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Health Battle Over Abortion Moves to Senate Bill

Wednesday, November 25, 2009

Pro-choice activists are battling to keep the House's Stupak-Pitts amendment out of the Senate version of the health care bill. In doing so, they find themselves squaring off against an old, nearly forgotten barrier: the 1977 Hyde amendment.

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Pro-choice activists are battling to keep the House's Stupak-Pitts amendment out of the Senate version of the health care bill. In doing so, they find themselves squaring off against an old, nearly forgotten barrier: the 1977 Hyde amendment.
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Lois Herr speaks out against the Stupak-Pitts amendment at a pro-choice rally in West Chester, Penn.WEST CHESTER, Penn. (WOMENSENEWS)--Progressive organizations and pro-choice activists will team up for a rally in the capital on Dec. 2, during the week the Senate is expected to begin debating its version of health insurance reform.

Their aim: to stop senators from absorbing the Stupak-Pitts amendment--which is in the U.S. House of Representatives' bill--in their version.

"We're working our hearts out to stop Stupak-Pitts," Terry O'Neill, president of the National Organization for Women, or NOW, told Women's eNews in a recent interview.

The amendment--named for Rep. Bart Stupak, D-Mich., and Rep. Joe Pitts, R-Pa.--infringes on abortion access in three ways:

  • It prevents any government-run plan from offering abortion coverage, even if women pay for the service with their own premiums;
     
  • It prohibits participants in a proposed health insurance exchange from receiving abortion coverage if they also receive government subsidies available to low- and moderate-income earners;
     
  • It requires private insurance companies in the exchange to only provide abortion as supplementary coverage.

The practical result of the Stupak-Pitts amendment would mean "a new norm of exclusion" for abortion coverage, according to a recent analysis by George Washington University's School of Public Health.

Chance of Dropped Coverage

In the five states that currently regulate the insurance industry's coverage of abortion there's no market for supplementary coverage. The George Washington University study concludes that it would be "virtually impossible" for the industry to segregate a supplemental abortion plan from a more general plan because of legal, technical and administrative hurdles. That could encourage insurers interested in participating in the public exchange system to drop abortion coverage, which is now widespread in private plans.

Activists will be pushing senators to accept a carefully crafted compromise on abortion named after Rep. Lois Capps, D-Calif., rather than one similar to Stupak-Pitts.

Scuttled by the vote on Stupak-Pitts, the Capps amendment proposes a ban on federal funding for abortion, except in cases of rape, incest or to save the life of the mother. But Capps' compromise does allow insurance companies in the exchange and a government-run plan to cover abortion if women pay for the service through premiums.

With its explicit and potential consequences, Stupak-Pitts is widely seen as the greatest infringement on abortion access since the days before Jan. 22, 1973, when abortion was illegal and the Supreme Court had not yet enshrined abortion as part of a woman's constitutional right to privacy in its Roe v. Wade ruling.

How did abortion restrictions manage to travel forward, politically speaking, under the cover of reforming health insurance?

The answer is the Hyde amendment, which was passed in 1977 and persists as an annual rider to the Department of Health and Human Service's spending bill.

Hyde prohibits federal funding for abortion for Medicaid recipients, except in cases of rape, incest or if the woman's life is threatened.

Paving the Way for Restrictions

For two decades after its passage, Hyde helped pave the way for the expansion of federal funding restrictions on abortion to women in the military, in federal prison, Native Americans, poor residents in D.C., and Peace Corps volunteers.

In 1977 the late Rep. Henry Hyde, R-Ill., explained his vision for the amendment that bears his name.

"I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman. Unfortunately, the only vehicle available is the…Medicaid bill," he said.

The Hyde amendment suffered multiple blows as lawsuits brought in individual states successfully allowed states to extend abortion coverage through their Medicaid programs.

In light of that, Rep. Jerrold Nadler, D-N.Y., a member of the House Pro-Choice Caucus, recently expressed a widespread view--before the passage of Stupak-Pitts--that Hyde was "ancient history." He also told Women's eNews that opposing sides in Congress had been at a "stalemate" over Hyde for years.

With 23 states using their own funding for abortion in their Medicaid programs, the House Pro-Choice Caucus and other pro-choice groups paid little attention to Hyde as a potential element in health reform politics.

Days before the House vote, however, the U.S. Conference of Catholic Bishops caught pro-choice advocates off guard by rejecting the Capps amendment as insufficiently stringent and citing Hyde as a reason to restrict abortion coverage in health insurance reform. Stupak carried that argument into Congress.

In presenting his amendment on the House floor, Stupak invoked Hyde five times in what opponents say was a deliberate effort to misrepresent his amendment as the status quo on the use of federal funds for abortion.

Hyde Underestimated

In hindsight, Laura MacCleery, director of government relations at the New York-based Center for Reproductive Rights, said Hyde was underestimated.

"I think the intention was that we would fight the fight on Hyde another day," she said. "It's obvious now what an advantage it gives anti-choice groups to have the Hyde restrictions in the background."

During the House debate anti-choice advocates, she said, managed to generalize Hyde's restrictions to cover all federal funding for abortion.

The amendment passed, with the help of 64 Democrats, by a vote of 240 to 194.

That leaves pro-choice advocates facing the need to settle an old political score, going back more than two decades.

"We've got to get the codification of Hyde out of our health care because abortion is health care," said NOW's O'Neill.

On Nov. 21, about 100 pro-choice advocates gathered outside the county courthouse in West Chester, Penn., waving signs saying "Keep Abortion Legal" and "Stop the War on Choice."

NOW sponsored the weekend rally to mobilize against the amendment and to support Lois Herr, who's challenging Pitts, Stupak's co-sponsor, in the 2010 elections.

Lisa Wickenheiser, a 34-year-old accounting representative from Ephrata, Penn., said she worries that Stupak-Pitts would jeopardize the reproductive rights of millions of women.

"It's going to stop coverage for middle class and working women," she said. "If we don't stop it now we're going to regret it later."

Julia Marsh is a D.C.-based correspondent covering domestic and foreign affairs for a Japanese newspaper.

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