Imagine that you are strongly opposed to abortion rights, and what you'd like is for all abortions to be illegal. Then you're faced with two alternatives:
1. In Path 1, federal funds will not be used to give anyone abortion coverage, but the number of abortions will either stay the same or increase.
2. In Path 2, federal funds will not be used to give anyone abortion coverage, but the number of abortions will decline.
Seems like a clear choice, right? Well, not if you're Rep. Bart Stupak. Stupak is withholding support for the Senate's health-care bill and trying to get as many anti-choice Democrats as he can to join him, because he worries that the Senate language on abortion isn't restrictive enough. The truth, however, is that the Senate language is actually more restrictive. In both bills, if you're getting your coverage through the insurance exchange, you're receiving subsidies, and if you want abortion coverage, you'll have to jump through hoops. The Senate bill demands that you write two checks to your insurance company, while the House version requires that you purchase a separate "rider" to your policy, in either case announcing, "I might want an abortion some day!" Federal insurance subsidies can't be used.
So why does Stupak think the House version is tougher? It's hard to tell, because in practice they do the same thing -- the difference is between paying a separate premium and buying a separate policy, which is a technical distinction that may matter to file clerks but will make no difference to women. And the Senate version allows states to outlaw all abortion coverage within their exchanges, which means that there will be large swaths of the country where under the Senate bill there will be no coverage in the exchange for abortion at all (though if you have an employer-sponsored plan it could still cover the procedure).
In practice, this means that virtually no one who is getting subsidies will have abortion coverage in the exchange. As The Washington Post reported over the weekend, North Dakota has such a requirement right now, and precisely zero women have gone through it. But let's get back to those two paths we started with. Path 1 is not passing the Senate bill, which Stupak and a few others now say, because of their firm commitment to the little babies, is their preferred solution. This is despite the fact that no federal funds will be used for abortion under the bill, and it will make it essentially impossible for poor and many middle-class women to get coverage for an abortion. Path 2 is passing the Senate bill, which will lead to fewer abortions.
Why? As T.R. Reid explained in an op-ed, the U.S. has the highest rate of abortion in the Western world, due in no small part to the fact that we are the one country without universal health care. When a woman has secure health insurance, she'll be more likely to see her doctor and get birth control. And if she does get pregnant, the enormous cost of carrying the baby to term won't factor in to her decision on whether to get an abortion (as it is now, many insurance companies consider pregnancy a "pre-existing condition" they won't cover).
Universal health care means fewer abortions -- simple as that. Stupak and the other anti-choice Democrats are being offered the opportunity to reduce the number of abortions in America. But they won't take it, because they're worried that writing a separate insurance check for abortion might not be quite as humiliating for a poor woman as buying a separate insurance rider. Such an admirable display of principle.
-- Paul Waldman