How Catholic Bishops Threw the Health Care Debate into Turmoil with Anti-Abortion Maneuver

Personal Health

It was a bold power play -- one that caught progressive members of the Democratic caucus off-guard, and one that has sown distrust and dissension among House Democrats.

With a major assist from the United States Conference of Catholic Bishops, two members of Congress -- both members, as well, of a secretive, right-wing religious group -- made it impossible for House Speaker Nancy Pelosi, D-Calif., to pass an historic health care reform bill without the attachment of anti-abortion amendment that, if signed into law, could set women's rights back decades.

While few think the amendment's draconian language will find its way into a final bill, its passage last weekend as part of the Affordable Health Care For Americans Act set the stage for a battle that could determine whether health care reform legislation ever makes it to the Senate floor for a vote.

The amendment, spearheaded by Bart Stupak, D-Mich., goes far beyond the standard prohibition on the use of federal dollars for abortion services known as the Hyde Amendment; Stupak's would prohibit the purchase, through the health insurance exchange the bill would create, of even private health insurance plans that cover abortion -- even for women who were not eligible for government-subsidized premiums.

The cumulative effect of the Stupak amendment is it would likely kill abortion coverage in nearly all health insurance plans, whether purchased through the exchanges or not, since the exchanges will come to constitute the bulk of the market for policies purchased by individuals.

It would also affect the coverage offered employees of the federal government -- one of the nation's largest employers -- who already choose from among a range of insurance packages offered in the Federal Employee Health Benefits Plan.

"This is a very serious development here," said Kate Michelman, the former president of NARAL. "Women across the country -- Democratic women in particular -- but women, I would argue, all across the country, as they are learning about this, are really, really upset.  And this isn't only the result of the bishops; this is the party, as well, not really standing up for women and allowing a group of conservative Democrats, who they recruited and helped elect, rule the day in the House." (Michelman has an essay on this topic, co-authored with Frances Kissling, on the op-ed page of today's New York Times.)

Stupak and Rep. Joe Pitts, R-Pa., the co-sponsor of his amendment, are members of The Family, the stealthy religious group exposed by journalist Jeff Sharlet in his book of the same name. In both houses of Congress, members of The Family have been working for months to defeat health care reform. Although the anti-choice views of both men are said to be rooted in their religion, it's hard not to suspect their amendment of being a poison pill intended to kill health care reform entirely. After all, the bill already contained language restricting the use of federal money for abortion.

How Stupak Happened

As members prepared last weekend for the vote on landmark health care reform legislation, House leaders thought they had forged a compromise, after days of negotiation with anti-choice members of Congress, that would assure conservaDems that no public monies would be disbursed through the federally administered health insurance program the bill would create. 

Then, at the 11th hour, the compromise fell apart. The Catholic bishops weren't buying in, and that was enough to scuttle the deal. Stupak said he wouldn't vote for the health care bill unless his amendment saw a vote, and Pelosi needed his vote and the votes of members he claimed to represent.

But in order for Stupak to get a vote for his amendment, Pelosi would need Republican votes for the rule that would allow the amendment to move to the floor. That's when the language of the amendment turned ugly, according to Politico.

Members from heavily Catholic districts wouldn't sign on until the bishops gave their blessing on the language, Republicans wouldn't vote for the rule until the National Right to Life Committee signed off. Pelosi assessed her risk, apparently calculating that the Stupak language would be stripped out of the bill that is eventually sent to the president's desk.

Few were more dismayed by the Stupak amendment than Rep. Rosa DeLauro, D-Conn., a member of the Congressional Progressive Caucus and a key member of the "whip team" that Pelosi put together as a kind, arm-twisting, cajoling, Dem-whispering corps charged with bringing in the votes of any reluctant colleagues.

At first, DeLauro explained, House leaders thought they might have won a compromise weeks ago with a change to the bill's language offered in the Energy and Commerce Committee by Rep. Lois Capps, D-Calif., that made it more explicit how public monies would be separated from private dollars used to purchase health coverage through the exchange.

