Abortion and Republican Ideas on Reforming Healthcare

It’s been a source of great irritation to me for a while now that many on the right are using the specter of abortion to vehemently oppose the current healthcare reform bill – even salivating over the election of a pro-abortion pro-torture senator who might well have had the power to derail the whole process. It’s been clear for some time now that they oppose this reform mainly on individualist grounds – the imposition of a mandate to purchase insurance combined the healthy subsidizing the sick (either directly through community rating or indirectly through government subsidies). Yet again, the unborn are being used as a weapon in a broader political fight.

Do I have any evidence to back up this claim? Exhibit A: the effect of current and past Republican healthcare initiatives on abortion. The issue of the proximity of federal subsidies to abortion has been raised to a higher level in this debate than ever before. The political pro-life movement, including the NRLC, gave the thumbs-up to past legislation that had far fewer bulwarks against abortion than the current bill.

Take, for example, Medicare Advantage, the Republican initiative to contract with private insurers in Medicare. It works by the government channeling subsidies to the private insurers participating in the program, instead of paying for Medicare directly. It turns out that this is a rather inefficient program, costing the government quite a bit more per enrollee than traditional Medicare, which is why the Democrats are keen on rolling it back, but this is not the point I want to make here. Rather, the point is that Medicare Advantage had a rather cavalier attitude to the ability of these private insurers to provide abortion.

Courtesy of Kurt, a regular and informed Vox Nova commenter, here is the Medicare Advantage appropriations language:

“EC. [211]210. None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry out the Medicare Advantage program if the Secretary of Health and Human Services denies participation in such program to an otherwise eligible entity (including a Provider Sponsored Organization) because the entity informs the Secretary that it will not provide, pay for, provide coverage of, or provide referrals for abortions.”

I realize this is rather dense legislative language, but it says something quite simple: if the Secretary refuses to allow an insurer to participate in the program because it will not cover abortion, the whole program gets no money. In other words, no company can be required to include abortion services as a condition of participating in Medicare Advantage. Of course, it does not stop these companies providing abortion services. It’s actually an extremely weak pro-life protection, but it never raised a fuss at the time.

One objection might be that given its demographics, abortion is not an issue in Medicare. I have two responses to this. First, Medicare also provides disability insurance – this affects about 5 million people, 14 percent of all beneficiaries. Some of these people have returned to work, and are permitted to keep their Medicare for a certain period if they do not have healthcare otherwise. Second, the federal funds are being given to private insurers that are covering abortions in some private plan somewhere. After all, money is fungible, and the concentrated nature of the US insurance market means there are few players involved.

Is Medicare Advantage offering abortion in practice? Yes it is. See here for one example, showing clearly the difference between Medicare Advantage and traditional Medicare when it comes to “voluntary abortion”. And this flies under the pro-life radar…why?

It is clear that the current Democratic bills include far more rigorous pro-life language. The House voted for a bill that prohibited insurers accessing the exchange from offering abortion. The Senate voted for a bill with somewhat weaker protections, but allowed states to prohibit access to plans offering abortion, insisted that at least one plan without abortion be offered, and shone the light on abortion provision by forcing a separate payment. As I noted before, pro-choicers are deeply dis-satisfied, complaining that this signal the end of abortion coverage in private insurance plans. How ironic. It could well be a Democratic Congress, with zero support from Republicans, that  implements the first attempt at the federal level to regulate the ability of private insurance companies to fund abortion from peoples’ premiums.

What about current Republican healthcare plans? The main “big ideas” center around tort reform, tax credits for purchasing individual insurance, and the ability of insurers to compete for business across state lines. I assume that the goal, as with the Democratic plan, is to increase the number of people with private insurance in a cost-effective manner. But where are the abortion protections? Republican plans tend to shy away from any attempt to regulate what private insurers can do. If people use tax credits to purchase private plans that they would not otherwise purchase, then is this tantamount to the subsidization of abortion-covering private plans. If insurers can compete across state lines, without the kinds of restrictions in the Democratic plan, then the ability of each state to regulate abortion coverage is lost. The only real defense of the Republican plans is that they do not insure enough people for abortion to be a real concern – under their plan, 52 million would remain uninsured after 10 years.  But is this really a criterion for judging success? How would they plan on covering the same amount of people as in the Democratic plan while ensuring that the expansion does not increase abortion coverage in private insurance? There is no answer to this.

