Why “Abortion Neutrality” is a Healthcare Myth

In the current healthcare debate, both sides of the abortion debate claim to be preserving the status quo while the other side is hijacking it to advance their abortion-related agenda. In reality, both sides are correct that there’s no truly neutral abortion option: government funding for healthcare either includes abortion as federally-funded healthcare (against the Hyde Amendment) or it doesn’t (meaning that lots of people with covered abortion now won’t with the public option). Either abortion coverage goes substantially up or down, and the one middle-ground approach has been rejected by pro-abortion advocates. Here’s what’s going on right now:

1. Under the Hyde Amendment, no federal money is to be used to fund abortions (some states, along with the District of Columbia, fund it out of their own coffers). This means, for example, that those on Medicaid can’t charge the nation’s taxpayers for abortions. The Supreme Court has already upheld this as being completely constitutional.
2. Most people now have privately funded insurance coverage and this often covers abortion – there are plans which specifically do not, but the recent brouhaha over the RNC’s healthcare plan covering abortion (it’s worth noting that this provision was never employed) demonstrates how widespread private coverage for abortion is.
3. The proposed healthcare bill, in whatever form it finally takes, will move people from privately funded to publicly funded healthcare insurance.

So people are about to make a jump from the abortion-covering privately-dictated plans to the Hyde-governed plans. So will the government begin to foot the bill for abortion? Or will a number of people who once had abortion covered have it covered no longer?

The debate, at its heart, is really that simple. Once the government starts paying for plans, they either break the ban on paying for abortions with federal funding, or a number of these plans stop covering abortion. There’s no neutrality: either the government gets massively more involved in covering abortion, or insurance gets substantially less involved in covering abortion.

II. The Closest Thing to Neutrality: Abortion Riders
The closest thing to neutrality is this: the Stupak-Pitts amendment allows for an abortion rider. What this means is that the government will pay for everything but abortion, and if you want abortion coverage, you negotiate that yourself, and pay for it yourself. It’s as close as one can get to neutrality because it preserves (1) the Hyde Amendment’s ban on government funding for abortion, as well as (2) the ability of individuals to get abortion coverage in the market. None fo the other options I’ve heard do this successfully. Still, pro-abortion forces are livid with this proposal, and are using four basic arguments.

• First, they’re arguing that it’ll be too complex to negotiate (NARAL’s policy director claimed there would be “chutes and ladders” to obtain coverage). This argument is flatly false. Right now, individuals who obtain private insurance have to navigate a whole lot more chutes and ladders than would be required under an abortion rider. The reason’s pretty simple: with comprehensive health insurance, there are all sorts of moving parts: do you want coverage for x, y, and z ? How high a deductible on procedure A? Should name-brand or generic drugs be covered? And so forth. The abortion rider covers one thing and one thing only: abortion. It is by definition simpler than negotiating coverage now. Put even more simply, private plans now which include insurance coverage for abortion require the exact same chutes and ladders as would be required under the rider, plus all of the other rules and regulations for everything from cancer coverage to mental health coverage to premiums and such. This will be far less paperwork for individuals than it is in the status quo.
• Second, they’re arguing there’s no such thing as an abortion rider in the status quo. Laurie Rubiner, a Planned Parenthood Vice President, sent out a press release arguing that “As one alternative, the Stupak amendment purports to allow women to purchase a separate, single-service ‘abortion rider,’ but abortion riders don’t exist.” This argument is just stupid. Obviously, they don’t right now: they get abortion coverage as part of a privately funded plan. Douglas Johnson, the National Right to Life Committee’s legislative director, answers this argument pretty simply: “If there’s a market (for add-on abortion riders), if there are people who think it’s that important, it will be offered.” Right now, the primary people covered by abortion-less healthcare are seniors and poor people in Red States, and neither of those groups were a particularly lucrative market.
• Third, that women won’t get the riders because of lack of foresight. Of course, right now, there are a lot of people who don’t have any healthcare coverage because of lack of foresight – so the ball’s not really advanced one way or the other with that argument. But the argument’s usually put in a much more offensive way. The Baltimore Sun argued in an editorial that “Most people do not have the foresight to know if they’ll ever need an abortion any more that they might need to have a gallbladder removed or a kidney stone pulverized.” But, of course, these two things are totally distinct. I have no real idea what causes a kidney stone, or if I’m at risk for it: but I’ve got a pretty good idea where babies come from. Here’s an easy test: (1) Are you currently having sex, or considering doing so? (2) If you got pregnant from this sex, would you want the option of having an abortion? There’s no need to even look up family history to see how many of your ancestors ‘caught pregnant’ (hint: half of them). In fact, even if you can answer “no,” to (1), a “yes” to (2) will probably get you to at least consider getting the rider. Overall, this pro-abortion argument treats women like they’re idiots.
• Finally, they argue that women won’t get the riders because of embassment at getting an abortion-specific rider. Of the four arguments, this one’s the strongest. Nevertheless, there are still two problems with it. First, women can almost certainly obtain this coverage discreetly, “just in case.” Second, it’s worth noting that 87% of abortions are paid by the individual directly now: usually in cash. Many women right now, even those women with insurance coverage for abortions, prefer to pay a few hundred dollars out of pocket to avoid having insurance, credit cards, or prying eyes discover what they’ve done. Chances are, any woman who is too timid about her desire for abortion coverage (which is a pretty widely acceptable idea amongst pro-choicers) is never going to bill insurance for the abortion itself. So it’s unclear how many of the women currently paying out of pocket for abortion coverage will have had them paid for by abortion riders (or even government-funded abortion coverage).

Mostly, however, they’re trying to raise concerns that poor women in urban areas will be left without a chance to kill their baby on the cheap. But here, it’s they who are trying to relitigate already-finished abortion wars. A 1980 case called Harris v. McRae approved of the Hyde Amendment. So poor women on government-provided healthcare already either pay out of pocket for abortions or use state funds, and the jarring rate of abortions in low-income areas suggests that the women in question find a way to pay for these abortions.

Obviously, as a pro-lifer, it would be great to see fewer women having abortions, and there seems to at least a chance for that here – although, again, simply refusing to pay for the abortion isn’t a very strong deterrent against having abortions (it just keeps our hands clean of the bloody affair). The Stupak-Pitts amendment isn’t intended as some sort of end-run around Roe: it’s just an attempt to prevent the government from getting into the abortion business.