Thursday, August 13, 2009

Keeping Health Reform Neutral on Abortion

Keeping Health Reform Neutral on Abortion

AUGUST 13, 2009
Wall Street Journal

Lost in the vitriol about health care is a surprising development: pro-life and pro-choice leaders say they don't intend to use health reform to shift the balance of power in their direction. Many activists on both sides say any big changes to health care should maintain the status quo in the abortion stalemate.

Less surprisingly, while both sides agree on that goal, they look at the same words in the same bills and come to opposite conclusions about what they mean. For instance, the bill passed by the House Energy and Commerce Committee declares, "Nothing in this Act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage" for abortion in the "public option." Pro-choicers say that this neither-this-nor-that language is self-evidently neutral. Pro-life activists argue that since abortion "could" be covered, it will be covered.

My personal view: the legislation passed by the House Energy and Commerce Committee does not mandate abortion coverage, as pro-life groups claim, but does leave open the possibility that the government might pay for abortion. Nor did the "neutral" amendment offered by pro-lifers didn't achieve neutrality, as it would potentially roll back abortion coverage in private insurance plans.

From Waldman's Blog:

Full text of the key amendments

Will health care reform cover abortion?

Health reform, abortion and rationing

Of course, it's easy for me to criticize everyone for not coming up with a neutral solution. It's always more fun to carp than be constructive. So here's my best effort on how to make health care reform neutral on abortion.

First, we need to recognize that part of the problem in being neutral is that health care reform would likely introduce some new features, so you really can't just freeze the status quo. Instead, you have to look at broad principles. In general, the federal government is currently prohibited from directly paying for abortion but allowed to indirectly support abortion.

Indirect support currently happens in a variety of ways. For instance, the federal government set up the Medicaid program, pays for much of it, and allows states to pay for abortions. The government provides support to hospitals, some of which perform abortions. The government gives money to family planning clinics for maternal health care, even though those clinics might also do abortions. In each case, the primary purpose of the spending is not to encourage abortion but, but government funds do support some institutions that also, with their own money, perform abortions. That's the status quo...

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