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  • JoanC

    Your thoroughness is to be commended.

  • ctd

    Assuming this is correct – I am not saying that it is or is not – how is it relevant to the real issue before us – whether we should support a health care reform package that either (1) allows government funds to pay for abortions or (2) mandates that people pay an abortion surcharge as a condition of participating in the insurance exchange?

    The inconsistencies of Republicans, whether or not true, is irrelevant.

  • Kevin

    Perhaps they are just listening to the bishops.

  • Kurt

    (2) mandates that people pay an abortion surcharge as a condition of participating in the insurance exchange?

    ????? Where on earth did you get this idea from? Neither the House nor Senate bill has such a mandate.

  • http://www.patheos.com/blogs/voxnova Morning’s Minion


    You claim the issue is that it “allows government funds to pay for abortions”. Fine, but think about this. From a broad perspective, any money that comes from the government budget could be used to purchase abortion, so long as abortion is legal. A civil servant could use her wages, an unemployed person her unemployment benefit etc. The standard so far has been far narrower, as the Hyde Amendment relates only to public programs.

    But let’s be clear – this HCR is not a public program. It entails a mandate to purchase private insurance twinned with subsidies for those below a certain income threshold. To create some distance from abortion, we are now in the business of regulating what the private sector can do. I personally think this is fantastic, but it’s also a first. This never seemed to bother people before, which is why I brought up Medicare Advantage.

    Your other point relates to the “abortion surcharge”. This is from a talking point. It is referring to the separation of premium payments. What do you think will happen? I’ll tell you. People won’t like it. They won’t like the inconvenience and they won’t like the principal. Hence, they will be more likely to choose a plan that doesn’t offer abortion. And from the perspective of insurers, they will be less inclined to offer abortion – not worth the hassle. Now, you might say this is not very ironclad as pro-life measure, but it’s certainly not any worse than the provisions under Medicare Advantage.

  • http://www.opinionatedcatholic.blogspot.com jh

    “But where are the abortion protections? Republican plans tend to shy away from any attempt to regulate what private insurers can do.”

    This all gets tiresomesome. THe Democrats with a great deal of Catholic support are in control

    USE YOUR INFLUENCE. Why is it I am seeing Democrat leaning Catholics moaning about the GOP and not using their influence to change stuff. NEWS FLASH you are in a better position than us.

    I am sorry that the catholic progreessives could not propduce on their influence and it is little hid by attacking the GOP.

    It is amazing when devout Catholic Democrats leaning folks will just lean over and take it and the Republican folks look like the enemy Sigh!!

    I have watched this for a year now and seen yes DEVOUT CATHOLICS just don’t demand anything.

  • phosphorious

    USE YOUR INFLUENCE. Why is it I am seeing Democrat leaning Catholics moaning about the GOP and not using their influence to change stuff. NEWS FLASH you are in a better position than us.

    It is not. . . or not just. . . that devout catholics don;t use their influence, it’s that republicans have filibustered 100 times in the past year, an unprecedented record of intransigence that has paralyzed legislation.

    I agree, Obama and the democrats should simply roll over the minority. . . they have the votes. . . but as it is, Obama is denounced as a “viciously partisan” president who refuses to ;isten to republicans. Imagine how conservatives would react if he actually did what they say he does.

  • http://kylecupp.com Kyle R. Cupp


    To what extent do you think pro-lifers are aware of or regularly think about the funding of abortion through private insurers?

  • Kurt

    This all gets tiresomesome. THe Democrats with a great deal of Catholic support are in control


    I think we have, and very well.

    Along with a single brave Republican, we convinced most of our caucus to vote for the Pelosi-Stupak Health Care bill. We convinced the pro-choice members of our caucus to put health care first, above their views on abortion.

