Marketplace Today Blog

By Diana Marrero and Annysa Johnson
Milwaukee Journal Sentinel

A dispute over the way abortion coverage is treated under health care legislation moving through Congress remains a sticking point for House members as Democrats push for a final vote Sunday.

With passage of health care reform on the line, President Barack Obama and congressional leaders are courting a small group of anti-abortion Democrats who supported the House bill but express concerns that the final legislative package could allow federal funds to be used to provide abortion coverage.

The abortion question has also given rise to a public clash between the influential U.S. Conference of Catholic Bishops and some Catholic organizations over how to interpret the Senate language on abortion. How anti-abortion House members end up interpreting that language has the potential to make or break historic health care reform efforts. Members of the Catholic Church are playing a major role in framing the issue, but Evangelical Christians and other religious groups are also weighing in.

Milwaukee Archbishop Jerome Listecki said the bishops’ position is clear: The bill “does not give protections to human life that have to be present.”

But the Catholic Health Association and a group of nuns across the country say the legislation does, in fact, keep federal dollars from being used for elective abortions.

“This is the real pro-life stance, and we as Catholics are all for it,” said a letter signed by the heads of 55 religious orders and groups, including the Leadership Conference of Women Religious, which represents 90 percent of American nuns.

Leaders of at least eight Wisconsin orders signed on to the letter, including Milwaukee’s School Sisters of Notre Dame and School Sisters of St. Francis.

At issue is the difference in the legislative language used in the House and Senate bills. Under the House version, women buying insurance under a proposed exchange would have to buy a separate premium using their own money if they want abortion coverage. In the Senate version, women wishing to have abortion coverage would send a separate check for the portion that covers abortions.

Under both bills, however, many women would have to pay for abortions out of pocket because of a complex set of restrictions on insurers and buyers that could limit the development of insurance plans that offer abortion coverage, according to a report by the Kaiser Family Foundation.

Congressional leaders are asking House members to vote for the Senate bill, along with a package of tweaks, in order to get around a Republican filibuster in the upper chamber. Because of parliamentary rules, the legislative tweaks can include only provisions that have a financial impact on the federal government. Changes to the abortion language would not qualify under those rules.

Leading the charge against the Senate language in the House is Michigan Democrat Bart Stupak, a Catholic who has threatened to derail the final legislation if his concerns are not addressed. He has said that he and about a dozen anti-abortion Democrats will vote against the bill unless they can reach a deal with congressional leaders.

At the same time, a number of anti-abortion Democrats who voted for Stupak’s abortion amendment in the House have announced in recent days that they are now prepared to endorse the Senate language. Rep. Dale Kildee, a Michigan Democrat who spent six years in Catholic seminary, said the Senate language conforms to his stringent anti-abortion views.

“I’m a pro-life member of Congress both for the born and the unborn,” he said. “This bill is important for both.”

Rep. Paul Ryan, a Janesville Republican who is also Catholic, said he was surprised by Kildee’s announcement this week but thinks the bishops have a stronger understanding of the legislation’s impact on abortion funding. He called the break between the Catholic Health Association and the bishops “an argument between hospital administrators and the keepers of doctrinal discipline.”

But Father Thomas Reese, a senior fellow at the Woodstock Theological Center at Georgetown University, said the fissure amounts to a “disagreement over the meaning of legislative language.”

“It’s not a theological or doctrinal issue. It’s not a moral issue. It’s legislative language, and bishops have no special expertise on this,” Reese said. “This is a matter on which Catholics can disagree.”

The abortion language in the House and Senate versions also has managed to rankle abortion rights supporters, who say either bill would make it so onerous to obtain abortion coverage that few women will choose to do so.

“It sets up so many ridiculous arbitrary barriers that we feel it’s the same as saying they can’t buy coverage with their own money,” said Judy Waxman of the National Women’s Law Center.

