Ready to start all over again on the abortion debate? Especially in places like Maryland, where a 1992 referendum provided a political settlement and mercifully enabled state officials to get beyond the issue, that prospect is not a happy one. But health care reform is presenting a new context for the debate. By opposing the inclusion of abortion services in any standard benefits package, abortion opponents could effectively deny millions of women access to abortion.
Abortion has always loomed as a potential stumbling block to health care reform. Now, as Congress prepares for floor debates, abortion opponents are turning up the heat. The various draft bills produced by congressional committees included abortion coverage in their standard benefits packages, hedged by "provider conscience clauses" enabling hospitals or doctors to refuse to perform abortions. The Senate Finance Committee's bill went even further, allowing any employer or health plan to refuse to buy or provide abortion coverage for religious or moral reasons.
In recent days, the nation's Roman Catholic bishops have warned they will firmly oppose any plan that requires employers to cover abortion as part of a standard package of benefits -- even if the plan includes the provider conscience clause. In their view, even the Finance Committee's broader clause would significantly expand the availability of abortion.
All this ratchets up the pressure on the administration, which is strongly pro-choice but which has also staked its prestige on the health reform issue. If abortion is dropped from standard benefits packages, millions of women would lose benefits that are currently included in most private insurance plans, exacerbating problems that already make abortions difficult to obtain in many parts of the country. And, facing a fierce scramble for votes, Democratic floor leaders are acutely aware that dropping abortion benefits can also exact a heavy toll. Some 70 members of the House of Representatives have said that they would reject any plan that does not treat abortion the same as any other medically necessary procedure.
The White House has signaled its willingness to compromise on virtually every aspect of health care reform, and abortion rights supporters have reason to be nervous. In a pluralistic society, health care benefits ought to accommodate a wide range of conscientious views. Abortions are never desirable, but they are sometimes preferable to the alternative. The availability of safe abortions is a critical component of a sound, fair health care system.