Health bill amendment threatens promise to cover abortion

The House passage of a health care reform bill on Nov. 7, 2009, has nearly been overshadowed by an amendment approved by lawmakers the same day. The amendment, which expanded limits on federal funding for abortions, is so unpopular with abortion rights supporters that it could derail the Democrats' plan.

The new controversy prompted the Planned Parenthood Action Fund to highlight a speech President Barack Obama made to the group in July 2007.

In that speech, made while Obama was just a few months into his quest for the Democratic presidential nomination, he said, "In my mind, reproductive care is essential care. It is basic care, so it is at the center and at the heart of the plan that I propose. Essentially what we're doing is, we"re going to set up a public plan that all persons and all women can access if they don"t have health insurance. It will be a plan that will provide all essential services, including reproductive services, as well as mental health services and disease management services, because part of our interest is to make sure that we"re putting more money into preventive care."

We missed this promise when we were assembling our collection of Obama promises, so we are adding it now.

Until recently, it looked as if the House health care bill would live up to Obama's promise, by allowing people who signed up for health coverage under the new health care bill to secure abortion coverage. A provision written by Rep. Lois Capps, D-Calif., that was included in the House bill when it came to the floor last weekend would have explicitly made abortion coverage available in both the public plan and in private plans participating in the new health insurance "exchange" -- a virtual marketplace for the uninsured or people who work for small businesses.

Under the Capps amendment, insurers would not have been required to offer, nor would they have been prohibited from offering, abortion services in order to participate in the exchange. The public plan -- the government-run option -- could include abortion coverage, but the cost of the additional coverage would have to be paid by premiums, not by federal subsidies. In addition, at least one plan in every region would have to offer full abortion coverage, and one would have to exclude it. Any insurance plan participating in the exchange would not be able to discriminate against hospitals or other health care facilities, such as Catholic hospitals, that are unwilling to provide abortions. And the plan would not allow pre-emption of any state laws regarding abortion, such as parental notification laws.

But this language was unacceptable to many antiabortion lawmakers in both parties, and they rallied their forces to propose an alternative. Their amendment, offered on Nov. 7 by Reps. Bart Stupak, D-Mich., and Joe Pitts, R-Pa., passed by a 240-194 vote. It won the support of 64 mostly antiabortion Democrats, who joined virtually all Republicans.

The Stupak-Pitts amendment said people buying coverage on the exchange using federal subsidies for lower- to middle-income Americans would not have abortion coverage except in the case of rape, incest or when the life of the mother is endangered. It also would prohibit abortion coverage for anyone getting coverage on the public option. People buying subsidized private coverage on the exchange could still opt to purchase abortion coverage as a separate rider, as long as they did not pay for it with subsidies. Insurers would be barred from mingling funds from people who use affordability credits to buy coverage with those who do not, and they would have to offer a similar plan on the exchange that does not include abortion.

Abortion-rights groups consider the Stupak-Pitts amendment a severe infringement on rights that have been upheld by the Supreme Court in Roe vs. Wade . While we have rated one Democratic lawmaker's quote about its impact False, based on an overly expansive view of the amendment's restrictions, there is little doubt that the Stupak-Pitts provision would make the measure fall short of Obama's 2007 promise to "provide all essential services, including reproductive services."

The amendment's prohibition on providing abortion coverage to participants in the exchange who receive subsidized coverage or use the public option would clearly break Obama's promise. And while the Stupak-Pitts provision wouldn't establish an outright ban on abortion coverage for subsidized health exchange participants who buy private plans, it would add a significant logistical hurdle by forcing them to obtain a rider to obtain such coverage. Even unsubsidized health exchange participants -- whose ability to secure abortion coverage would not be directly restricted by the law -- might find themselves facing limited coverage choices if insurers take the path of least resistance and simply ignore the market for abortion-inclusive policies on the health exchange.

So, if Obama were to sign a bill with the Stupak-Pitts language, he'd be breaking his promise to make reproductive health care "at the heart" of his program. This could change on a dime, as it did on Nov. 7, and we'll be watching the debate closely to see if this promise merits a change in ruling. But for now, we'll rate this promise Stalled.