In the final days of health-care reform, we're once again mired in a dispiriting debate about whether the legislation is sufficiently anti-abortion. The Senate health-care bill will allow states to ban insurance policies that include abortion from their insurance exchanges. In states where such policies are allowed, women will have to send a separate check for the portion of the plan that covers abortion, which very few are likely to do. Still, conservative Democrats in the House complain the legislation doesn't go far enough – they want plans that cover abortion removed from the exchanges altogether. It's become clear that if health-care reform passes, it's going to significantly erode, and probably end, insurance coverage for abortion. That makes it a serious step backward for reproductive rights.
Feminists should support it anyway.
The simple fact is that health-care reform, even with its awful provisions on abortion, will hugely improve the health of American women. According to the Kaiser Family Foundation, more than 17 million women are uninsured, and millions more are underinsured. "In 2008, one in seven privately insured women reported she postponed or went without needed care because she couldn't afford it," Kaiser reports. Women are more likely to rely on their spouse's insurance coverage, leaving them vulnerable if they're divorced or widowed, if their husband becomes old enough to qualify for Medicare, or if their partner's employer decides to drop dependent coverage, which is happening with increasing frequency. As a study by the National Women's Law Center found, "Overall, women are more likely than men to have difficulty obtaining needed health care (43% vs. 30%) -- a difference more pronounced for uninsured women (68% vs. 49%)."
The inequities of our health-insurance system are a major reason that the United States has higher maternal mortality than almost any other industrialized country. A new Amnesty International report on America's maternal health crisis suggests that things are only getting worse: "More than two women die every day in the USA from pregnancy-related causes. Maternal deaths are only the tip of the iceberg. Severe complications that result in a woman nearly dying, known as a 'near miss', increased by 25 per cent between 1998 and 2005. During 2004 and 2005, 68,433 women nearly died in childbirth in the USA." Amnesty points out that health-care reform, as currently constituted, will not solve this problem -- among other things, it will still leave too many uninsured. But it will almost certainly ameliorate the problem. And that's reason enough to back it.
Needless to say, uninsured women already lack abortion coverage. So the burdens of the abortion restrictions in health-care reform will fall mainly on the middle class. To say this is not to suggest that the concerns of middle-class women aren't important. Throughout his campaign and his presidency, Obama has promised that no one will lose the coverage they have right now. Given that most insurance plans now cover abortion, health-care reform is poised to break this promise. This frightens me personally -- should I decide to have a baby in the next few years, I want to know that if I have a pregnancy that goes horribly wrong, I could afford to end it. But preserving health-insurance coverage for abortion at the cost of excluding millions from insurance altogether isn't much of a victory.
Of course, this debate isn't just about a utilitarian reckoning of the greatest good for the greatest number. It's also about principle. Abortion is an important aspect of women's health care. It's one of the most common outpatient procedures in the United States, and around a third of American women have abortions during their life. Stigmatizing abortion and segregating it from other kinds of care has a terrible impact on abortion access -- many ordinary ob-gyns don't offer abortion services to their patients, and abortion instruction is severely lacking in medical schools. Health-care reform that excludes abortion from insurance coverage furthers the notion that abortion is aberrant and illegitimate, not something to which every woman has a right.
Anti-abortion forces have had the advantage in this fight because they're willing to sacrifice the health of millions on the altar of their ideology. Their nihilism gives them leverage. It's tempting to wish that pro-choice forces could be equally resolute, and it's possible that stronger demands early on could have made a difference. But it's too late for that now. The choice is the Senate bill or nothing, and nothing would be a tragedy. There are very few things in this world for which it is worth compromising reproductive rights. But the greatest expansion of the social safety net in a generation is one of them.
It would be unfair to expect pro-choice groups like NARAL to campaign for the Senate bill, since reproductive rights are their raison d'être, and sacrificing them for a larger goal would defeat the organization's purpose. But feminist groups like the National Organization for Women and the Feminist Majority Foundation should join progressive groups like MoveOn.org in pushing hard for passage. If they succeed, feminists can regroup and focus on repealing the Hyde Amendment, which bans federal support for abortion and which forms the basis for these new types of restrictions. But if reform fails, women have the most to lose.