Bullets Flying Over Abortion Coverage in Health Reform Bill

No one seems happy about the way abortion coverage is being handled by reconciliation process.

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It's high noon for abortion coverage in the health reform bill, and the pistols are drawn. Who will win the duel over abortions if and when a final bill is passed remains to be seen. Simply put, abortion-rights activists want the language in any final healthcare bill to allow insurance plans in the federal exchange system to provide abortion coverage as part of their comprehensive plans. Those opposed to abortion don't want any plans in the exchange to offer abortion coverage. The Senate bill and the White House tweaks to it that will be the basis of the final reconciliation bill contain language that's something of a compromise—allowing abortion coverage but with restrictions.

While writing this blog, I was hit with an E-mail from House Republican Leader John Boehner warning that "President Obama and Democrats in Congress intend to defy the will of the American people and overturn a long-standing prohibition on taxpayer funding of abortion." He warned that House Democrats will have to pass the Senate bill during reconciliation, including "a loophole that would permit government funding of abortion."

Taking its own shots, the antiabortion National Right to Life Committee posted a statement on its website objecting to Obama's addition of $11 billion in new funding for community healthcare centers—some of which provide abortions—saying that the funding could theoretically be used to pay for the procedure since no specific restrictions have been placed on the money. In this memo, the organization claims that the new funding wouldn't be covered by a congressional amendment banning the use of federal dollars for abortions. The group called the latest health reform bill "the most expansive pro-abortion piece of legislation ever to reach the floor of either house of Congress for a vote, since Roe v Wade." (Fighting words, though I don't recall Congress having any role in that decision made by the Supreme Court.)

Planned Parenthood, which supports abortion coverage, fired off a missive yesterday from President Cecile Richards, who said that she wasn't happy with either the House bill or the Senate version. "Under the burdensome Nelson provision in the Senate healthcare reform bill," Richards said in an E-mailed statement, "it is anticipated that most private health insurers would no longer offer coverage for abortion. Since most women with private health insurance have coverage for abortion, the Nelson provision would take away coverage that women have now." The Nelson provision does allow plans to offer coverage, but it requires every enrollee who wants it to write a separate check for it; the provision also prohibits insurance companies from taking into account cost savings from, say, prenatal care when estimating the costs of abortion care and calculating premiums for that care. And the provision eliminates language in an earlier version of the Senate bill that would have ensured that at least one insurance plan in each exchange offered abortion coverage and one did not.

Richards called for Congress to "fix the Nelson provision" as part of reconciliation and added that Planned Parenthood is "deeply concerned" that the Senate bill will be altered to include an amendment in the House bill, which actually goes further in limiting abortion coverage than the Nelson provision by banning health plans that enroll in the federal insurance exchange from providing abortion coverage. (This morning Democratic Rep. Bart Stupak of Michigan, who wrote the House amendment, said on ABC's Good Morning America that he and 11 other House members will vote against any final bill that doesn't include the abortion coverage ban.)

[Read about Obama's campaign promise to end the prohibition on abortion funding.]

Jodi Jacobson, editor of the reproductive rights health blog RH Reality Check, wrote in this blog post that the Nelson language in the Senate bill, which she calls "discriminatory," will remain in whatever health reform bill is passed through the reconciliation process. That's because this process, which will rely on the Senate bill, can't alter anything that's not "germane to the budget." Since abortion coverage has zero net effect on federal spending, it isn't on the table for altering. Republican leader Boehner agrees, stating in his press release that the "one issue reconciliation cannot address is abortion." That's probably the one thing the two sides agree upon.

What could be on the chopping block? That $11 billion in new funding set aside for community health centers. That may be the bargaining chip the Democrats use to entice antiabortion members of their own party, like Stupak, to continue their support of healthcare reform.

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