Abortion and Republican Ideas on Reforming Healthcare

Abortion and Republican Ideas on Reforming Healthcare March 1, 2010

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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