November 5, 2009
Two hot buttons
by
Los Angeles Times
Sponsors of the healthcare reform bills in Congress have tried hard to steer the legislation around the hot-button issues of abortion and illegal immigration, but to no avail; controversies about both continue to threaten the measures. Supporters say the bills respect the government's long-standing approach to abortion and undocumented immigrants; opponents, however, argue that the bills would flout current policy by allowing tax dollars to finance abortion on demand and nonemergency medical care for people who are here illegally.
These disputes aren't really about what the federal government does with tax dollars, however. They're about the indirect effects of that spending, and that's an unreasonable standard.
Most of the spending in the House and Senate reform bills comes in the form of subsidies to help lower-income individuals and families buy health insurance. In a nod to current policy, the bills would bar insurers from using money from the subsidies they collect to pay for any abortions that would not be eligible for federal Medicaid dollars. (Eligibility is currently limited to cases of rape, incest or threats to the mother's life.) The bills also would prohibit private insurers from being compelled to pay for any abortions as part of their basic insurance plans. On the other hand, the bills would allow people who receive subsidies to pay extra, if they choose to, for policies that cover elective abortions. And they would require insurance exchanges -- new markets to help individuals and small businesses shop for policies -- to offer at least one plan that covers abortions and one that does not. The "public option," a government-run insurance plan that would be one of the choices available through the exchanges, would be required to cover abortions at least to the extent Medicaid does, although it also would have to assure that no federal subsidies directly financed elective abortions.
Opponents argue that those who receive subsidies should not be able to buy a policy that covers abortion, even if they pay extra out of their own pockets, because money is fungible. By subsidizing the purchase of basic health insurance, the government in effect makes the extra coverage more affordable. But that argument is not persuasive. Federal aid for any purpose frees up money for other uses, including those that the government may be barred from supporting. Should Congress not give tax credits to a publisher who sets up shop in a distressed community if it finds that he's using the savings to start a religious broadcasting arm? Besides, the federal government already provides indirect aid for elective abortions by exempting employer-provided health benefits -- many of which cover abortions -- from income taxes.
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