By Ruth Marcus
Let’s dispense with three fallacies swirling about the question of abortion coverage in health care reform. Two are being peddled by anti-abortion forces. One, perhaps the most relevant, is being pushed by the pro-choice side.
To be clear about where I am: firmly pro-choice. Firmly opposed to the amendment from Rep. Bart Stupak, D-Mich., which would effectively prevent women who purchase insurance on the newly created exchanges from obtaining abortion coverage.
But also: respectful of the convictions of those who disagree. And, consequently, sympathetic to the notion that taxpayers should not have to pay for a procedure they believe is tantamount to murder.
The pending proposals on health reform entangle the government in insurance in a different way than it has been previously, and therefore call for a new, nuanced approach to the issue. Of course, nuanced and abortion don’t generally occupy the same sentence. Hence, the fallacies about abortion coverage.
Fallacy No. 1: The Stupak amendment is necessary to maintain the status quo, in which no federal money is used for abortions, except in cases of rape, incest or to preserve the life of the mother.
As it went to the floor, the House bill included an amendment, by California Democrat Lois Capps, that would have required all insurance plans in the exchanges to segregate public and private dollars to make certain that the public subsidies would not be used to underwrite abortion coverage.
But if the Capps restrictions do not go far enough, existing efforts to segregate federal funding from abortion coverage fall short as well. For example, Medicaid is a joint federal-state program. Federal law prohibits federal Medicaid funding for most abortions. But the law also lets states decide to use their own money for abortion coverage, and 17 do. How is that different from separating public and private dollars in the exchange? Likewise, current law allows family planning funds, national and international, to go to clinics that perform abortions, so long as the federal money is kept separate.
And no one questions—not yet, anyway—the fact that millions in tax dollars subsidize abortion coverage through the employer exclusion, which allows health insurance to be provided as a tax-free benefit. News alert: The single-largest subsidy in the tax code is going to pay for abortions!
Fallacy No. 2: Your money is fungible but mine isn’t.
The wall of separation between public and private funds is always going to have some degree of permeability. It’s just that some fungibility is deemed acceptable, and some not. It depends, it seems, on who gets the money.
The same folks who squawk about money being fungible when it comes to federal funding and abortion take the opposite view when it comes to federal funding and parochial schools or federal funding and faith-based programs.
When the Catholic Church takes government money to run homeless shelters or soup kitchens, it frees up dollars for other, religious expenses that wouldn’t be a permissible use of government funds. Somehow, the U.S. Conference of Catholic Bishops, which pushed the Stupak amendment, isn’t bothered by this reality.
When the government gives low-income families school vouchers to use at parochial schools, or sends educational material and equipment to parochial schools, the bishops aren’t worried about whether that money is being commingled to subsidize religion.
“The simple fact that broad governmental social programs may have some effect of aiding religious institutions ... cannot be cause for invalidating a program on Establishment Clause grounds,” the bishops argued in one case before the Supreme Court.
Fallacy No. 3: The Stupak amendment is such an intolerable intrusion on the rights of women to choose that it cannot be allowed to stand.
I’ve come to the reluctant conclusion that this is wrong, and that pro-choice forces may be making a mistake in elevating the importance of the amendment to the degree they have. The Stupak amendment is not worth killing health reform over.
The women most hurt by the amendment stand to gain much more from expanded insurance coverage. And while having coverage is preferable, it is not the same as putting an insurmountable obstacle in the way of abortion rights. Women who lack insurance still obtain—and, if the amendment survives, still will be able to obtain—abortions. It’s possible that the exchanges will evolve to supplant employer-based insurance, making the amendment’s impact far greater than it now appears.
That remote risk isn’t worth the greater danger: losing the opportunity to get reform now.
Ruth Marcus’ e-mail address is marcusr(at)washpost.com.
© 2009, Washington Post Writers Group