Last week the U.S. Conference of Catholic Bishops sent a letter to U.S. Senators about current health reform legislation. The USCCB has supported the goal of universal health coverage for decades, but the letter made clear that they do not yet support the Senate Finance Committee’s bill because of concerns about affordability, coverage for immigrants, and financing for abortion. I’d like to focus on that last point, because I think it’s here that the bishops may be moving the goalposts on what they can and cannot accept.
For the bishops and other abortion opponents who have concerns about the Senate bill–as opposed to those who are using abortion to mask the fact that they would oppose any health reform proposal–the objections break down into two parts. They want to make sure that: 1) coverage of abortion is not mandated, and 2) federal funds are not used to pay for abortions. Both concerns would seem to be addressed by the Senate Finance bill. But the USCCB letter makes clear that it considers the nuances of the second point to be critical.
Both Obama and Kathleen Sebelius have publicly vowed to support language explicitly preventing federal funds from being used to directly fund abortions–a continuation of current federal law (with exceptions for Medicaid-funded abortions in the cases of rape or incest). But the bishops go further than that, calling for a health reform plan that “prevent[s] federal funds from being used for abortions or to help purchase benefits packages that include abortions.” [italics in original] As Mark Silk writes, that principle is behind the fact that the Federal Employee Health Benefits program does not allow beneficiaries to choose health care plans that cover abortion. But he points out that Medicaid, which the USCCB strongly supports, “does help purchase benefits packages that include abortion in the case of those states that supplement federal Medicaid by paying for abortion services out of their own funds.”
Furthermore, as Jonathan Cohn has also explained, taxpayers already subsidize abortions through the tax break for employer-sponsored insurance:
If you have insurance through your job, then you’re getting government assistance just as surely as if Washington wrote you a check. And if your policy happens to cover abortion services–which about half of you do, according to the Kaiser Family Foundation’s annual benefits survey–then the taxpayers are helping to subsidize it.
As Cohn admits, these distinctions probably don’t matter much to the USCCB, which would undoubtedly prefer a world in which no subsidies of any sort could be traced to the funding of abortions. (Although I do think Silk’s point raises the question of whether the USCCB is now willing to oppose current Medicaid practice. I suspect not.) But for those voters who simply think it makes sense to keep abortion legal while preventing taxpayer funding of abortions, there’s a point at which the fungibility argument ceases to be compelling.
After all, while there has always been a special concern about taxpayer dollars, very few of us seem particularly troubled about whether our own private dollars go to fund abortions. As Cohn says, about half of us belong to health plans that cover abortion services. And yet I’m willing to bet even most pro-life voters don’t know whether their health plan includes abortion coverage–and whether, therefore, their premiums indirectly fund abortions.
In fact, it would be nearly impossible to guarantee that your dollars never indirectly allowed someone to purchase a plan that covered abortion. Let’s say IHOP provides its employees with a health care plan that includes coverage of abortion services (I’m not saying it does–I have no idea–so please don’t start boycotting IHOP. This is just a hypothetical.) When you stopped in at your neighborhood IHOP for a Rooty Tooty Fresh ‘N Fruity and paid for it with your own money, your dollars would–albeit in a very small way–contribute to IHOP’s ability to provide that health care plan that pays for abortions.
Which is all to say that there are ways to provide some insulation between your money–tax dollars or otherwise–and the funding of abortions. But if the goal is a zero-tolerance system in which no one’s money ever allowed the purchase of a health care plan that covers abortion, that may well be impossible.