Hijacking Healthcare Reform
Guardian.co.uk, December 1, 2009
Nancy Northup, President, Center for Reproductive RightsThe debate over US healthcare reform has taken many surprising twists and turns, and the task of navigating the bill through the divided Senate promises yet more deep bends in the road before passage. One of the most divisive of those is the controversy over paying for abortion coverage for women, a debate in which sparks have flown – but which has thus far produced a lot of heat and little light.As proponents of women’s reproductive health, we would expect coverage for abortion services to be treated the same as any other fundamental health need, as was the case in some of the Senate and House of Representatives’ versions of the bill passed out of committees. Yet, after strong opposition in the House, we compromised these expectations, allowing abortion services coverage to be singled out for different treatment that segregates federal funding, adds red tape, and requires women to pay for abortion coverage out of a separate fund made up of private contribution dollars.Even this sacrifice of both principles and policy proved insufficient to appease the US Conference of Catholic Bishops, which forced a last-minute vote on the abortion coverage issue in the House and essentially ban abortion coverage to anyone who participates in a health reform-related insurance plan, even if women pay for the related premium with their own money. Market incentives make it virtually certain that abortion services coverage, even outside of government-subsidized plans, will dry up, as insurance companies consolidate and streamline their policies, according to experts and academics.House members were told, misleadingly, that the amendment, called Stupak-Pitts, merely applied a long-standing funding restriction (known as the “Hyde Amendment“) to the healthcare reform context, and were therefore taken aback by the shock and uproar that ensued following this regressive and far-reaching vote. Buyer’s remorse has now taken hold in many congressional offices, which are finding ways to quietly indicate their chagrin.Another area in which Congress has been misled concerns the loud objections to the mechanism which segregates federal funding from private funding and would ensure that no federal money is used for abortion services coverage. The Senate bill, announced by majority leader Harry Reid, contains even more stringent accounting requirements in this regard. Yet critics, including a small group of vocal Catholic bishops, claim that the segregation requirement is a mere “accounting gimmick” or trick.This assertion is spurious. Accounting firewalls are as old as the tax code, and are relied upon as part of basic federal policy to set out rules for funding streams that flow into non-profits, charities, churches, schools and other organisations. A few examples amply prove the point. First, religious organisations receive federal funding to run numerous social programs such as food banks, substance abuse counseling, after-school programmes for troubled youth, and veteran services. These groups, including the Catholic church, are required to place federal funds in a separate account from non-federal funds so that none of the federal money is used to subsidise religious activities such as worship, religious instruction and proselytising to ensure that there is no violation of the constitutional principle of separation of church and state.Second, 17 states currently use state dollars to pay for all or most medically necessary abortions while accepting federal Medicaid funds. While no federal Medicaid funds can be used to pay for abortion services beyond the narrow circumstances allowed by federal law, state governments can use their own state Medicaid money to pay for additional health services, including abortions.Non-profit organisations often contain arms that have different restrictions on lobbying and electioneering activities for tax putposes. Some, known as 501(c)(3) organisations, are charities forbidden from using tax-exempt donations to influence elections and engage in partisan politics. Others, known as 501(c)(4)s, can do a limited amount of electioneering under certain circumstances. Yet organisations can operate both arms, so long as they keep separate accounting of their funding, activities and expenditures.
The list of examples is endless. Somehow, under all of these circumstances, the fungibility of funds is acceptable, even uncontroversial. More fundamentally, Americans are currently allowed to pay for the premiums of their employer-provided health insurance with “pre-tax” income, thereby reducing their tax liability because their net taxable income is reduced by the amount of their health insurance premiums. And employers are allowed to provide health insurance as a tax-free benefit to employees. A majority of plans in the private insurance market today provide abortion services coverage. Thus the logic of denying abortion coverage to those who get a tax credit to help pay insurance premiums could be extended to everyone who gets a tax deduction to help pay their insurance premiums. That is the slippery slope that the House of Representatives has embarked upon.Unsurprisingly, the anti-reproductive health lobby has not even attempted to explain away these common examples in which organisations use segregated funds or why a tax credit is fundamentally different from a tax savings. That’s because the anti-choice agenda in the health care debate is to seize this moment to block reform or, at the least, to further restrict access to a full range of reproductive health services.Recently, the Republican Senator Orrin Hatch, who is expected to offer an amendment similar to Stupak’s, said it quite plainly on the Senate floor: “The sanctity of life is not an issue that can be traded away for political expediency.” In other words, passing health reform, in his view, is not as important as tightening the reins on women’s access to abortion. If anti-choice politicians manage to put this narrow agenda ahead of the goal of expanding coverage for 37 million uninsured Americans, for some in Congress at least, that looks like a win-win.