COMPROMISE NEEDED WITH ABORTION FOES IN HEALTHCARE REFORM

Anti-abortion and pro-life advocates successfully added an Amendment to the House Health Reform Bill that prohibited any Federal Funds from subsidizing private insurance purchases by individuals and families on public exchanges that would cover abortions. Pro-abortion and pro-choice advocates cried foul and the amendment constituted an impermissible limit on a woman’s right to choose. The President also complained that abortion legislation does not belong with healthcare reform.

Conservatives may be more correct than Progressives on this limited debate. Pregnancies and abortions are intrinsic parts of any healthcare debate since they impact the health of a woman. It is also a covered medical procedure for a majority of private health policies provided by employers across the country. However, many women do not make claims for reimbursement or present their insurance cards at the time of an abortion because they do not wish to inform their employers they have elected for such a procedure that generally costs between $300 and $600.

Since the 1973 Supreme Court decision, U.S. law permits an abortion for any reason during the first trimester. After the first 3 months, then states can limit it for certain public policy reasons or prohibit certain procedures altogether. There are not that many physicians and medical facilities that provide these services and overall availability varies greatly between different cities and states. The nation is evenly divided on this issue with a slight majority supporting the procedure anytime the mother’s life is at risk or the pregnancy was the result of rape of incest. The Supreme Court has cited these reasons to permit some later-term abortions. Certain abortion foes do not even sanction those exceptions, nor do they support the sale and distribution of RU-486, the morning-after pill since it causes an immediate menstrual period even though a recently-fertilized egg may or may not be present.

Employer-sponsored healthcare exists in the U.S. because of favorable tax treatment by the Federal Government. The benefits of medical insurance are not considered taxable income to the employee yet the employer may deduct those expenses against gross revenues to arrive at taxable net income. This preferential tax treatment has also been subject to considerable debate during the past 10 months. Therefore Conservatives can reasonably argue that federal funds and tax policy impermissibly support and pay for abortions covered under private employer-sponsored health plans.

If Democrats want to pass any healthcare before the 2010 Midterm elections, they will have to compromise with Democrats and some Republicans who support such broad limitations on public funding for abortion. In fact, those opponents of this elective pregnancy-terminating procedure could logically demand that all abortions not be covered in any public or private health insurance policies and that morning-after pills should also be excluded.

This national policy would not limit a woman’s choice, but merely eliminate public funds from paying for those particular legal private choices, without disrupting the need for federal subsidies so lower-income families can afford private health insurance. The left would argue that poor woman cannot afford these procedures without public assistance, but that misses the entire point. The choice is always there but the lack of money to pay for an elective and legal procedure has never been an adequate challenge against restrictions on how public tax funds are allocated.

It is highly probable that the Senate Bill and the later joint conference committee’s final Bill merging the Senate and House versions will have to deal with these issues. The U.S. Conference of Catholic Bishops and other abortion foes will likely widen their demands in light of their recent successful amendment to the House Bill. If they are successful at banning all public and private insurance policies from covering abortions and morning-after pills, Democrats might be able to insert an exception if a physician determines and signs a written certification that the life of the mother is at stake, to make it a covered procedure for all public and private insurance. To expand access to on-demand elective abortions for poor women, proponents may have to depend upon private charitable fundraising for such specific financial support.

As a counterbalance to sweeping prohibitions of any insurance coverage for all abortions, both liberals and conservatives should demand greater public and private insurance coverage for comprehensive pregnancy care, childbirth, extensive infant and maternity care during the first 6 months after birth, and full coverage for surgical remedies of various congenital birth defects.

In addition, progressives could advocate more public funds for comprehensive sex education in all public, charter and private schools starting in the 4th or 5th grade, being this is a healthcare education issue. Those schools that refuse to provide such sex instruction could lose all their federal and state public funds.

All condoms and other pregnancy-prevention medicines and devices for both men and women could be fully covered by public and private health insurance plans. A compromise should be sought to greatly reduce the need for any abortions because there would be far fewer unwanted pregnancies. For those pregnancies that proceed to birth, the mother and new child must become societal priorities so we significantly reduce our inexcusably high infant mortality rate. Any “continuum of life” should include adequate healthcare though every stage of life.

Whereas we can all believe different things with respect to when life begins and death occurs in humans, we need to establish firm, secular lines in a pluralistic society with respect to what is legally protected and what the public will support financially. This compromise would maintain a workable separation of church and state within the healthcare reform debate. These provisions might provide an opportunity for the Democratic Party to bring into its fold a number of pro-life Independents, Democrats and Republicans.

Meaningful healthcare and health insurance reform should move forward this year, even if it does not include everything many people desire. Life in general – and specifically politics in Washington – is an endless compromise. The choice of doing nothing will cost taxpayers far more under the current system in excessive payments under Medicare and permitting tens of thousands of people to die or go bankrupt due to a lack of adequate health insurance.

The public option, whether with an opt-out or triggering provision, or immediately effective for a small number of uninsured, may not survive into the final bill sent to the President. He probably has understood this inevitability since January that politics in Washington would not permit its survival. Some of my prior healthcare posts suggested the same or that a public option was not needed for comprehensive healthcare reform. On this policy initiative, these past 10 months of extreme vitriol, hyperbole, anger, debate and horse-trading were probably all for naught.

I would strongly advocate that the final healthcare legislation permits any state to try its own public option or complete single-payer plan free of any legal challenges. There are probably a half-dozen interested states that should be given the opportunity to be national incubators of these ideas. To oppose even this option for experimentation by individual states would be contrary to the very notion of federalism and our protection of individual freedom and liberty to choose all legal options that have been and still are intrinsic to our very system of government.

The many common, non-partisan, and non-debated proposed reforms in both the House and Senate bills should be enacted even if a major compromise must be made with those that oppose abortion since many of them also support expanded coverage to the uninsured and stricter regulations on private healthcare. We must realistically anticipate that we will be monitoring and modifying our national health system over the next decade. Neither the extreme right nor left is justified in complaining about most of these modest and incremental healthcare reforms.

After the passage of healthcare reform by the end of 2009, we will have to promptly turn towards addressing unemployment and all the other massive challenges facing this country.

Marc Pascal