Saturday, November 14, 2009

Abortion Puts Some in Congress in a Bind

individual health insurance

The abortion issue has put members of Congress who support abortion rights in a quandary over the health care legislation.

Do they stick to their longstanding principles and fiercely resist the legislative effort to limit access to insurance for abortions?

Or should they compromise on the issue and vote for legislation that in other ways could greatly improve health care for women?

The bill that the House narrowly approved on Nov. 7 would severely restrict access to insurance for abortions. But that same bill also tries to improve health insurance for many millions of women, chiefly by expanding coverage to the uninsured and eliminating sex discrimination.

Marcia Greenberger, co-president of the National Women’s Law Center, said supporters of abortion rights should not have to make such a choice.

“There is no reason why women should have to be asked to make trade-offs between having the basic right to coverage of their core health needs,” she said, “and the elimination of some of those unfair and discriminatory practices.”

Supporters of abortion rights are working hard to keep the anti-abortion measure out of the Senate bill, which may come to the floor late this week. But abortion opponents, backed by a powerful lobby that includes the nation’s Roman Catholic bishops, have vowed to fight for it when the House and Senate merge their bills later to produce final legislation.

The Restrictions

The House measure would block insurance companies from selling abortion coverage to anyone who receives a federal subsidy when they buy insurance through the exchanges, or marketplaces, that would be set up for individuals and small businesses. It would also ban abortion coverage for anyone who gets her insurance through a government-run insurance plan.

Most Americans get their insurance through their employers, and it typically covers abortions, so they would not be affected by the legislation’s abortion provision, for now. But because the bill envisions eventually expanding the insurance exchange to include larger employers, the number of women barred from getting insurance for abortion coverage could gradually grow.

For now, the number of those who rely on insurance to pay for an abortion seems relatively small.

The Guttmacher Institute says that of the 1.2 million abortions among American women each year, about 13 percent — 156,000 — are directly billed to their insurers. Most women pay out of pocket, at least initially; an unknown number are reimbursed by their insurers after the fact.

Adam Sonfield, a senior public policy associate at the institute, said so few women were using insurance for abortions now largely because they were unaware that their policies covered them or they did not want their insurer or employer to know they were having one.

The average cost in a clinic in an early stage of pregnancy is about $400. Women may be more likely to use insurance for abortions if their pregnancies become complicated, when the procedure is performed in a hospital and can cost thousands of dollars.

But even as lawmakers who support abortion rights chafe over the anti-abortion language, they will be under pressure from the White House and others to remember that the bill seeks to expand health coverage to millions of women — and men — who do not have insurance now and to end discriminatory insurance practices.

An analysis by the National Women’s Law Center in 2008 found that insurers charged 40-year-old women from 4 to 48 percent more than they charged men for the same individual insurance plans. The House bill would make such “gender rating” illegal.

The same study also found that in some states, insurance companies can reject applicants for certain “pre-existing conditions” that effectively exclude women, like having had a Caesarean section or being the victim of domestic violence.

The bill would make it illegal to deny coverage or charge higher premiums, for men or women, based on pre-existing conditions.

‘So Wrenching’

Robert J. Blendon, a professor of health policy at Harvard, said the choice between trying to stop an erosion of abortion rights and trying to improve health care for women pitted “what are described as two fundamental human rights — the right to universal coverage and the right of access to reproductive services — against each other.”

“They aren’t just policy trade-offs,” he said. “And that’s why this is so wrenching.”

Some House Democrats initially vowed that if the final bill contained the anti-abortion measure, they would oppose it — even though they had just voted for the House bill with that language.

Representatives Diana DeGette of Colorado and Louise M. Slaughter of New York, Democrats and co-chairwomen of the Congressional Pro-Choice Caucus, said more than 40 members had attached their names to a letter to Speaker Nancy Pelosi, warning that they would not vote for a final bill if it “restricts women’s right to choose any further than current law.”

But the two have not released the names of those 40 members, and aides said the commitments were oral, not written. Ms. Slaughter, for one, declined in an interview to say whether she would vote for a final bill with an anti-abortion measure.

“We have to have this health care bill,” she said. “We just have to fix it.”

Supporters of abortion rights are actively lobbying the Senate to do just that.

They want Harry Reid, the Senate Democratic leader, to maintain the status quo — continue to bar federal financing of abortion services but not restrict access to insurance for the procedure. President Obama has backed that approach.

Mr. Reid, who personally opposes abortion, has not tipped his hand. But some activists are sounding more confident that he will find a compromise, and they are being more careful not to draw lines in the sand.

Cecile Richards, president of the Planned Parenthood Federation of America, predicted that the House language would not appear in the Senate bill. “We’re hearing from the Senate that cooler heads are prevailing,” she said.

“There’s a lot of buyer’s remorse in the House,” she added. “But they didn’t want to see health care reform go down on their watch.”