Senate Bill Could Increase Abortion Coverage

Senate Finance Committee Chairman Max Baucus today released a new version of a healthcare reform bill, and—not surprisingly—abortion coverage is again a sticking point. None of the Republican committee members have signed on to support the bill, and ranking member Chuck Grassley from Iowa noted that "there are still some serious outstanding issues that have yet to be resolved, like preventing taxpayer funding of abortion services."

Just three pages of the 223-page proposal deal with abortion coverage, and, at first blush, the provisions seem pretty innocuous. The law would not supersede state laws regarding the procedure, nor would it negate conscience protections for doctors who don't wish to perform it, nor abortion-related antidiscrimination laws. The law would also ensure that abortion can't be mandated as part of a minimum benefits package except in cases where federal funds are already permitted to be used, that is, in cases of rape or incest or to save the life of the mother.

Here's, though, where it gets sticky: Insurers that participate in a government exchange and provide abortion coverage beyond the limits set by the federal government for its own employees, to terminate an unplanned pregnancy for reasons other than the ones above, must separate the cost of coverage for abortions from their total costs for all coverage that they report to the federal government for tax credits. The secretary of health and human services will determine how much that abortion coverage costs "per enrollee" (though it should really be per female enrollee), and those costs can't be estimated to be less than $1 per enrollee per month.

Abortion-rights activist Frances Kissling wrote in a Salon piece this week that while it was "discouraging to hear" President Obama, in his recent address to Congress, call for no federal dollars to be used to fund abortions, she and her colleagues accepted that the status quo should continue because we don't want "to bear the responsibility for health reform failing." Now, though, she's worried that antiabortion groups will use Obama's remarks, and the draft legislation reflecting them, as a starting point for negotiations. These groups have said they want legislation that specifically prohibits insurance companies that join the exchange from covering abortions for a broad range of circumstances—which, in essence, would eliminate abortion coverage that most private plans currently offer.

Abortion opponents will probably renew their calls for these limitations when they see this additional provision, certain to get their tempers flaring: Each state exchange must have "at least one plan [that] provides coverage of abortions beyond those for which federal funds ...are permitted" and "at least one plan [that] does not provide coverage of abortions." Abortion opponents could argue that this provision will increase the rate of abortions by enabling currently uninsured women to join an insurance exchange that provides the service.

The Solomonic solution—to keep us, as Obama urges, from "getting distracted" by abortion—is to draft legislation that doesn't affect abortion procedures in any way. The exact same number of women should have access and coverage, and not a single taxpayer cent should be used to fund the procedure. That would certainly remove abortion from the debate, but I think it's probably impossible to draft any law that won't shift access to either the plus or minus side—to say nothing of trying to separate out insurance funds used for abortion coverage. Whatever estimate HHS Secretary Kathleen Sebelius comes up with will be a guesstimate at best. Change in the administration of abortions is bound to occur. The question is: Is it worth the price of successful health reform, or should we, indeed, not allow ourselves to get too distracted by this issue?

• Recent news: Abortion Coverage Threatens to Derail Health Reform