Lying To Make Friends

Before I begin, I’ll note that this is going to be one of those “easy for you to say” kind of posts.

Saturday night the House brought health care reform closer to reality than it’s ever been. The House bill is the best of the various bill that’s been proposed, and would, among other things, ban the most egregious insurance company practices and provide subsidies to ensure all Americans could afford coverage.

Tragically, at almost the last minute, pro-life Democrats, at the urging of Catholic bishops, rejected two already difficult compromises on abortion coverage and forced a vote on an amendment offered by Rep. Bart Stupak of Michigan.  Stupak’s amendment would expand the Hyde Amendment, which bars any federal funds from subsidizing abortion, and would bar policies offered through the newly created health insurance exchange from covering abortion.  The broadly worded ban potentially has a very broad affect on access to abortion.  The measure undermines the cause of health care reform by denying coverage for an important medical procedure. It also represents a betrayal to a constituency vital to the recent Democratic ascendancy, and underscores the shameful state of female representation in our government.

It’s unclear exactly how women will be affected if the Stupak amendment makes it into the final bill and becomes law.  For lowest income women, Stupak maintains the unjust status quo, since the Hyde Amendment already prevents Medicaid from covering elective abortions.  The next tier, women between 150% and 400% of the federal poverty line, are those  most likely be buying insurance through the exchange, and thus to be barred from purchasing insurance that covered elective abortion.  Because of subsidies and insurance market reforms, these are also the women that have the most to gain from reform overall, and they would see their overall health care costs lowered the most.  Those who potentially have the most to lose under Stupak are women who currently receive health insurance from their employer that covers abortion.  Some are speculating the restrictions Stupak places on policies sold within the exchange will lead insurance companies to stop offering abortion coverage even in policies sold outside the exchange, though this is not a certain outcome.

It’s difficult to predict what happens to the Stupak amendment as the health care bill moves forward.  Pro-choice groups and members of Congress are hopeful that the Senate will at least weaken the restrictions on abortion coverage, and that the final bill will contain something less egregious on abortion.  This hope is shared by the President.  At least one Democratic Senator, however, has already said he cannot vote for the bill unless the Stupak language is in it.  And unlike the House, where the Democrats can afford to lose 40 votes, Harry Reid cannot afford to lose a single Democratic vote to pass the bill.  And so it’s possible that the Democrats will ultimately be faced with the choice of passing a health care that, for all the good it does, also sets back women’s rights (and, in a topic that deserves its own post, may contain a terribly punitive provision driven by anti-immigrant sentiment).  If that is what it comes down to, my hope is that, after fighting like hell to strip the anti-choice and anti-immigrant provisions, Democrats will pass the bill.  America’s regressive attitudes towards reproductive rights and immigration, and the racial and gender imbalance of Congress, cannot be fixed in the next two months.  The most abusive practices of insurance companies, and the tragedy of 46 million uninsured Americans, can be.

A historical analogy is the Fair Labor Standards Act of 1938, which established a minimum wage and 40 hour work week.  To secure the support of Southern Democrats to pass the Act, occupations that were disproportionately black and female, namely domestic work and agriculture, were excluded from the Act’s protections.  Clearly this is one shameful chapter in our shameful history on issues of race and gender.  But there’s a more optimistic reading as well; the Act immediately improved the lives of millions of workers, helped fuel the creation of the middle class, and, as America has progressed in its views on race and gender, the law has been expanded, occupations have become less segregated, and more and more people have been able to take advantage of the Act’s protections.

The danger of that more optimistic reading is that it can be too easily turned into an excuse for always discounting the rights of disfavored and/or less powerful groups in the name of compromise and “the greater good.”   Republicans have gone all-in with a strategy of preventing the government from doing anything, and are likely to continue invoking abortion and immigration whenever they can to kill legislation.  It’s one thing to go through the academic exercise of deciding whether it’s better to have health care reform without coverage for abortion or no health care reform at all.  It’s much more difficult, at least as an outsider, to gauge whether that’s actually the choice we are faced with.  How hard did the Democratic leadership push to keep the Stupak language out?  What other compromises could have been made?  How credible were the threats of pro-life Democrats to kill health care reform without Stupak?

I’m not sure what the answers to these questions are, but I’m willing to assume that Nancy Pelosi knows what she is doing and does not and will not make concessions on abortion and immigration lightly.  I’m glad the House bill passed, and while I hope everything is done to weaken or remove the Stupak language, if President Obama ends up signing a bill with the Stupak language in, I’ll be happy on that day as well.  As I said at the outset, I recognize that that’s easy for me to say.  But I have to imagine there are millions of women struggling to pay medical bills, without insurance, underinsured, or simply paying too much, driven into bankruptcy or denied coverage because of a pre-existing condition, who will be happy as well.  It’s terrible if health care reform has to be passed this way.  But it has to be passed.

-AR