Inside Health Reform
May 20, 2009
Julian Pecquet

House Republican leaders have sent a letter to President Barack Obama calling for restrictions on abortion services, in what some see as the opening salvo of a battle over abortion within the health reform debate. Democrats' calls for a public plan and for individual and employee mandates have sparked fears that the government will mandate abortion coverage as a condition for insurance plans, a pro-life advocate says.

The battle over abortion became a major issue during the 1993-94 Clinton-care debate and was one of several factors that helped doom the reform effort then. And the issue's enduring potential for divisiveness was on full display over the weekend when Obama addressed the graduating class at the Catholic Notre Dame University, where the president called for "open hearts, open minds, fair-minded words" on both sides of the debate but acknowledged that "at some level, the views of the two camps are irreconcilable."

The GOP letter calls for a discussion on "areas of potential common ground on health care reform" and largely consists of mostly vague and politically charged language critical of "rationing care" and "empowering government bureaucrats at the expense of patients and doctors." But a paragraph on abortion stands out because of its level of detail and the fact that this hasn't been a central issue to date in the health reform debate.

"We also believe," the May 13 letter states, "these goals can be accomplished through health reform that maintains current law provisions regarding restrictions on federal funding of abortion services, restricts federal funds from flowing to abortion providers, and does not impose mandates either on insurance carriers or medical providers to participate in activities that violate their religious and moral beliefs."

A House Republican aide tells Inside Health Policy that "as the health care discussions continue, there is a likelihood the majority might try to legislatively mandate treatments through health care reform. Health care providers shouldn't be forced to perform any practice they are morally against."

Douglas Johnson, federal legislative director for the National Right to Life Committee (NRLC), said his group was "happy to see the Republican leadership lay down a marker." He said the Democratic-led Congress' tight timeline for health reform all but guarantees that the fight over abortion "is going to ramp up quickly" as Democrats get closer to unveiling legislative language.

"They can only pass this through stealth, speed and subterfuge," Johnson said. "We might as well do what we can to make it difficult for them."

Johnson said his group was particularly worried about proposals for a public plan and for individual and employee mandates, because these could lead the federal government to administer an abortion plan or mandate abortion coverage as a condition for insurance plans to participate in a health insurance exchange. His group has called for "pro-life Americans" to "vigorously oppose" any "federal health care reform legislation that does not explicitly exclude abortion from the scope of any government-defined or government-mandated package of health care services."

Johnson pointed out that Medicaid paid for 300,000 abortions a year in the first three years after the Roe v. Wade decision before the Hyde amendment (which bars the use of federal funds to pay for abortions except in cases of rape, incest and danger to the mother's life) reduced it to about 300 a year.

But that flies in the face of what pro-choice groups such as the Planned Parenthood Federation of America want. In a "wish list" signed by PPFA and more than 60 other pro-choice organizations and submitted to the Obama transition team in November, the groups, according to a document quoted in the NRLC's newsletter, called for the president to "put forward a health care reform plan that guarantees access to comprehensive, high-quality, affordable health care for all... Comprehensive benefits must include access to the full range of reproductive health services, including contraception, maternity care, and abortion care."

Appearing before the annual conference of the Planned Parenthood Action Fund on July 17, 2007, then-Sen. Obama said "in my mind, reproductive care is essential care, basic care, so it is at the center, the heart of the plan that I propose."

Planned Parenthood did not return several calls for comment by press time.

Also according to the NRLC, Columbia University's school of public health recently issued a report calling for the inclusion of abortion in a national health care system, arguing that existing federal and state laws prohibiting the use of public funds for abortions spills over into the private sector, with four states prohibiting private insurance from covering most abortions and 11 states restrict or prohibit abortion coverage under policies sold to public employees. The report is endorsed by 38 deans of university public health schools.

"A new national health care plan should provide the full range of family planning services, medications and devices," the report says, "and assure confidentiality so that women seek needed care in a timely way."

One health policy consultant suggested that the abortion issue could be used to undermine other aspects of health reform that some groups dislike. "I guess they're trying to appeal to their base with the abortion stuff," the consultant told Inside Health Policy. "If you're trying to oppose something, you try different strategies to see what sticks and that has not come up before (in the health reform debate)."

Although it hasn't taken center stage, the issue of abortion has already come up in the context of health reform. Obama's choice of Kansas Gov. Kathleen Sebelius to head HHS. Sebelius' nomination was opposed by key GOP members who were upset she accepted funding from an abortion provider.

HHS has also announced its intention to rescind a Bush administration regulation that allowed providers to refuse abortion services. Critics of the Bush regulation argued that the policy was written too broadly and that providers are already allowed exemptions from providing services to which they object on moral grounds. At Notre Dame, Obama spoke for the first time of the need for a "sensible conscience clause."

Obama has also eliminated the Bush-era restriction on giving aid to international groups that provide abortions, and eased restrictions on embryonic stem cell research.

The abortion issue is currently gaining greater traction because of a combination of factors, including Obama's need to choose a replacement to retiring Justice David Souter from the Supreme Court; the defection of pro-choice Sen. Arlen Specter (PA) to the Democratic Party; and Obama's address Sunday (May 17) at Notre Dame University, during which 38 protesters were reportedly arrested on campus, mostly for trespassing.

And a new Gallup poll, conducted May 7-10, finds that more Americans -- 51 percent -- consider themselves "pro-life" rather than "pro-choice" (42 percent), adding weight to the argument that the fight over abortion still resonates.

"The poll marks the first time a majority of U.S. adults have identified themselves as pro-life since Gallup began asking this question in 1995," according to Gallup, and the findings "represent a significant shift from a year ago, when 50% were pro-choice and 44% pro-life. Prior to now, the highest percentage identifying as pro-life was 46%, in both August 2001 and May 2002."