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Health Insurance Reform, Abortion, Conspiracy Theories, Etc. | jonmower.com

Health Insurance Reform, Abortion, Conspiracy Theories, Etc.

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Tomorrow the House will vote on the Senate health reform bill and a set of amendments to it.  They will do it with explicit votes rather than the "deem and pass" strategy that had been floated.  Although the Senate will still have to pass the amendments itself via reconciliation, it is assumed that those votes are there.  That means tomorrow's votes will likely be decisive.

Much of today's drama surrounded whether or not Bart Stupak could be brought back on board by addressing his concerns about the Senate bill's abortion language.  Apparently that's not going to happen.  On the other hand, an executive order incorporating Stupak's language is apparently being considered.

The debate over whether or not the Senate bill subsidizes abortion is quite odd.  Folks like Stupak and the United States Conference of Catholic Bishops say it does.  Folks like Brad Ellsworth, The Catholic Health Association, and Catholics in Alliance for the Common Good say it doesn't.  The status quo (via the Hyde Amendment) is that the federal government doesn't pay for abortions, and President Obama has made it clear that he doesn't want the health insurance reform bill to change that status quo.

A look at the bill's abortion language makes if difficult to understand why so many people are apparently so sure that it funds abortions.  While not requiring or preventing insurance plans to include abortion coverage, it prevents public money from funding them. It requires that the state-based exchanges have at least one plan available that doesn't cover abortions and allows a state to rule out abortion coverage if it chooses.  Nevertheless, there seem to be two remaining threads to the pro-life opposition to the Senate bill.

First, the bill stipulates that anyone who wants to purchase a plan that includes abortion coverage in the state-based exchanges must make a separate payment for that coverage, and the insurer must keep that pool of money separate from any governmental subsidies so that they don't directly fund abortions.  This is not adequate to Stupak because there will be people who would not have insurance at all without the federal subsidies who then purchase abortion coverage for their subsidy-enabled health insurance.  Stupak seems to take the view that once you give someone aid you are effectively subsidizing any other way that they choose to spend money. By that logic I'm sure I have "paid for" all kinds of bad things (by giving money to a church that gives aid to people who also spend their money on bad things), but of course I haven't actually "paid for" those things.  Also, many employer-sponsored insurance plans cover elective abortions.  A Guttmacher Institute Study indicated 87 %, while a Kaiser Family Foundation said 46 % (LifeNews believes the KFF numbers).  I checked on mine (Aetna), and it does.  Famously, the Republican National Committee's plan covered elective abortion until it became a news story, and the argument could be made that even Focus on the Family indirectly pays for abortions.  By Stupak's logic, isn't everyone who pays premiums to those plans indirectly funding abortions?  Furthermore, the tax exclusion for employer sponsored health care is (by Stupak's logic) an enormous abortion subsidy that dwarfs the small, theoretical one that is his current focus.

Secondly, the bill includes funding for "community health centers" which some have claimed could provide abortions.  This may in fact be (theoretically) true since that funding would come via a route that might not be subject to the Hyde Amendment.  However, it's been argued that there are other long-standing regulations that would prevent programs administered by the Health Resources and Services Administration (programs such as the community health centers) providing abortion services and that the funds will end up in the same pot as other funds subject to the Hyde Amendment, effectively making it subject to the same restrictions.

Here is what National Association of Community Health Centers has to say about it:

Community health centers "have never performed abortions," said Dan Hawkins, senior vice president of policy and programs for the group. "They do not plan to or seek to become a provider of abortions. They don't do that."

Community health centers are focused on their mission of providing primary and preventive health care -- things like immunization and prenatal care -- to those typically underserved by the health care community, he said.

Community health centers were around for 11 years before the Hyde Amendment went into effect in 1976 and they never provided abortions, he said. And last year, they got $2 billion in federal stimulus funds. Of that, $500,000 was for operational funding. It has already been used to provide health care to more than 2 million additional people, he said. Like the Senate bill's proposal, the stimulus money came separate from the HHS appropriation funds (with its Hyde Amendment limits) and contained no specific abortion language. And again, none of it was used for abortions.

Hawkins makes one last point: the $7 billion over five years through the Senate health care bill would be combined by the secretary of HHS (currently Obama appointee Kathleen Sebelius) with the roughly $2.2 billion the centers receive through the annual appropriations bill.

"In our opinion, once this money is combined with the appropriated funds, the Hyde restrictions will apply to the whole thing," Hawkins said.

Together with repeated assurances from Sebelius that no federal funds will be used to pay for abortions, Hawkins said, "We feel confident the restriction (against abortions) will apply."

"And again," Hawkins said, "they haven't done abortions and they aren't looking to do them in the future."