    We also convinced all of Senate members to support the Reid-Nelson bill in the Senate that includes pro-life restictions even stronger than those supported by the Right-to-Life Committee in 2003.

    There is now a deal in the works where the House will pass the Senate bill along with a separate bill including package of changes they want as well as either the Stupak language or something close to it.

    The pro-life Senate Republicans will then have the Senate bill as a reality and a chance to vote on some other provisions they probably don’t like but stronger pro-life language.

    Can I get some guidence on how much influence my pro-life Catholic Republican friends will have on this? Can I just get a statement that in such a situation abortion trumps whatever else is in the health care package?

  • Gerald A. Naus

    File under “Once you’re born, you’re on your own”:

    “Sen. Jon Kyl of Arizona, the Republican whip, argued that unemployment benefits dissuade people from job-hunting “because people are being paid even though they’re not working.”

    Unemployment insurance “doesn’t create new jobs. In fact, if anything, continuing to pay people unemployment compensation is a disincentive for them to seek new work,” Kyl said during debate over whether unemployment insurance and other benefits that expired amid GOP objections Sunday should be extended.”

    Health “insurance” may just be a way for people to avoid being healthy.

  • ctd

    Regarding the the subsidy question. I did not say that the Senate bill is morally different than Medicare Advantage. I just said that the inconsistency is not an issue. What is the issue for the bishops is that, until now, federal law prohibited the use of federal dollars to purchase plans that cover abortion. Who cares whether Republicans are consistent.

    On the surcharge question – check it out. If the only plan that meets your family’s needs covers abortion, you must write a separate check for abortion coverage.

  • http://www.usccb.org/catechism/text/pt3sect2chpt2art5.shtml Gregory Benedict

    You guys make things way to complicated.
    Obama is not achieving anything as God is in total control and God loves his Children. Maybe it is time all “CINO” Democratic politicians repent.
    The Catholic Church gives us sign posts to light the way.
    Do you know the Church Teaching on Abortion?

    Human life must be respected and protected absolutely from the moment of conception. From the first moment of his existence, a human being must be recognized as having the rights of a person—among which is the inviolable right of every innocent being to life.72

    Before I formed you in the womb I knew you, and before you were born I consecrated you.73

    My frame was not hidden from you, when I was being made in secret, intricately wrought in the depths of the earth.74
    Since the first century the Church has affirmed the moral evil of every procured abortion. This teaching has not changed and remains unchangeable. Direct abortion, that is to say, abortion willed either as an end or a means, is gravely contrary to the moral law:

    You shall not kill the embryo by abortion and shall not cause the newborn to perish.75

    God, the Lord of life, has entrusted to men the noble mission of safeguarding life, and men must carry it out in a manner worthy of themselves. Life must be protected with the utmost care from the moment of conception: abortion and infanticide are abominable crimes.76
    Formal cooperation in an abortion constitutes a grave offense. The Church attaches the canonical penalty of excommunication to this crime against human life. “A person who procures a completed abortion incurs excommunication latae sententiae,”77 “by the very commission of the offense,”78 and subject to the conditions provided by Canon Law.79 The Church does not thereby intend to restrict the scope of mercy. Rather, she makes clear the gravity of the crime committed, the irreparable harm done to the innocent who is put to death, as well as to the parents and the whole of society.

  • jaded voter


    Everything that is wrong with the Republican brand is in those quotes of Sen. Jon Kyle. I wonder if he loses sleep at nite about overpaid executives. Perhaps paying lavish bonuses to executives who run companies into the ground could encourage them to run more entities aground.

    Part II. This article is spot on. Many Republicans have zero interest in expanding health coverage. It is just something they don’t care about. They are using abortion as a distraction. [Pro-lifers must not allow either party to use them.] At the same time while I fully support healthcare expansion I worry how a Democratic bill will play out in practice. Sensible Republicans should engage with Dems to make a bill which properly serves the public as efficiently as possible while containing costs.

