[b]Understanding the health care reform abortion trap[/b] [b]Why it has little chance of passing[/b] [b] [/b] [b] [/b] [url=http://commons.wikipedia.org/wiki/Image:Bart_Stupak_official_109th_Congress_photo.jpg][img]http://trueslant.com/rickungar/files/2010/03/300px-Bart_Stupak_official_109th_Congress_photo.jpg[/img][/url]

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Who would have thought that after a year of ‘death panels’, ‘bending cost curves’ ‘Cornhusker Compromises’ and ‘reconciliation’, the success or failure of health care reform would end up riding on the question of federal funding for abortion?

Make no mistake – abortion [i]will[/i] be the issue that determines whether or not some kind of health care reform makes it to the president’s desk.

So, what’s really going on here?

Historically, there has been a truce between the pro-life and pro-abortion forces in Congress on the question of federal funding for abortion dating back to 1976 when the Hyde Amendment, which barred the use of federal funds to pay for abortions, was signed into law.

However, there have been many contradictions in how the law was applied. For instance, while federal dollars contributed to state Medicaid programs – typically one-half of a state’s Medicaid budget – may not be used to pay for abortions, many states have permitted elective abortion coverage to be paid solely out of the funds the state contributes to their Medicaid program, thus thwarting the federal intent. Bear in mind that states have an obligation to follow federal guidelines on their Medicaid plans if they want the federal contributions. Yet, the federal government has never pushed the issue on providing elective abortion, despite the Hyde Amendment, so long as the states use their own money to pay for it.

Seeing an opportunity to resolve some of these issues in favor of the anti-abortion forces, Rep. Bart Stupak (D-MI) wedged a provision into the House health care reform bill that would bar any insurance policy being offered on the proposed insurance exchanges from including a benefit allowing  payment for elective abortions [i]if the beneficiary is receiving a subsidy from the federal government [/i]to buy that insurance. How did he do it? Pelosi couldn’t pass a health care reform bill through the House without Stupak and the votes he controlled.

Should the abortion language in the House bill ultimately become law, a woman or family accepting federal subsidies to purchase health care insurance on the insurance exchanges to be created, would not be permitted to buy an insurance policy with an elective abortion benefit. In that way, the federal money provided by way of the subsidies will not run the risk of being spent on buying an elective abortion benefit.

In the Senate bill that was passed, there is also language banning federal funds for abortion– but the language is far less stringent. Introduced by Sen. Ben Nelson (D-Neb.), the very same Ben  Nelson who brought us the ‘Cornhusker Compromise’, the bill requires that those who receive federal subsidies to purchase their insurance may not pay for an elective abortion benefit with those federal funds. That is not to say that the insurance policy cannot offer this benefit – it is only to say that the federal funds may not be used to buy the benefit.

So, let’s say you are a family who is receiving federal monies to assist with buying health insurance on the exchange. The cost of the abortion benefit runs, by most estimates, about a dollar a month. You would be required to write two, separate monthly checks – one for the main body of coverage and one for the one dollar to cover your elective abortion coverage- and that dollar may not be a dollar received from the government via subsidies.

It’s not difficult to see why those in the House who are committed to keeping federal money out of abortion would find the Senate offering to be less than satisfying. While the Senate effort was a clever way to sidestep the issue, those in the House who support the pro-life agenda, including at least 12 very committed Democrats, understandably see the Senate action as falling well short of the House bill. And the pro-life House Democrats are not biting.

If you think that these 12 Democrats should hardly be in a position to hold up health care reform, you would be very much mistaken. Recall that the reform bill that passed the House did so on a vote of 220-215 with Stupak and friends voting in support of the bill. Subtract those 12 votes and the measure dies in the House.

While those who are supportive of health care reform and/or pro-abortion may find it difficult to believe that these 12 House Democrats would hold up legislation of such great importance in order to push their pro-life agenda, you might want to get used to the idea. There is no question that these Democrats are prepared to trash health care reform in support of the language they insist must be included.

In an interview with ABC’s George Stephanopoulis, Stupak said,

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The bill that they are using as the vehicle is the Senate bill. If you go to page 2069 through page 2078, you would find in there the federal government would directly subsidize abortions … We’re not going to vote for this bill with that kind of language in there. [url=http://politicalticker.blogs.cnn.com/2010/03/04/stupak-prepared-to-vote-no-on-health-care/?fbid=JHf-KzgKndX]Via Politcal Ticker[/url]  

And when asked if he was willing to live with the consquences of bringing down the bill, Stupak added,

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[/quote]  

Yes, we’re prepared to take responsibility. I mean, I’ve been catching it ever since last fall. I mean let’s face it, I want to see health care. But we’re not going to bypass some principles and beliefs that we feel strongly about.” [url=http://politicalticker.blogs.cnn.com/2010/03/04/stupak-prepared-to-vote-no-on-health-care/?fbid=JHf-KzgKndX]Via Political Ticker[/url]  

I have no doubt whatsoever that he means it.

Pro-life folks tend to be very committed to an issue they see as being morally far more important than a health care reform bill and certainly more important than party loyalty. I don’t say that as a criticism. Like them or hate them, these folks feel strongly enough on the issue to run the political risks that attach to voting one’s conscious knowing that many of their constituents may disagree with them.

But there is a problem in the moral logic being pursued by Stupak and friends – one that could just possibly have an impact on where this all ends up.

Based on the numbers we see with respect to people who die because they do not have health care coverage, Stupak and friends will be trading in lives in being – estimated at 44,000 a year – to save the lives of those not yet born. Of course, pro-life supporters would no doubt be quick to point out that elective abortions in the United States number approximately [url=http://emedicine.medscape.com/article/252560-overview]1.3 million each year.[/url]

Still, that’s got to be a tricky one for even the most committed anti-abortion believer.

There are also some serious moral issues regarding those who might be denied elective abortion services, should Stupak have his way, and be forced to seek more affordable abortions outside the medical system. Many of us remember the barbaric days when women were forced to seek abortions in less than ideal circumstances leading to disastrous, life threatening results.  Could anyone possibly want to see a return to such horrible practices?

Should the Stupak group vote against the Senate bill, as currently drafted, health care reform is over. It’s that simple. And yet, even if the Senate Democrats wanted to accommodate Stupak, and include his language in their legislation, it would seem impossible. The abortion provisions are not likely to qualify as an issue that can be resolved via reconciliation as it is not a budgetary issue. Thus, any effort to include the Stupak language in a Senate bill would necessarily re-open the Senate legislation to a filibuster vote. With there now being 41 GOP votes in the Senate to block the legislation, it is highly unlikely the bill could get through.

Where does this leave health care reform?

In very big trouble. It is difficult to see a way out of the box on this. Calls and letters from constituents in those districts represented by the House Democrats prepared to vote against the Senate Bill as a result of the abortion language will not likely carry much influence. As noted, anti-abortionists tend to put the importance of the issue above the desires of their constituents or anything else.

We’re about to discover just what kind of skills Nancy Pelosi and President Obama can bring to the table. It’s going to take all they’ve got – and then some -to find a way out of this mess.