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House Leadership’s Big Gamble on Health Care Amendment

November 7th, 2009

Last night the path to 216 votes became more clear to the Democratic leadership trying to get a health care insurance reform bill passed through the House of Representatives. In order to address the concerns of the anti-choice membership of the Democratic caucus, a vote on a controversial amendment has been scheduled and is expected to garner majority support, after which those anti-choice supporters will be able to vote for the bill itself. But I’m increasingly convinced that that the House leadership has no intention of allowing this to stand when all is said and done.

What is this controversial amendment, you ask? Well, to answer that we start by understanding what the bill say before the amendment. First a quick caveat, I haven’t read the bill so this is all second hand reporting… consult a health care expert for full details. But do keep reading, as I do have a genuine thought near the end here that will only make sense once the context is provided. Anyway, the bill itself currently contains a compromise between some (read: not all) anti-choice Democrats and the pro-choice wing which requires that in any given insurance market there always be at least one insurance option that provides abortion services and one insurance option that does not. Once those requirements are met any number of additional plans, with or without abortion services, can be offered. My understanding is that, at present, most insurance plans in the United States cover some level of abortion services, so the existing compromise is a net “gain” of sorts for anti-choice supporters, as this increases their own ideologically-pure insurance options.

Of course, the compromise itself is somewhat silly, because most Americans don’t select their own insurance but rather sign up for their employer’s plan. Even at my tiny company where worker opinion is solicited for important business decisions on a regular basis, the health insurance decisions are quite opaque. But even though it’s a “win”, it apparently wasn’t enough of a win. The anti-choice partisans are worried that poor Americans who receive insurance through the new Insurance Exchange with federal subsidies will have access to abortion services paid for by federal dollars. This, for reasons I’ve never fully understood, is a big deal. Money is fungible, and if you really have a problem with the idea that your money is paying for abortions, just pretend like all of the taxes collected during your entire lifetime goes to pay for .001% of a cruise missile used to blow up something in Iraq… but I digress. Years ago an amendment was passed called the Helms Amendment that prevents the spending of any federal dollars for abortion services unless in the case of incest, rape, or saving the life of the mother (note, no general health exception is provided… she has to be dying to get access to federal funds). Thus medicad — the primary source of health funds available to those still able to reproduce, since medicare is primarily for the elderly — have always been highly restricted.

The original compromise maintains this restriction. Someone buying insurance on the Exchange, even the one with abortion services, would only be able to access those services under the Helms Amendment restrictions. In order to cover any other abortion services you would need to purchase additional coverage. In this, it was believed, the status quo was more or less maintained.

Not so, says the anti-choicers! Best as I can figure, their argument boils down to this: if the government is providing subsidies to help me purchase insurance, that leaves me with more money in my pocket which I can then use to purchase the “full service” abortion package, and thus federal taxes are indirectly being used to pay for non-Helms-Amendment type abortions. The proposed solution is to ban the sale of abortion service insurance on the Exchange entirely. That’s right… NO ONE on the individual market or public option would be able to buy insurance that covers abortions. To draw an analogy… by providing food stamps to the poor, we enable them to spend what money they do have on alcohol, which is probably not a good use of their funds. The obvious solution then is to mandate that the poor can only purchase food at one approved location, regardless of whether they are using stamps or hard cash, and that said location will not carry any products we deem inappropriate… and that since we are dismantling all the rest of the stores while we are at it, everyone is going to have to buy from that same no-alcohol location even if they aren’t on food stamps. Only then can our conscience rest peacefully.

Okay, context is provided… here’s my original thought. I don’t think this amendment can stand legal scrutiny, and I think the Democrats know it. Access to abortion is a legal right in this country, and insurance is the way we pay for it. The government cannot prohibit insurance from paying for a service that is a right as it’s functionally no different than an outright ban. I suggest that prohibiting a whole section of the population from even having access to insurance options is more or less the same. But this is a gamble. The court isn’t what it used to be when it comes to choice. Though the case wouldn’t ultimately be about choice as much as a questions of the power of Congress to regulate beyond the scope of federal dollars (remember, there is only a tenuous connection between federal dollars here). Given this, I’d still place bets that the amendment can’t withstand scrutiny. Which I think is why the vote is going forward. As long as they can get together 216 votes today, the Democrats can worry about the five votes on the Supreme Court later.

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