Health Care Win, Pro-Choice Loss

The law of unintended consequences walloped Democrats in the key congressional vote on health-care reform over the weekend, as internal warring over abortion split the party-despite the best efforts of Rep. Lois Capps.

The elation of the historic House vote in favor of sweeping reform legislation was chilled for progressives by the 11th hour inclusion in the bill of an amendment to greatly expand restrictions on abortion, which would prohibit many women from purchasing insurance to cover the procedure-even with their own money. As the full implications of the anti-abortion amendment became clear, pro-choice groups reacted angrily and the bitter, long-simmering cultural divide over the issue threatened to derail the entire reform effort.

“As is too often the case, women’s access to reproductive health care, specifically abortion services, were sacrificed” by passage of the anti-abortion amendment, Capps said after Saturday’s vote. “This victory for comprehensive health care is a bittersweet one.”

The Santa Barbara Democrat was in the middle of the abortion controversy, which focused on how to comply with an existing ban on federal taxpayer financing for elective abortions-known as the Hyde Amendment-in the course of making health insurance available to millions of uninsured and underinsured people. Under her “abortion neutral” amendment, a new, government-run “public option” plan to provide federal subsidies for those who cannot afford insurance could offer coverage for abortion; however, women receiving federal dollars would be required to pay for the procedure themselves. Also, people without employer-based coverage, who enrolled in a private plan offered through a newly created insurance marketplace, would face some restrictions on abortion coverage.

Her measure, praised by the New York Times as a “careful compromise,” was aimed at keeping federal and private funds for abortion reimbursements separate. But pro-life representatives attacked the Capps amendment as “an accounting gimmick” that allowed public funds to be used effectively, if indirectly, to pay for abortions. Spurred by the U.S. Conference of Catholic Bishops, pro-life Democrats succeeded in removing Capps’s measure from the House bill and replacing it with far tougher language.

The amendment in the House bill, by Rep. Bart Stupak (D-Mich.), would not only ban abortion coverage for those in the new insurance programs, but also for those enrolled in any private plan that accepts people using government subsidies to get coverage. This means that abortion coverage would be denied to millions of women who pay for health insurance without a government subsidy. Under Stupak’s amendment, women enrolled in these plans would have to buy a separate “rider” policy for coverage of the procedure.

“There’s going to be a firestorm here,” Rep. Diana DeGette (D-Colo.) told the Washington Post. “Women are going to realize that a Democratic-controlled House has passed legislation that would prohibit women paying for abortions with their own funds.”

Capps was one of several pro-choice House members who attended a stormy meeting in the office of Speaker Nancy Pelosi (D-S.F.) on Friday night before the vote, during which it was clear that the anti-abortion amendment was the price House leaders would have to pay for the support of the overall reform bill by conservative, “blue dog” Democrats. Spooked by election results a few days before, in which Democrats saw Republicans make substantial gains among independent voters in several states, some blue dogs who had been wavering over health reform threatened to vote down the legislation unless anti-abortion language was added.

“The Speaker was playing four-dimensional chess,” said a congressional source who watched the behind-the-scenes drama. “The votes weren’t there for passage, she had a host of unpleasant choices, and she was running out of time.”

Abortion rights advocates now hope to block the restrictions in a version of reform legislation in the Senate, where passage of any health-care bill remains unclear. Even if the Senate acts, abortion is one of several major political conflicts that would require resolution by both houses, including how to pay for expanded insurance benefits, inclusion of a public option, and requirements for employers to pay for workers to be covered. Any could scuttle health-care reform. Despite the emotional celebration that erupted on the House floor after Saturday’s vote, it is clear the real health-care battle has just begun,

PEOPLE’s POLITICS: Amy Goodman, host of public radio’s Democracy Now will be speaking at UCSB’s Campbell Hall next Wednesday (Nov. 18). Sponsored by KCSB radio, in partnership with S.B. Channels public access TV, the event starts at 6:30 p.m. Capitol Letters says check it out.