Are Conservatives Trying to End Insurance Coverage for Abortion?

Remember the nasty fight over federal funding of abortion that nearly derailed the health care package? It's not over.

The issue is sure to flare up again early in the next Congress in the form of a bill floated by Rep. Chris Smith (R-N.J.), the "No Taxpayer Funding for Abortion Act." The proposal -- which has the support of 185 cosponsors and incoming House Speaker John Boehner -- has a stated aim of making the Hyde Amendment (a rule that has to be renewed every year that prohibits federal funding of abortions through Medicaid) into permanent, government-wide law. But abortion-rights advocates fear Smith's bill could have even broader consequences. They view it as a Trojan horse for the elimination of private insurance coverage for abortion. If they're right, tens of millions of Americans could see their health insurers stop covering abortions.

Susan Cohen, the director of governmental affairs for the pro-abortion-rights Guttmacher Foundation, argued in a policy brief this fall that "the Smith bill would go...into uncharted territory" by preventing employers from taking a tax deduction for offering an insurance plan that covered abortion. (Like most other benefits, health insurance costs are generally tax-deductible for employers.) Analysts at NARAL Pro-Choice America and Planned Parenthood, the leading abortion rights advocacy groups, agree. According to abortion-rights advocates, Smith's bill would create a huge incentive for employers to only offer health insurance that doesn't cover abortion. Insurers would respond to what their customers wanted, and the percentage of health plans offering abortion coverage -- currently 86 percent -- would undoubtedly plummet.

While experts agree that Smith's bill would have some impact on tax policies, not everyone buys the abortion-rights groups' analysis. Timothy Jost, an expert in health law at Washington and Lee University Law School, says he agrees with the abortion-rights groups that the tax provisions in the Smith bill would mean that self-employed people and people with health savings accounts (HSAs) wouldn't be able to treat abortions as medical expenses. But he doesn't agree that the bill would prevent employers from deducting the costs of insurance plans that include abortion coverage. Nevertheless, Jost believes that "going after the tax subsidies that affect abortion" would represent a "substantial victory for the pro-life movement in America."

If pro-life forces are really pushing to eliminate private abortion insurance, they haven't been up front about it. The National Right to Life Committee (NRLC) and the Susan B Anthony List (SBA List), two right-leaning groups that support the bill, focus their rhetoric on how it would affect federal funding, not tax exemptions. So does Democrats for Life. The SBA List's petition promoting the bill says Congress needs to "stop abortion funding!" The group even registered the domain name StopAbortionFunding.com. But the site says nothing about private insurance -- which pro-choicers say the bill will affect dramatically. And when I asked Marjorie Dannenfelser, who runs the SBA List, about the tax provisions, she said she didn't know whether they would curtail private abortion insurance or not.

Despite the pro-life groups' focus on direct federal funding in their promotion of the bill, there's no question that it's intended to have some effect on the tax code. The section in dispute is a "prohibition on tax benefits relating to abortion." A lot is riding on how broad that prohibition is. The employer tax exemption for health insurance is the government's largest tax expenditure. It affects nearly every American who gets health insurance through their employers. If the abortion rights advocates are right, the tax section of Smith's bill would affect far more people (and more money) than any other portion of the law.