Here we go again. Do you remember that fine spring morning when President Obama stood in front of the graduation crowd at Notre Dame and spoke of finding “common ground” between foes and supporters of reproductive choice. Abortion politics have reared up again, this time threatening to derail health reform legislation as we eke ever closer to the finish line.

In a move clearly meant to scorch that newly fertile “common ground,” nineteen House Democrats recently sent a letter to House Speaker Nancy Pelosi warning that they would vote against any health care reform plan that included abortion as a covered procedure—either through a mandate or even through a recommendation for coverage.

Here’s an excerpt from the letter which can be found in full here:

“We believe in a culture that supports and respects the right to life and is dedicated to the protection and preservation of families. Therefore, we cannot support any health care reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan. We believe that a government-defined or subsidized health insurance plan should not be used to fund abortion.
“Furthermore, we want to ensure that the Health Benefits Advisory Committee cannot recommend abortion services be included under covered benefits or as part of a benefits package.”

Currently, abortion is not even mentioned in any health reform legislation coming from either the House or Senate. What is mentioned is family planning, which includes contraceptives, sex education, gynecological exams and even prenatal care. Since the passage of the Hyde Amendment that specifically banned the federal government from directly funding abortion, the procedure has not been included in the government’s definition of family planning. Most state Medicaid plans do not pay for abortions and neither does insurance provided to federal employees and the military.

Taken at face value, the call by 19 Congressman for an amendment specifically banning coverage for abortion is worrisome, but may not strongly affect policy. 

What is more troubling is that they are using the abortion issue to wring other concessions from Democrats in health reform legislation. Those 19 Congressmen are joined by a significant group of House Republicans who are happy to use the abortion issue to force the administration to abandon a public plan option and make other concessions to industry and large employers. There have been reports that Max Baucus, chairman of the Senate Finance Committee, may consider compromising on abortion rights in order to garner that all-important bipartisan support he so craves, including support from Orrin Hatch and other key Republicans for the Senate reform bill.

Such a limit on abortion benefits could have consequences beyond affected women who are covered under a public plan. Currently, some 90% of subscribers with private health insurance have some coverage for abortion.

According to Dana Goldstein at The American Prospect;
“[S]ome Senate Republicans say they will oppose any health reform plan that subsidizes abortion coverage or even includes, in the new health insurance exchanges, private insurers who cover abortion. The result of a Democratic capitulation to anti-choicers? Women who currently have abortion coverage under employer-based health plans could lose that access.”

The Guttmacher Institute recently released a study that looks at how restrictions on federal funding for abortion have disproportionately affected poor women. In the report, which can be found here, the authors find:

"Approximately one-fourth of women who would obtain a Medicaid-funded abortion if given the option are instead forced to carry their pregnancy to term when state laws restrict Medicaid funding for abortion, because they lack the money to pay for the procedure themselves.
“Medicaid funding restrictions also delay some women’s abortion by 2–3 weeks, primarily because of difficulties women encounter in raising funds to pay for the procedure.”

Guttmacher estimates that by age 45, one in three women will have an abortion. Unintended pregnancy is four times more likely among low-income women. These women are five times more likely to have an unintended birth; a situation that only adds to the burden of economic and social hardship. One could easily see how removing this benefit from a public plan meant to help cover the working poor and others who are currently uninsured would magnify the effect.

Abortion is not the only flashpoint for conservatives opposed to health reform. Conservatives in Congress say they won’t support health reform legislation that doesn’t include a “conscience clause” that would protect doctors, pharmacists and other providers who refuse to participate in an abortion, prescribe abortion-producing drugs or contraceptives, or turn off a ventilator for a dying patient.  This kind of clause, supported by Obama when it comes to individual providers, can be very dangerous if expanded to include entire institutions like clinics, hospitals or even health plans.

A preemptive strike by these Congressmen on abortion opens the door for using one group’s moral compass—not comparative effectiveness, not scientific reasoning or even cost-benefit analysis—to decide which health practices are worthwhile. What other benefits are at risk of being banned? How about the “morning-after pill?”  Contraception for teenagers or other unmarried individuals? What about palliative care at the end of life whose goal is not life-saving and might even hasten death? Will some Congressmen try to remove mandates for coverage for hospice care? The list of possible faith-based amendments to health reform legislation can grow absurd.

The clear answer is to move decisions about which benefits are included in any government-funded health plans out of Congress and into the hands of a panel of experts. This is far superior to using reactionary amendments to micro-manage coverage, or even to leaving it up to Kathleen Sebelius and the HHS staff to determine health care priorities. The administration understands that we should have a commission made up of medical professionals, researchers and public advocates determine a menu of comprehensive benefits—supported by scientific evidence and medical need.

Abortion politics have derailed judicial nominations, executive appointments, and even helped decide presidential elections. It’s time to get back to the process of reconciliation Obama spoke so eloquently about just weeks ago and to avoid using this incendiary issue to derail health care reform.