Monday, September 28, 2009

Reproductive health and the public option

by Thomas Dollar

The better part of this country’s political energy this summer has been consumed by the debate over health insurance reform. As one of the 47 million uninsured Americans, I have been following this debate quite closely—especially the contentious proposal to provide a public health insurance option. Opponents of the public option have employed a “kitchen sink” approach to defeating it, stoking people’s fears of death panels, rationing, and—the classic trump card—Socialism. This not being enough, opponents have tossed another controversial issue into the mix: abortion.

Since 1976, the Hyde Amendment (brainchild of the late Rep. Henry Hyde, famed adulterer, Clinton impeacher, and Savings and Loan profiteer) has banned Federal funding of abortions, except in cases of rape, incest and endangerment of the woman’s life. Most states also place these same restrictions on their own Medicaid funding. Still, most private health insurers cover comprehensive reproductive health care (in some states by law)—including abortions. If the public option is meant to be a meaningful alternative to private health insurance, it would have to offer the same medical coverage as private plans—including reproductive care. The public option would not be a Federally funded plan like Medicare. Like private plans, it would be funded through by employer contributions and insurance premiums. Not one dime of Federal money would go to pay for abortions (or anything else). Cecile Richards, President of Planned Parenthood, points out that “individuals who oppose abortion will not be forced to pay for abortion services.” The president has said the same.

So why do the falsehoods persist? In part it’s to add another poison pill to kill meaningful health insurance reform. But it also represents a larger shift among anti-abortion activists, who are increasingly targeting contraception and other non-abortion reproductive health care. Though the vast majority of Americans approves of contraception (even most of those who call themselves “pro-life”), coverage of birth control has come under attack. The Federal Deficit Reduction Act of 2005 already sent subsidized birth control to the chopping block (though this “budgetary oversight” has recently been corrected). Last fall, voters in Colorado defeated ballot initiatives that would have defined personhood under the state consitution—with all the rights and guarantees thereof—as beginning at the moment of conception. Unfazed by this defeat, its backers are pushing a similar initiative in Florida. This law would prohibit not only abortion, but the morning-after pill and the regular old Pill too. (Under a strict interpretation, it would also criminalize menstruation, as up to two-thirds of fertilized eggs never implant. One wonders how they intend to enforce this.) These initiatives blatantly conflict with the US Constitution (not to mention basic standards of reasonability), but are meant to erode reproductive health care with a barrage of attacks. Cutting reproductive health coverage out of a public insurance program would go one step further toward a health system that delegitimizes women’s health care as non-essential.

President Obama and pro-choice members of Congress face a great deal of pressure to make compromises to pass some sort of health insurance reform. But reform should not come at the expense of reproductive health care, and no compromise should be made to placate people who won’t vote for any reform bill anyway. The Planned Parenthood Action Center has more information on the different bills wending their way through Congress, and what you can do to help safeguard reproductive health care.

Whatever happens with health insurance reform, it won’t resolve the problem of the Hyde Amendment. Having legalized abortion is completely meaningless if women cannot access it. The Hyde Amendment establishes a two-tiered health system: freedom of choice for wealthy women with private insurance, tough luck for low-income women and women in the military. (As Justice Ginsburg noted last spring, women of means can always get an abortion if they want to—here and everywhere else.) Congress renews the Hyde Amendment every year, and pro-choice members of Congress have so far been unsuccessful in removing it from budget negotiations. But with a pro-choice president and majorities in both houses of Congress, there is hope for positive change. The proposed Freedom of Choice Act (FOCA) would overturn the so-called “Partial Birth Abortion Act” and codify Roe v. Wade into Federal law. Obama has expressed his support from FOCA, but so far the loudest voices on the issue have been in opposition.

I understand that some people object to their tax money being used to pay for abortions. I object to my tax money being used for lethal injections, cluster bombs, and subsidized logging in the Tongass National Forest. But individual taxpayers are not given a line-item veto over Federal appropriations. The Supreme Court has ruled that our Constitution’s guarantee of due process gives women the right to make fundamental decisions about their bodies. That right means nothing if it’s not backed up by a health care system—public and private—that covers reproductive care.


