Politico.com,
November 19, 2009
Bishops
reprise old abortion fight
By David Rogers
Thirty-three years
ago this fall, a bitter, race-tinged fight over abortion matched
Roman Catholic bishops and the House against the nation's first
popularly elected black senator, Republican Ed Brooke of Massachusetts.
Now, with health care reform on the line, the same male-dominated
church hierarchy is dictating to the first woman speaker of the
House, Democrat Nancy Pelosi, a Catholic herself and past ally
for the bishops on everything from human rights in China to tax
credits for low-income families.
Beneath this stark picture is a much more diverse nation - and
set of political actors.
Two Americas have evolved since the late Rep. Henry Hyde (R-Ill.)
first attached his famous amendment in 1976 barring federal Medicaid
dollars from being used to fund abortion services for poor women.
Seventeen states, representing 40 percent of the nation's population,
have exercised the option to use their own money to provide abortion
services for Medicaid beneficiaries. And in these same states,
women generally are far more likely to rely on their private insurance
plans to help pay for abortions.
At the same time, the anti-abortion lobby remains dominant in
Congress, fathering "mini-Hydes" that go beyond Medicaid
to affect millions of federal workers, the military, the American
Indian health service, women in federal prisons and even Peace
Corps volunteers.
The bishops can make a strong case that the anti-abortion language
inserted into the House health care bill extends only this central
principle: Federal health dollars can't go to pay for abortions.
And for 12 years, these same restrictions have applied not just
to fees for abortion services but also to any federal contributions
to health plans that cover elective abortions.
"We have 53 million people already under Medicaid, and now
we're going to add about 33 million uninsured?" asked Richard
Doerflinger, an associate director with the U.S. Conference of
Catholic Bishops. "It applies to a new situation, but it
is not qualitatively a new situation."
Or is it?
The political reality is the anti-abortion movement has largely
succeeded in Washington by applying Hyde restrictions to what
are captive populations reliant on the government. Thus the U.S.
Supreme Court held in 1980 that a poor woman lost nothing under
Hyde since she had so little to begin with.
Health reform is very different in that the government is mandating
that individuals obtain coverage, not just for their own good
but also for the good of the health system generally. Expanding
the risk pool is essential before requiring insurance companies
to end their most onerous practices, such as excluding people
with pre-existing conditions. And by cutting down on freeloaders,
the hope is to slow the rise of health premiums for everyone.
It's a shared endeavor made easier by government subsidies, but
the costs are real - especially for those who don't have employer-paid
coverage.
Consider, for example, projections by Massachusetts Institute
of Technology economist Jonathan Gruber for a family of four with
an income of $60,640 or a single individual earning $29,780. Both
stand at 275 percent of poverty and therefore qualify for tax
credits to reduce their costs. But the family would still pay
$5,740, or 60 percent of its premium; the single individual would
pay $2,830, or 80 percent, of the cost.
That's a far higher private contribution than is seen with Medicaid
or federal workers and the military. But the House language makes
no distinction, barring anyone who accepts a stipend of any size
from using it to buy a policy covering abortion services.
Insurance companies marketing to individuals in the exchanges
would also have to tailor their health plans to comply. And this
limits the options for those who get no stipend at all.
It's estimated that 3 million people enrolled in the exchanges
will get no assistance. An additional 9 million will fall into
that category as more employers buy in to cover their workers.
But since the great majority of those in the exchange will get
some stipend in the early years, insurance companies will be inclined
to target their plans to this market and not cover abortion.
"It tells people what they can do with their own money, and
it taints the private insurance market," Susan Cohen, director
of government affairs for the New York-based Guttmacher Institute,
told POLITICO.
Added Sen. Sheldon Whitehouse (D-R.I.): "For the first time,
what the anti-choice advocates are saying is that [the federal]
dollar now has to control ... what these private-sector companies
can offer. That's new, and that's a big intrusion into the relationship
of the private citizen with his or her insurance company."
Going forward in the Senate, the bishops will press their case
hard; a new action bulletin went out Monday. But neither side
in the abortion debate is a stranger to compromise.
Short of votes in 1993, Henry Hyde agreed to restore old exemptions
for cases of rape and incest. Ten years later, as chairman of
the House Foreign Affairs Committee, he went lighter on family
planning groups - who counsel on abortion - to get to his goal:
abstinence programs in the battle against AIDS in Africa.
Hyde always left governors some flexibility - a distinction that
could be important now, depending on what role states finally
have in running the insurance exchanges. And even in the case
of health care for federal workers, anti-abortion senators embraced
a compromise in 1993 under which the government would shoulder
the administrative costs so plans could cover abortions through
separate riders demanding an added premium.
This proposal narrowly failed on a procedural vote. But it was
a more generous approach - from the standpoint of abortion rights
- than the House language and could yet make such riders more
viable, especially if small-business employers chose to buy them
for their workers in the exchanges.
In striking her bargain with the bishops, Pelosi may have underestimated
the anger it provoked among her women friends. But she had little
choice if health care was to move forward, and she was looking
for an ally going into the Senate.
Church leaders appear to have played to this desire by tapping
Cardinal Theodore McCarrick, the retired archbishop from Washington
and a longtime force in the USCCB, to make a call to Pelosi from
Rome. The two had overlapped before because of their common interest
in international policy. And in a 2007 interview with the Catholic
News Service, McCarrick praised Pelosi for being someone "you
can always talk to" and "a very bright lady who understands
politics more than most people in Washington do."
The speaker refuses to discuss their conversation. McCarrick,
back in Baltimore meetings this week, indicated through a representative
that he is also uncomfortable talking about the phone call at
this time.
But the bishops are the first to admit they are far closer to
the speaker than to the Senate on the major issues of subsidies
for the poor and treatment of immigrants - two flash points for
Pelosi's left. And the big question for House Democrats now is
whether they will see some of the same muscle that was applied
to them on abortion.
"The bishops are willing and eager to meet and talk with
whoever wants to about our issues and concerns about passing genuine
health care reform," said Kathy Saile, director of domestic
policy. "The bishops see it as a moral imperative and national
priority."
Monday's bulletin to the Senate began with abortion but then added:
"Health care must be made more affordable and accessible
to those in need, and immigrants must not lose or be denied health
care coverage."
"We need more than a bulletin," said a House Democratic
aide.
Speaking in Baltimore on Monday, Chicago Cardinal Francis George,
president of the USCCB, defended its tactics, saying the church
must ensure that "issues that are moral questions before
they become political remain moral questions when they become
political."
Watching it all with a special perspective is Rep. Dale Kildee
(D-Mich.), who once studied for the priesthood and counseled the
bishops to hold firm with the speaker and fellow leaders.
"They were wearing down. I told them time is on our side,"
Kildee told POLITICO. "The Catholic Church is great at politics.
They've been around for 2,000 years. If you go to the Vatican
library, you can find correspondence between the pope and Genghis
Khan."
"What about the separation of church and state?" a reporter
asked.
"In law," Kildee said, smiling broadly. "Not in
politics between the church and politically minded people."
Back
to Top
Send
this page to a friend!
