Topic Brief: Healthcare Debate Update, Part 2

While the Republican Party fought a small civil war over the 23^rd New York House district a couple of weeks ago, Democrats are gearing up for their own civil war over the abortion issue.  One of the misconceptions made in the healthcare debate is that the Republican Party is pro-life and the Democratic Party is pro-choice.  While it is true that it is hard to imagine the Republican Party rallying behind a pro-choice candidate (just ask Rudy Giuliani) or the Democratic Party rallying behind a pro-life candidate, both parties have a mixture of ideas about the abortion issue in their camps.

The initial House version of the bill did not expressly allow for federal money to be used to cover abortions in the new public insurance exchange.  However, it did allow for the Secretary of the Department of Health and Human Services to decide if the public option or private insurance plans in the public exchange could cover abortion.  On the eve of the vote, conservative Democrats threatened Speaker Nancy Pelosi with a pledge that they would vote against the healthcare bill unless they were able to put an amendment on the floor that would restrict this.  The so-called Stupak amendment (known also as the Stupak-Pitts amendment), presented by Representative Joe Stupak (D-Michigan) bars the public option and public insurance exchange from offering plans that cover abortion.  Also, the amendment does not allow anyone getting subsidies from the federal government for insurance from purchasing a private insurance policy that covers abortion.  The purpose of the amendment is to prevent Americans from having their tax dollars used for abortion, which is arguably the most divisive issue in American politics.  Although Pelosi tried to work out a compromise she failed and the Stupak amendment passed 240-194, with 64 Democrats jumping ship to join 176 Republicans in supporting the measure.  Pelosi was caught off guard by the large number of Democrats who supported the amendment and it demonstrates how the Democratic caucus in the House is not fully committed to a pro-life agenda, which Planned Parenthood pointed out shortly after the vote.  It should be mentioned that the Stupak amendment does allow for federal funds to be used for abortion in case of rape, incest, or if the health of the mother is threatened by the pregnancy.

Extempers should keep in mind that federal dollars are not used through the Department of Health and Human Services for abortion thanks to the Hyde amendment.  The Hyde amendment was passed shortly after the landmark 1973 Supreme Court decision of Roe v. Wade.  This 1976 amendment was where the pro-life movement in the United States made its legislative influence known and this amendment has provoked much debate in pro-choice circles and among groups like Planned Parenthood and the American Civil Liberties Union (ACLU) which think that it hurts low income women who cannot get abortion coverage under Medicaid.

Now that the Stupak amendment has passed in the House bill it threatens to derail the healthcare agenda.  Abortion rights groups are arguing that the amendment would bar women from getting abortion coverage in the future because insurance companies might follow the federal government’s lead and not carry proper policies.  Some Democrats are threatening to look into the Catholic Church’s tax exempt status after it lobbied lawmakers to support the amendment but this is highly unlikely because of the political fallout it would generate.  Ardent abortion supporters in the Democratic caucus are arguing that if the Stupak amendment is part of a final bill with the Senate that they will vote against it but that demand may kill the bill because if the same 64 Democrats refuse to come on board because of the bill then a final bill without the amendment will fail.  President Obama has signaled that he may not sign a bill with the Stupak amendment in it, but that might kill his major domestic project.  Overall, the Stupak amendment has thrown a political hand grenade into the Democratic tent and has the potential to give the GOP an easy out in voting against the healthcare bill.

Furthermore, polls demonstrate that Americans do not want their tax dollars to go for abortion coverage.  Opponents counter that lots of Americans do not get to choose where their tax dollars go so pro-life groups should not be any different.  However, a CBS poll taken this week shows that 56% of Americans do not favor federal funds being used for abortion and 34% are in favor.  Therefore, insisting that abortion be covered in a final healthcare bill could alienate pro-life and even some pro-choice independents who are queasy of their tax dollars being used for abortion and looking at the latest election results that might not be good politics for the Democratic Party.

The Future

Based on the public option and abortion issues, healthcare reform may not be able to be on President Obama’s desk by the end of the year.  In fact, these two issues together might prove to be too much for some lawmakers to stomach.  For example, Senator Blanche Lincoln of Arkansas is up for re-election in 2010 and polls show that her approval ratings are not in good shape.  A vote for healthcare reform might lead to her losing election and a Republican filling her seat.  In some ways the Democrats may have to examine whether healthcare reform will increase their approval ratings and help them win re-election or whether it will lower their approval ratings and cost them re-election.  This is more of a calculation for the House’s Blug Dog Democrats.

Ultimately, the fight over healthcare could endanger other Obama initiatives.  The bruising battle over healthcare might ward off attempts at imposing a cap and trade system, which will likely have Midwestern states rise up and fight hard against the administration.  Also, Obama’s promise to Mexican President Felipe Calderon to pursue immigration reform in 2010 may prove hollow depending on how long the healthcare debate drags on.  A bigger political risk for Obama is that the longer he spends on healthcare reform the less he looks focused on the economy and with unemployment at 10.2% and likely to go higher that could spell political death.

Another factor to consider is that the public is getting wary of healthcare reform.  Some of the early enthusiasm is starting to fade as the process drags out and the longer the GOP can drag out the reform process the more likely they are to win.  Thanks to the Stupak amendment, the GOP may have found a quick lightning rod that can win over more Democrats to oppose the bill in the House and stop the reform effort in its tracks.  On the other hand, the Stupak amendment may reinvigorate Democrats on the healthcare debate and the lobbying of pro-choice groups may convince some Democrats to change their views on the amendment.

In the final analysis, the healthcare debate still has a ways to go and it is fraught with peril for the Obama administration.  Of the issues confronting the healthcare debate, the public option might be the hardest sell in the Senate while the abortion issue might be the biggest in the House and this analysis neglects any influence elderly groups might have when they find out that hundreds of billions of dollars are cut from Medicare in the bill (although the AARP has endorsed the healthcare effort).  Ultimately, it looks like Obama won’t be able to pass his healthcare bill by Christmas and instead of getting a magnificent present will just be given a huge lump of coal.