"[Y]ou had pro-life, pro-choice members, come together, forge a compromise -- a very good compromise," DeLauro told AlterNet, "[of] how to deal with the segregation of the funds ..." When the Capps language failed to satisfy the anti-choice contingent led by Stupak, it was "further strengthened, or clarified, if you will, by Congressman Brad Ellsworth.

"Now, that was an excellent compromise -- one, again, that was forged by pro-life, pro-choice members. It didn't come out of the blue. And what happened was is that that compromise -- where we moved for common ground, found it -- wasn't acceptable to Congressman Stupak and to others."

That left House leaders and vote-counter DeLauro in a very tough spot -- either allow the Stupak amendment to come to floor, or almost certainly lose the vote on the health care bill, which was ultimately won by a two-vote margin.

DeLauro voted for the rule that allowed Stupak to come to the floor, while Rules Committee Chairman Rep. Louise Slaughter, D-N.Y., boycotted her own committee's proceedings. DeLauro voted against the amendment when it came up for its vote, delivering a passionate speech from the floor condemning the measure.

Bill Giveth With One Hand, Taketh Away With the Other

In her interview with AlterNet, DeLauro rattled off a number of substantial improvements for women's health care contained in the bill: The proscription on excluding people from coverage will mean no more denial of coverage for such "pre-existing conditions" as being the victim of domestic violence, or a prior pregnancy. Gender discrimination in premium costs is prohibited under the bill.

"Today, women pay 48 percent more for health care coverage than men," DeLauro said. "Very strong for women, a lot to gain here. Now the goal all along, as I said, was to move health care reform. On the issue of abortion in the discussion, that has always been that we maintain current law -- that no public funding is available for abortions services, except the Hyde exceptions."

Michelman told AlterNet: "I agree that there are some positive, positive aspects for women in the bill. However, having said that, any health care reform bill that leaves women, millions of them, worse off in terms of their ability to obtain health care -- necessary health care -- than they were before health care reform is unacceptable. It's wrong!

"You know, I don't think we should ... take one advance and trade it for moving back in the area of major health care for women."

"It does seem really clear to me," Rep. Donna Edwards, D-Md., said, "that [Speaker Pelosi] did what she had to do ... in order not to sabotage this effort for health care reform. But at the end of the day, when our House and Senate bills are merged, and we send a bill on to the president for his signature, it will not contain -- it cannot contain -- this language that constrains what women are able to do legally and constitutionally."

AlterNet contacted Pelosi's office for comment, but as of press time, we had not heard back.

Pro-Choice Dems Demand Meeting With Obama

Still, on Tuesday, Edwards -- along with 89 other Democrats -- signed a letter (PDF) initiated by Pro-Choice Caucus co-chairwomen Slaughter and Rep. Diana DeGette, D-Colo., requesting a meeting with President Barack Obama to discuss the status of reproductive health issues in the bill.

"Health care reform must not be misused as an opportunity to restrict women's access to reproductive health services," the letter reads. "The Stupak-Pitts amendment ... represents an unprecedented restriction on a woman's access to health insurance coverage of reproductive health services."

The amendment would permit women in the exchanges to purchase, on their own dime, supplemental coverage for abortion services -- coverage that few would likely buy since no one really plans for an unplanned pregnancy.

Plus, there are privacy concerns involved in any abortion-insurance scheme. At least one elected official, former Kansas Attorney General Phill Kline, sought the medical records of abortion clinics for a case against the clinics that was ultimately dismissed -- a move critics condemned as a means of intimidation against women who had had abortions.

Fears abound that the impact of the Stupak amendment would go far beyond the letter of the restrictions written into the bill. Edwards believes the measure would influence insurance policies offered outside the exchanges. Michelman decries the message it sends, separating abortion from other health care procedures, further stigmatizing it.

