Health Care Policy
The World According to Stupak
By Jessica Arons
March 2, 2010
President Obama's healthcare proposal adopts language on abortion from the Senate health reform bill that requires insurers to segregate public and private premiums and use only private money to pay for abortion services. But Representative Bart Stupak will have none of it, claiming that the legislation still allows public funding of the abortion. In fact, the legislation very clearly prohibits direct government funding of abortion. But Stupak also objects to "indirect" funding, refusing to vote for a reform bill unless it prohibits taxpayer money from "subsidizing" health plans that cover abortion care.The amendment Stupak sponsored, which is currently part of the House bill, does bar so-called indirect funding. It forbids insurers from selling plans that include abortion coverage to any people who receive help from the government in paying their premiums--a restriction that would apply to approximately 85 percent of customers in the new health insurance exchange and thus virtually eliminate abortion coverage from the exchange.
An analysis of Stupak's opposition to indirect funding, however, reveals implications that go well beyond the fight over abortion.
Money in Stupak's world is "fungible," or interchangeable, meaning whatever money the government gives you frees up private money for you to use on something else. So every dollar the government pays toward your health insurance premium allows you and the insurer to spend private funds in that plan that you might not otherwise have had on abortion. To Stupak, that subsidization is the equivalent of a direct payment.
But by that token, every government benefit a woman receives, whether monetary or in-kind, whether for healthcare or for something else, could be seen as subsidizing an abortion if she has one.
If everyone thought like Bart Stupak, a woman seeking an abortion:
(1) would not be able to take a public bus or commuter train to an abortion clinic, even if she paid her own fare;
(2) would not be able to drive on public roads to a clinic, even if she drove her own car and paid for her own gas;
(3) would not be able to walk on public sidewalks to the clinic, even though she paid property taxes;
(4) would not be able to put her child in childcare while she was at the clinic if she received a tax credit that offset the cost of childcare;
(5) would not be able to take medicine at the clinic that was researched or developed by the government, even if she paid for the medicine herself.
Would anyone argue that the government is "subsidizing abortion" by building roads and sidewalks, offering public transportation, developing medicine and providing childcare? Similarly, making healthcare premiums more affordable, even for plans that include abortion coverage, would not mean that the government would be paying for abortion.
Our society recognizes the distinction between direct and indirect funding all the time. Indeed, if we did not, our government probably could not function. Religious organizations receive tax money to provide direct social services but are strictly prohibited from using that money for sectarian purposes. Nonprofit organizations obtain government grants that can be used for charitable activities but not for electioneering. And we already have a precedent with respect to abortion: family planning clinics get public funding to provide contraception that cannot be spent on abortion. No reasonable person sees this funding as subsidizing activities that have been deemed ineligible for government spending or views the accounting practices used to segregate funds as illegitimate or inadequate.
No transaction in our modern society is completely free of government involvement. The food we eat costs less because of farm subsidies. Students attend private universities with the help of Pell Grants and Stafford loans. Our churches and temples can afford to operate in part because they are tax-exempt. And employers who offer health insurance do so because of tax incentives. Stupak's reasoning, taken to its logical extreme, would mean that virtually every activity in which we engage is government funded, regardless of whether it is condoned or condemned.
Either there is no such thing as indirect funding or everything receives indirect funding, but there is no in between. Either the government pays for abortion or it does not. Stupak, who until recently lived in the "C Street House"--a townhouse owned by a religiously affiliated organization that receives a tax exemption--cannot accept indirect subsidies in one area but reject them in others.
For these reasons, segregation requirements alone should have been sufficient for those who object to taxpayer-funded abortion. But Senator Ben Nelson also managed to wrangle a last-minute deal that goes even further, making customers write two checks each month--one for the abortion coverage and one for everything else--even though both checks would come from private, not public, sources.
Last week the White House chose to go with the Senate solution, in part because Democrats must now use the reconciliation process to pass comprehensive healthcare reform. Because this process can address only items that affect the budget and the abortion provisions do not change government spending levels, they probably can no longer be modified. Therefore, the White House may have had no option but to endorse the Senate's version.
Moreover, prochoice legislators and advocates refuse to accept the Stupak Amendment and have vowed to block it at every turn. And though they also oppose Nelson's language because it imposes unprecedented restrictions on private abortion coverage, they recognize that it is the lesser of two evils. Meanwhile, Stupak claims that he too has enough votes to stop health reform in its tracks.
But Stupak's line of thinking goes way too far. He and the House members who voted for his amendment ought to accept the Senate language that already prohibits government money from being spent on abortion, put the issue to rest and take this historic opportunity to extend health coverage to millions of Americans.