  • Kurt


    You have some serious errors of fact and logic in your posts.

    First you asserted one or the other of the two bills “mandates that people pay an abortion surcharge as a condition of participating in the insurance exchange.

    The you somewhat moved into factual truth by claiming “If the only plan that meets your family’s needs covers abortion, you must write a separate check for abortion coverage.”

    So, I appreciate your withdrawal of your previous inacurate claim that particpating in the exchange mandates people pay an abortion surcharge. The truth is they would have a selection of a wide variety of plans, of which you are guaranteed a pro-life option and may also have an option for plans for a plan that includes abortion if both state law and the private sector accomodate it. Yes, of 30 plans, 12 may have abortion and one of those 12 may be the one you otherwise like best (though the plans are not expected to be all that different). It is a vast improvement over the status quo of take or leave what your employer offers (often including abortion to which your premium contributes to).

    The you write: “I did not say that the Senate bill is morally different than Medicare Advantage. I just said that the inconsistency is not an issue. What is the issue for the bishops is that, until now, federal law prohibited the use of federal dollars to purchase plans that cover abortion.”

    You do understand that Medicare Advantage is not a Republican proposal but currently in law? Therefore it really makes no sense to say until now federal law prohibited the use of federal dollars to purchase plans that cover abortion. The Medicare Advantage program is more lax in meeting that test than the Senate bill and was not objected to by either the bishops nor Right-to-Life.

    I am going to take a stand for charity. Some things are fairly clear. A sweater is a sweater and a pair of slacks is a pair of slacks. But if I buy a sweater in 2003 and call it beige colored, and then in 2010 say the same sweater is creme colored, I don’t think that proves I am a liar or a hypocrite.

    So too with RTL and the bishops. What in 2003 they called pro-life and in 2010 they suggest is pro-abortion is just a reflection of the difficulty of discerning how to define indirect subsidies. It is not an easy discernment and open to different legitimate defintions — even by the same person!!!!!!

  • R


    After seven years, it’s no wonder your sweater faded from beige to creme.

    (Just kidding. I agree with all you said. Carry on.)


  • David Nickol

    If the only plan that meets your family’s needs covers abortion, you must write a separate check for abortion coverage.


    It doesn’t sound at all plausible that there will be one and only one plan that meets a family’s needs and that covers abortion. But it seems to me from your point of view, the only choice if that were the case would be for that family to do without insurance.

    If it is so important not to have government money even indirectly supporting abortion that a bill that a bill should not be passed that extends medical insurance to 30 million people, then an individual faced with choosing a policy with abortion coverage or going without insurance altogether must surely do the latter.

    If denying 30 million people insurance coverage over the issue of abortion is the right thing to do, certainly denying yourself insurance coverage over the issue of abortion is the only consistent approach.

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  • Kurt

    Right to Life it seems gave more than passive consent to Medicare Advantage.

    It is their view that the government run Medicare program naturally leads to rationing and that seniors need to be able to get Medicare Advantage plans that allow private sector corporations to determine benefits, networks and services (with, of course, the abortion restriction in Section 211 of the Labor/HHS Appropriations bill), in order to protect life.

    Here is a statement of Kansas Right to Life:

    “Due to years of hard work by the National Right to Life Committee, seniors eligible for Medicare are currently free to purchase alternative insurance plans that are less likely to deny life-saving treatments. [These are policies offered under the Medicare Advantage program– as distinct from the supplemental “Medigap” policies.]”

    So there you have it. Medicare Advantage is a good thing from a pro-life perspective.

  • Kevin


    A bit of a stretch. When someone 65 or older decides to have an abortion we’ll have an intervention. Should we check if priests insurance covers pregnancy and protest that too?

  • Rick Garnett

    MM, are you and E.J. sharing a research assistant? =-)

  • http://www.patheos.com/blogs/voxnova Morning’s Minion

    Hey Rick, Did EJ talk about Medicare Advantage???

  • Kurt


    You forget that Medicare also covers those on Disability Insurance, about 15% of the program partipants.

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