s accounting books—“federal insurance premiums” are not “federal tax dollars”.  This means that strictly speaking abortions will be funded by “insurance premiums” and not “tax dollars.”  This tortured distinction between premiums and taxes is the ground upon which Democrats have boldly asserted—without qualification—that no federal tax dollars will be spent on abortions under HR 3200.  But this is the grossest form of wordsmithing.  Everyone will be required to have health insurance.  Everyone will be required to write checks to the federal treasury to pay for insurance.  The federal treasury will use those funds to finance health care, including abortions.  So federal funds will be used to pay for abortions.  To quote the Susan B. Anthony Fund: “The bottom line is this: in order to reimburse abortion providers who offer abortions for public plan enrollees, checks will be written from the U.S. Treasury directly to abortion clinics” [1].  Since the government makes no money of its own, the federal funds with which it pays for abortions will come from the back accounts of American citizens.  You and I will be paying for these abortions.

In addition to the specifically “public option,” HR 3200 establishes a wider health care market regulated by the federal government but composed of multiple competing private health care insurers.  The government will set up large networks of health care consumers (i.e., people like you and me who need health insurance but who decide not to participate in the “public option”).  These networks of consumers will be called “exchanges.”  Private health care companies will obviously benefit greatly if they can enroll large numbers of consumers through these exchanges; and so health insurance providers will compete to enroll exchange customers on the basis of price, quality of benefits, and other relevant factors.  The exchanges will negotiate with providers using the purchasing power of their numbers of members.  The insurance premiums paid by exchange members will be subsidized by federal funds.  Tens of millions of Americans will secure health insurance via these government sponsored exchanges. 

Most private health insurance providers will participate in the government established exchanges.  The Capps Amendment explicitly prohibits these insurance providers from discriminating against health care providers (e.g., hospitals and clinics) because they “provide, pay for, provide coverage of, or refer for abortions.”  In other words, if a private insurance company participates in a government exchange, which most will, it must cover the exchange member’s abortions.  This means the federal funds used to subsidize the premiums of exchange members will pay for abortions.  So not only will all participants in a “public option” be forced to fund abortions, but all participants in universal health care will be forced to fund abortions.

Finally, perhaps you have heard the claim that because the Hyde Amendment is still in effect, a government plan couldn’t fund abortions even if it wanted to.  Rep. Ron Klein (D-FL), for example, recently stated: “There are no federal tax dollars that will fund abortion under the bill.  The Hyde Amendment…already bars federal funding for abortion.  It still exists.  It will not change.  There is nothing in the bill that will change that.”  This is false. 

The text of the Hyde Amendment reads: “None of the funds appropriated in this Act […] shall be expended for health benefits coverage that includes coverage of abortion” (sec. 507, emphasis added).  The “Act” to which it refers is the annual appropriations bill passed in order to fund the work of the Department of Health and Human Services.  But the federal funds collected by Americans to pay for universal health care would not be designated as funds “appropriated in [the HHS funding] Act” [2].  So the restrictions on abortion funding imposed by the Hyde Amendment are utterly unrelated to the funding liberties secured by HR 3200.  It gets worse.  The restrictions imposed by the Hyde Amendment will be effectively annulled by HR 3200, since that bill, as I have shown, requires all abortions formerly restricted under Hyde to be funded under a “public option.”

In other words, abortion will be available for federal funding under both the private option and the government subsidized exchange options.  Presently, because of the Hyde Amendment, only abortions in extreme situations (e.g., rape, incest, threat to the life of the mother) can be federally funded.  If HR 3200 and its counterpart in the Senate are voted into law, the federal government, with our money, will go from funding a very small number of abortions annually to funding almost all our country’s annual abortions.

___________________________

[1] The Susan B. Anthony List provides a very helpful explanation of this rhetorical maneuver of the liberal Democrats at http://www.sba-list.org/site/c.ddJBKJNsFqG/b.5489321/k.656C/Stop_Hiding_Behind_Hyde.htm

[2] Ibid.

(c) 2009 Culture of Life Foundation.  Reproduction granted with attribution required.