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The Weaknesses of the Pro-Choice Movement Have Been Exposed -- Now What?

How did an invigorated pro-choice movement, still pumped up from Democratic victories in 2008, wind up shafted? Where do we go from here?

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But if pro-choice leaders felt beleaguered, the outcome was not so much a reflection of their loss of influence as a painful public display of their longstanding political weakness. "The conditions that allowed health care reform to totally exclude abortion existed before it happened," says Frances Kissling, a visiting scholar at the Center for Bioethics at the University of Pennsylvania, who was president of Catholics for a Free Choice for 25 years. "The difference now is that everyone knows we're powerless." Or, as Tanya Melich, a political consultant who has worked on women's issues for 30 years, puts it, "We've never had the votes. And we've always had anti-choice Democrats."

Indeed, by some measures the pro-choice movement is actually in better shape than it's been in for years. "This is the best vote count we've had in my time here," says Donna Crane, policy director for NARAL, where she has worked for 11 years. "But we're still more than thirty votes short in the House and almost twenty away from a pro-choice Senate."

How can we be doing better than ever and yet still so poorly? If you count just those who are strictly pro- or anti-, there are actually 41 senators who consistently vote in favor of choice in the Senate, versus just 40 who consistently vote against it. In the House, there are 203 strict opponents of choice, 185 in favor. But the real battle lies in the middle, the remaining 19 senators and 47 representatives who vote according to the issue at hand. Activists have long known that the abortion war is to be won or lost in this gray area. Abortion opponents have done better in constructing wedge issues, through legislation such as "partial birth" bans and the Stupak and Nelson amendments, attracting lawmakers who are neither firmly pro- nor anti-choice but on the fence.

Now, of course, the Nelson Amendment is law. And unless it is mitigated or eliminated through the regulatory process (a possibility that policy experts and lawyers are delving into), it will definitely create hassles for both women and insurers and will probably result in some health plans dropping abortion coverage altogether. Politically, it will likely create a new platform for antiabortion groups, which are expected to push state legislators to ban abortion coverage offered in their state-level exchanges (existing policies outside the exchanges would not be affected).

The new law and the debate that preceded it set back the pro-choice movement in subtler ways, too. Among the collateral damage was the delicate effort that had been under way to loosen restrictions on some abortion coverage. Before the health care reform debate, pro-choicers had been within a handful of votes of overturning a ban on abortion coverage through the Federal Employees Health Benefits (FEHB) plan, making the case that salaries earned by government workers should be considered private dollars. But such a win now seems impossible.

"Whereas before, only direct money was considered federal funds, now even things like government underwriting or government administering of programs are considered public," says Planned Parenthood's Rubiner. "We knew [health care reform] gave the anti-choice side an opportunity to impose Hyde on everyone, and they went far with it."

How can abortion rights supporters regain the ground they've lost? Part of the usual fix, getting more pro-choice lawmakers into Congress, has been complicated by health care reform. Traditionally, pro-choice PACs enforce their power by supporting only those candidates and lawmakers who support their exact positions. EMILY's List, for instance, contributes to the campaigns of women candidates who vote exclusively pro-choice--and almost always drops people who vote for anything that would set back reproductive rights. The fact that the health care legislation included abortion restrictions initially put the group in a quandary, but after much discussion it decided not to impose negative consequences on supporters of health care reform.

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