As the House and Senate produce and mark-up various health reform plans, reproductive health care is emerging -- surprise, surprise -- as a political football. Both the House bill and the Senate HELP committee proposal mention "family planning," but contrary to yesterday's scare-mongering Washington Times op-ed by the Family Research Council's Tony Perkins, "family planning," under federal law, has never included abortion services. Indeed, health reform will do nothing to repeal the Hyde Amendment, which prevents the federal government from directly funding abortions. (This applies mostly to Medicaid recipients and women in the military.)
But that doesn't mean there is no additional, new threat to reproductive rights. Sen. Max Baucus, chairman of the Finance Committee and a key player on health care, has indicated some openness to compromising on abortion rights in exchange for Republican support for a final reform bill. Alongside a group of 19 anti-choice House Democrats, some 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.
Contraceptive services are also at stake. Anti-choicers are using the "conscience clause" as an anti-health reform stalking horse. Current law requires no physician or nurse to provide a service he or she would rather not provide -- say, sterilization, or emergency contraception for rape victims. President Obama has even promised to support "a robust conscience clause" for individual providers. The problem is that anti-choicers want to expand the definition of "conscience clause" beyond recognition, claiming that entire hospitals, companies, or HMOs can use "conscience" as an excuse to deny patients basic health care, such as birth control pills. Civil rights law requires hospitals and clinics to refer patients to another doctor or facility that will take care of reproductive health needs, if one provider refuses. Health reform must not endanger that precedent.
It looks as though both the Senate and House leadership are willing to hand the Health and Human Services secretary -- currently the pro-choice Kathleen Sebelius -- ultimate discretion over these questions of what will and won't be covered by plans that participate in the health exchanges. Earlier proposals to leave those decisions up to an independent council of medical experts have been scuttled. In the long term, though, that will mean reproductive health care -- even care provided by private insurers -- will be subjected to the whims of political appointees. We've seen this play out over decades with the Mexico City Policy, which under Reagan and the Bushes banned American foreign aid from funding abortion services abroad, but was overturned by both Bill Clinton and Obama. It would be a shame for domestic reproductive health care to be subjected to the same caprices.