While abortion coverage isn't currently mentioned in the health reform legislation, it threatens to derail President Obama's health reform efforts. A group of conservative Democrats in the House have vowed not to vote for any bill that doesn't include explicit language banning the use of federal funds for abortion. They, as well as most Republicans, charge that abortions will otherwise increase if more women have insurance coverage that pays for the procedure.
I was hoping Obama would address this hot-button issue last night in his press conference. He did not, and none of the journalists he called on asked him directly. Obama did, though, tell CBS anchor Katie Couric in an interview on Tuesday that lawmakers should "not get distracted by the abortion debate" as they hammer out health reform legislation. When asked if he would favor federally subsidized insurance plans that covered abortion, Obama said, "As you know, I'm pro-choice. But I think we also have the tradition of, in this town, historically, of not financing abortions as part of government-funded healthcare."
The official White House position is that decisions on abortion coverage and other benefits should be "left to medical experts in the field," said Press Secretary Robert Gibbs earlier in the week. This could be in the form of a new advisory board that would outline minimum levels of coverage for private insurers. But women's health activists are concerned that abortion is being used as a bargaining chip. "We're certainly worried," says Marilyn Keefe, director of reproductive health programs at the National Partnership for Women and Families. "Abortion is basic healthcare for women. We're worried about the possibility that existing coverage will be rolled back. There are certain members of Congress that would like see coverage disappear altogether."
In fact, most insurance companies currently cover both drug-induced and surgical abortions. A Guttmacher Institute survey found that 87 percent of "typical" employer-based insurance policies cover medically necessary or appropriate abortions, while a Kaiser Family Foundation survey found that 46 percent of insured workers had coverage for abortions. (The true number is probably somewhere in between since the two surveys were conducted differently, says Guttmacher on its website.) That means those of us whose insurance companies provide abortion coverage are already indirectly paying for abortions via our premiums.
Politics doesn't come into play in the private sector. "Insurance companies base their coverage on how much they have to pay out," explains Adam Sonfield, a senior public policy associate at Guttmacher. "They cover contraception and abortion because they've calculated that it's cheaper to prevent or terminate pregnancy than to pay for the birth itself and the care of the child afterward." Sounds creepy, but so is calculating life insurance premiums based on a person's life expectancy.
It certainly seems logical that those who are opposed to abortions wouldn't want their tax dollars going to pay for them. The trouble is, why aren't we applying this to other medical services? Members of the Church of Scientology—including actor Tom Cruise, who has spoken out against antidepressants—could argue that psychiatric drugs shouldn't be covered by a federal plan because their religion opposes them. Other religious groups, like the Christian Scientists, are against vaccinations, or even all medications to treat illnesses. The pope recently restated the Roman Catholic Church's opposition to birth control, so why shouldn't Catholics put the kibosh on federally subsidized contraception coverage?
"People can have religious objections to in vitro fertilization, to high doses of painkillers at the end of life, to Pap tests for single women," says Sonfield. "Why should abortion be singled out?" The best solution, he adds, is one proposed by Democratic Rep. Tim Ryan of Ohio Democrat, a self-described "pro-life" antiabortion advocate, who says health reform legislation shouldn't require insurance companies to provide coverage for abortions, nor should it prohibit them from covering them. (Ryan also introduced a bill today to prevent abortions and unplanned pregnancies by improving access to contraception, expanding Medicaid family planning coverage, and increasing adoption assistance.)
Other options ensuring that no federal funds are used for abortions are also doable, says Sonfield, even if federally subsidized plans allow for abortion coverage. "These plans will be getting a big pot of premiums from private individuals and corporations and a big pot from the federal government. It's pretty easy to keep the funds separate," he says, so that only funds in the private pot will be earmarked for abortion reimbursements.
What's become increasingly clear, however, is that federal workers probably won't see abortion coverage anytime soon, including women in the military, who all too often face unplanned pregnancies while serving overseas.
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