Even so, many abortion rights supporters say they still back the bill and that they believe it retains the status quo when it comes to banning federal funding for abortions. “This is a health bill, not a bill addressing abortion as an issue,” said Rep. Tammy Baldwin (D–Madison).

In the final days before a House vote, Catholic groups on both sides of the debate have launched a series of ads aimed at swaying wavering lawmakers. Catholics United, which supports the bill, is running television ads in eight congressional districts urging members to vote for the bill. A newspaper campaign by the Catholic bishops asks members to oppose the bill.

In Wisconsin, the 10-county Archdiocese of Milwaukee posted statements by the U.S. bishops opposing the legislation on its Web site and urged members to voice their opposition to Wisconsin’s representatives in Congress.

Listecki said in a meeting with the Journal Sentinel Thursday that he stands with the conference and its president, Cardinal Francis George of Chicago. He said he has not lobbied Congress, as George has done, saying he believes Wisconsin’s delegation has made up its mind.

Although Rep. Dave Obey, a Wausau Democrat, voted for the Stupak amendment in the House, he has been vocal in his support for health care reform. Obey, a Catholic who has long expressed anti-abortion views, has not formally announced whether he will vote for the Senate bill.

Catholic supporters of the legislation stressed they were not breaking with the bishops on either abortion or Catholic social teaching, and that their differences stem from their interpretations of the legislative language.

“We don’t support abortions. We don’t perform them. We subscribe to all the elements of Catholic social teaching ... that promote the common good and respect for human dignity,” said Terri Rocole, senior vice president of mission services for Wheaton Franciscan Healthcare in Milwaukee.

Sister Theresa Sandok, president of the Servants of Mary in Ladysmith, called health care reform a “social justice issue.”

“In this regard there is no disagreement between the sisters and the bishops,” said Sandok, one of the few signers of the letter in support of the Senate health care bill to speak openly of her support.

Health care experts and supporters of reform say expanding health care coverage is likely to reduce, not increase, abortions in the country. Massachusetts, which enacted what amounts to universal health care in 2006, saw a 1.5 percent drop in its abortion rate in the first two years of the new law, according to a study in the New England Journal of Medicine.

And according to the United Nations, industrialized countries that have universal health care, including Canada and Britain, have lower abortion rates than the U.S.

Key measures of the health care bill

Congressional Democrats have released a final version of President Barack Obama’s health care overhaul bill in advance of a House vote planned for Sunday. Some of the main features of the legislation, which makes changes to the bill the Senate passed on Christmas Eve.

How many covered: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today.

Insurance mandate: Beginning in 2014, almost everyone is required to be insured or pay a fine. There is an exemption for the poor.

Insurance market reforms: Insurers barred from placing lifetime dollar limits on policies or from denying coverage to children with pre-existing medical problems. Parents could keep children on their policies up to age 26. In 2014, insurers barred from denying coverage to anyone with pre-existing condition or charging them more, or from charging more for women. New high-risk pool would offer coverage to uninsured with medical problems until 2014, when coverage expansion kicks in.

Medicaid: Expands federal–state insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014.

Taxes: Beginning in 2018, taxes health care plans costing at least $10,200 for individuals and $27,500 for families. Increased Medicare payroll tax on investment income and wages for individuals making more than $200,000, or married couples above $250,000.

Prescription drugs: Gradually closes “doughnut hole” coverage gap in the Medicare prescription drug benefit that hits seniors who have spent $2,830. When it is eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare’s catastrophic coverage kicks in.

Employer responsibility: Larger employers to pay $2,000-per-employee fee if the government subsidizes their workers’ coverage. Companies with 50 or fewer workers are exempt.

Subsidies: Tax credits for purchasing insurance available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

How you choose your health insurance: Beginning in 2014, small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools. People working for medium-size to large firms would not see major changes.

Abortion: The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for abortion. In plans that do cover abortion, policyholders would have to pay for it separately. States could ban most abortion coverage in plans offered through the exchange.

Source: Congressional Budget Office