Beyond the immediate issues of the Stupak amendment is its larger impact within the Democratic caucus and in the women's movement. Many feminists embraced Obama only after Hillary Rodham Clinton lost her bid for the presidential nomination, and not a few were suspicious of his commitment to women's reproductive rights. The statement the president made yesterday to Jake Tapper of ABC News has heartened some and disheartened others.

"You know, I laid out a very simple principle, which is this is a health care bill, not an abortion bill," Obama said. "And we're not looking to change what is the principle that has been in place for a very long time, which is federal dollars are not used to subsidize abortions.

"And I want to make sure that the provision that emerges meets that test -- that we are not in some way sneaking in funding for abortions, but, on the other hand, that we're not restricting women's insurance choices, because one of the pledges I made ... was to say that if you're happy and satisfied with the insurance that you have, that it's not going to change."

"Well, I'm not comfortable with what has happened here at all," said Michelman, who supported Obama in the presidential primaries. "I really expect the president to step up to this challenge and say, this was wrong. This is health care for women, and we cannot allow a bill to damage the prospects of health care for women ... I need my president to do that. And of all the people, this is a man with great vision, and I had mixed feelings about the way he talked about the bill."

However, Donna Edwards, who also supported Obama's bid for the Democratic presidential nomination, found some comfort in the president's words and said she feels good about the state of the Democratic caucus.

"I was very heartened by the president's statement after [the health care bill] passed," she told AlterNet. "And although he is pleased that we are able to move the ball forward, move health care reform forward for the first time that we've been able to in decades, that his position is that he supports the status quo -- that is, that federal funds wouldn't be used for abortion. That is what the pro-choice groups signed off on -- that language."

The restrictions of the Stupak amendment go beyond the status quo, which is the decades-old Hyde amendment.

Fight Moves to the Senate

The president seemed to imply that the abortion language could get fixed as the Senate takes up the bill: "I think everybody understands that there's going to be work to be done on the Senate side," he told Tapper.

"I think there is a shot, a chance for the Senate to rectify this situation," Michelman said, "[but] you never know what obstacles along the legislative path you're going to run into. And you gamble when you do that; in this case, you're gambling with women's health, and we're gambling with women's rights."

On Tuesday, Sen. Barbara Boxer, D-Calif., told Sam Stein and Ryan Grim of the Huffington Post that a Stupak-like amendment would never get through the Senate.

"If someone wants to offer this very radical amendment, which would really tear apart [a decades-long] compromise, then I think at that point they would need to have 60 votes to do it," Boxer said. "And I believe in our Senate we can hold it."

But before the day was out, Sen. Ben Nelson, D-Neb., told TPM's Brian Beutler that he would filibuster a Senate bill that didn't contain language similar to that in the Stupak amendment -- meaning he would prevent the health care bill from seeing a final vote. (Rachel Maddow reported that, like Stupak and Pitts, Nelson is associated with The Family.)

DeLauro and Edwards agree that for a final bill to pass muster with the majority in the Democratic Caucus, the Stupak language will need to be ditched.

"You know, I don't like to make threats," Edwards said. However, she added, "I would not be able to support a final bill that has this onerous kind of provision in it and that says to women, we're going to reach into your wallet and into your handbag and tell you what you can do with your own money."

"Look," DeLauro said, "I've always approached these things in an affirmative, in a positive way. What we do is to try to achieve the same goals as we move forward ..." Those goals, she says, include peeling back the Stupak language to not exceed standard of current law prohibiting the public funding of abortion. "We move to achieve those goals in long run. And I'm gonna -- that is where I'm gonna spend my time and my energy over the next several weeks."

"This is a wake-up call," Michelman said of the Stupak amendment, "and Democrats have to look themselves square in the eye here and say, is our power and our majority more important than protecting and defending women's rights and protecting their health? And you can't trade off here. This is not acceptable."

Michelman did see one silver lining, though.

"It's also an opportunity for the women's rights community ... to moblilize women, to activate women on behalf of protecting and defending women's health from bishops and from anti-choice legislators."

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