At September 29, 2009 at 10:30 AM , Anonymous Dan said...

"Under a strict interpretation, it would also criminalize menstruation, as up to two-thirds of fertilized eggs never implant. One wonders how they intend to enforce this."

With this kind of flagrant misrepresentation of opposing views, I take it that you have no intention of engaging in anything resembling intellectually honest dialog. I therefore cannot take you seriously, Thomas.

At September 29, 2009 at 8:06 PM , Anonymous Dan said...

Ok, what happened to the comment I submitted earlier? Perhaps you didn't like the way I worded it, but I am very annoyed at Thomas for flagrantly misrepresenting opposing views.

I guess maybe I should be more charitable and allow for the possibility that he genuinely doesn't understand the opposing views.

At October 1, 2009 at 9:46 AM , Anonymous LSG said...

Tom, I thought this was a really excellent and thorough post and I've been meaning to write a longer comment to it -- but for now, a slightly encouraging update!

Senate Finance Committee rejected Senator Orrin Hatch's anti-abortion amendments on the bill they're working on, which would have gone above and beyond the restrictions on federal money being used for abortion that already exist in the bill. The first amendment (which I was freaking out about more) would have applied the current ban on federal money touching abortion to the entire health care reform bill. Basically, it would have meant private insurance companies wouldn't cover abortion in a standard policy, women would have to buy a supplemental policy if they wanted it covered. I hope everyone sees the problems with that without too much explanation. They also rejected Senator Hatch's conscience clause amendment, which I have more mixed feelings about but thought should absolutely be rejected in its current form.

The members of the Committee voted along party lines with two exceptions -- Republican Olympia Snowe both voted and spoke against the amendments, and Democrat Kent Conrad voted for it (he also voted against the public option amendments, along with Senators Baucus and Lincoln). I spent about half an hour last night writing to Senator Snowe and a few of the centrist Democrats on the Committee thanking them for their votes, and encourage everybody who feels the same as I do to do the same -- they have handy contact forms on their websites and maybe the positive reinforcement will help!

Dan, I think Tom was trying to show the logical conclusion of a law that defines a fertilized egg as a person, rather than describing the exact provisions of the law. Were the law to be passed, menstruation would be no more illegal than miscarriage, but defining a fertilized egg as a person could leave women who miscarry open to charges of neglect or child endangerment. I think that's where he was going with this -- pointing out that saying a "fertilized egg" is a person goes beyond even saying that an embryo or fetus is a person, and reaches into the time before a woman is even pregnant (ie before the egg is implanted) to control her body. Of course, I could be wrong about Tom's intent or understanding of the opposing position.

At October 1, 2009 at 3:31 PM , Blogger TommyD said...


Yep, I did see that the Finance Committee rejected the two Hatch Amendments. Highly encouraging. But don't pull out the Chandon yet--just as the public option will be back on the whole Senate floor, I imagine these amendments will make another appearance.

And Dan, I do not believe that it is anyone's intention to criminalize menstruation or miscarriages. (In fact, I don't think these Personhood Amendments are intended to be governing policies at all, only triggers for test cases to repeal Roe.) What I was trying to illustrate were the sticky legal consequences that would arise if "fetus/embryo/zygote=person" actually were taken seriously as policy. I think I'll devote my next full column to teasing these ideas out, so take this as a bit of a preview.

At October 1, 2009 at 8:19 PM , Anonymous Dan said...

Oh, come on guys... a fertilized egg *is* an embryo. It's the zygote (single cell) stage of the embryo. And yes, this occurs before implantation. The logical fallacy in Tom's assertion that "it would also criminalize menstruation" lies in his (and, apparently, your) failure to recognize the difference between an accidental death and a deliberately caused death. If I am in a situation where I know that 2/3 of a certain group of people are going to die, I would be guilty of murder if I kill *any* of them at any time, even the ones who are going to die anyway.

I also have other problems with Tom's piece, for example the gratuitous ad hominem he tossed at Henry Hyde.


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