To summarize, it's debatable (but very unlikely) that there is a theoretical risk that the bill could enable direct funding of abortions...but even if it is theoretically possible, it is still highly unlikely.  Even so, claims like "monstrously anti-life" and "the most anti-life piece of legislation in the history of our country" are common.  Such hyperbole is especially puzzling because there is good reason to think that the health insurance reforms will actually reduce the abortion rate.  As T.R. Reid recently argued:

There's a direct connection between greater health coverage and lower abortion rates. To oppose expanded coverage in the name of restricting abortion gets things exactly backward. It's like saying you won't fix the broken furnace in a schoolhouse because you're against pneumonia. Nonsense! Fixing the furnace will reduce the rate of pneumonia. In the same way, expanding health-care coverage will reduce the rate of abortion.

At least, that's the lesson from every other rich democracy.

The latest United Nations comparative statistics, available at http://data.un.org, demonstrate the point clearly. The U.N. data measure the number of abortions for women ages 15 to 44. They show that Canada, for example, has 15.2 abortions per 1,000 women; Denmark, 14.3; Germany, 7.8; Japan, 12.3; Britain, 17.0; and the United States, 20.8. When it comes to abortion rates in the developed world, we're No. 1.

No one could argue that Germans, Japanese, Brits or Canadians have more respect for life or deeper religious convictions than Americans do. So why do they have fewer abortions?

One key reason seems to be that all those countries provide health care for everybody at a reasonable cost. That has a profound effect on women contemplating what to do about an unwanted pregnancy.

Reid summarizes:

When I studied health-care systems overseas in research for a book, I asked health ministers, doctors, economists and others in all the rich countries why their nations decided to provide health care for everybody. The answers were medical (universal care saves lives), economic (universal care is cheaper), political (the voters like it), religious (it's what Christ commanded) and moral (it's the right thing to do). And in every country, people told me that universal health-care coverage is desirable because it reduces the rate of abortion.

It's only in the United States that opponents of abortion are fighting against expanded health-care coverage -- a policy step that has been proved around the world to limit abortions.

Michael New disputes Reid's thesis, claiming the figures Reid uses exaggerate the abortion rate in the U.S., ignores the impact of our racially-diverse population, and ignores the "experience of states that have offered more generous provision of public health benefits."  However, as David Gibson points out:

A study published in the latest New England Journal of Medicine shows that abortion rates declined during the first two years that Massachusetts implemented a near-universal health coverage program much like the nationwide plan currently before Congress.

As Ezra Klein put it:

...abortions were on a longer-term downward trend in Massachusetts, so it's possible (I might even say likely) that the reform didn't matter and abortion was dropping for other reasons. But it's hard to look at this data and say that the reforms led to a large increase in abortions.

Ron Sider, President of Evangelicals for Social Action, said the following about the bill:

It is a moral outrage for the richest nation in history to leave 47 million of its people without health insurance. This legislation substantially extends coverage and also retains the long-standing stance of the Hyde Amendment against federal funding of abortion. It will save thousands of lives, cover millions of people, and prevent federal funding of abortion."

It's disappointing to me that so many pro-life groups have opposed health reform so so vehemently and with so much hyperbole.  This is not the only way I've recently been disturbed by the tactics of the pro-life movement. 

Conspiracy theories seem to be flourishing these days: for example, 911 Truthers, birthers, and whatever nonsense Glenn Beck is pushing this week.  Here is one more: as reported in the New York Times:

Across the country, the anti-abortion movement, long viewed as almost exclusively white and Republican, is turning its attention to African-Americans and encouraging black abortion opponents across the country to become more active.

A new documentary, written and directed by Mark Crutcher, a white abortion opponent in Denton, Tex., meticulously traces what it says are connections among slavery, Nazi-style eugenics, birth control and abortion, and is being regularly screened by black organizations.

Black abortion opponents, who sometimes refer to abortions as “womb lynchings,” have mounted a sustained attack on the Planned Parenthood Federation of America, spurred by a sting operation by young white conservatives who taped Planned Parenthood employees welcoming donations specifically for aborting black children.

William Saletan has questioned the consistency of the messages of some of the conspiracy theorists.  Admittedly, the figures regarding abortion in the black community are certainly tragic:

Data from the federal Centers for Disease Control and Prevention show that black women get almost 40 percent of the country’s abortions, even though blacks make up only 13 percent of the population. Nearly 40 percent of black pregnancies end in induced abortion, a rate far higher than for white or Hispanic women.

...but I'm not glad to see pro-life groups encouraging conspiracy theories about racists specifically targeting blacks for elimination or to hear claims that blacks are worse off now than they were under slavery...

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