A Project of The Annenberg Public Policy Center

Surgery for Seniors vs. Abortions?

Family Research Council says abortions will trump care for the elderly in public plan.


Summary

An anti-abortion group’s TV ad shows a white-haired man fretting that under a federal health plan, "They won’t pay for my surgery, but we’re forced to pay for abortions."

“Will this be our future?” the ad asks, merging the fears of seniors worried about their health care with those of anti-abortion advocates. “Our greatest generation, denied care. Our future generation, denied life."

In fact, none of the health care overhaul measures that have made it through the committee level in Congress say that abortion will be covered, and one of them explicitly says that no public funds will be used to finance the procedure. Furthermore, none of the bills call explicitly for cuts in Medicare coverage, much less rationing, under a public plan.

The bills leave the specifics of what medical services would be covered up to advisory panels that are supposed to make recommendations to the Department of Health and Human Services, and ultimately up to the secretary of that department. Whether she or he would choose to cover abortions under any new federal plan is something we can’t predict. Our crystal ball functions no better on the topic of whether the elderly, or anyone else for that matter, will get the care they need under such a plan or under Medicare.

Analysis

It can’t be an accident that the spot’s kitchen-table setting makes us expect Harry and Louise to turn up at any moment. The 30-second ad from the Family Research Council is running initially in Pennsylvania, Arkansas, Alaska, Louisiana and Nebraska.

Abortion Flashpoint

Whether the House and Senate health care overhaul bills would result in the government providing for abortions to be performed is a hot topic with conservatives.

Family Research Council Ad: "Takeover"

 

[TET ]

On-screen text: Will this be our future?

Man: They won’t pay for my surgery. What are we going to do?

Woman: But honey, you can’t live this way.

Man: And to think that Planned Parenthood is included in the government-run health plan, and spending tax dollars on abortions. They won’t pay for my surgery, but we’re forced to pay for abortions.

Voiceover: Our greatest generation, denied care. Our future generation, denied life.

Call your senator. Stop the government takeover of health care.

Family Research Council Action is responsible for the content of this advertisement.

[/TET]

A Senate and a House measure that had passed committee by the time this ad began running are silent on the topic. A third measure, passed by the House Energy and Commerce Committee on July 31, after the ad was up, distinguishes between what might be covered by a federal plan – it leaves that decision to HHS – and what would be paid for with federal money. 

It’s true that at one point, President Obama said he wanted abortion to be covered. Speaking to a Planned Parenthood Action Fund audience in July 2007 – early in his presidential campaign – Obama said that his plan for expanding access to health insurance would cover "reproductive health services." A spokesman for the campaign said later that abortion would be included.

But we’re not aware of any comments he’s made to that effect since taking office, and on July 21, when asked in an interview with CBS News whether abortion would be covered, Obama seemed to have backed way off his campaign statement:

Obama: I’m pro-choice, but I think we also have the tradition in this town, historically, of not financing abortions as part of government-funded health care. My main focus is making sure that people have options of high quality care at the lowest possible price.

Actually, it’s not merely "tradition" that keeps taxpayer-funded health care from paying for abortions. It’s the law, starting with the 1976 Hyde Amendment, which prohibits public funding of abortions through the Medicaid program except in cases of rape, incest or life endangerment. And according to the Guttmacher Institute, whose research is generally respected by both sides of the debate, there are a number of other restrictions on the expenditure of federal funds for abortion. The TRICARE system, which covers active and retired members of the military and their families, pays for abortions only when the mother’s life is in danger. Military hospitals aren’t permitted to perform abortions, even if they’re privately paid for, except in cases of life endangerment or rape or incest. Similarly, the Federal Employees Health Benefits Program, which covers 9 million federal workers and their dependents, is prohibited from paying for insurance coverage of abortions, with the same exceptions as those in the Hyde Amendment. Ditto for the Indian Health Service.

On the other hand, abortions are covered for most Americans who have private, employer-based insurance, according to Guttmacher. An institute study found that "87% of typical employer-based insurance policies in 2002 covered medically necessary or appropriate abortions," though a Kaiser Family Foundation survey found that 46 percent of covered workers had coverage for abortions. The truth, said Guttmacher, is probably somewhere in between, given that the questions asked in the surveys were somewhat different. Five states, however, restrict private insurance plans’ coverage of abortion; additional coverage that includes the procedure is available for an extra fee. And 12 states restrict abortion coverage in plans for public employees, Guttmacher says.

What the Bills Say

In the Senate bill, abortion foes are most unhappy about an amendment to the health overhaul bill approved by the Health, Education, Labor and Pensions Committee that they say would fund abortions. Authored by Sen. Barbara Mikulski, a Democrat from Maryland, the provision states that "preventive care and screenings" for women would be covered by health plans, and that  "community providers" would be part of "health insurance plan networks." Those providers would include, according to a Mikulski press release, "women’s health clinics, community health centers and HIV/AIDS clinics."

Mikulski amendment: On page 17, between lines 5 and 6, insert the following:

"Sec. 2709. Coverage of Preventive Women’s Health Services.

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for, and shall not impose any cost sharing requirements (other than minimal cost sharing in accordance with guidelines developed by the Secretary) for, with respect to women … such additional preventive care and screenings not covered under section 2708. …"

On page 59, between lines 6 and 7, insert the following:

"(D) include within health insurance plan networks those essential community providers, where available, that serve predominately low-income, medically-underserved individuals, such as health care providers defined in section 340B(a)(4) of the Public Health Service Act and providers described in section 1927(c)(1)(D)(i)(IV) of the Social Security Act. …"

While Planned Parenthood would appear to be a qualified health clinic providing certain health services to women, there is nothing in the amendment’s wording to indicate that abortion would be a covered procedure. That would be up to the HHS Secretary.

The vice president of Family Research Council Action, Tom McClusky, says that in order to be sure that abortions won’t be funded with public money, Congress must explicitly exclude them. And in June, 19 Democratic House members wrote to Speaker Nancy Pelosi saying they couldn’t support a health care bill "unless it explicitly excludes abortion from the scope of any government-defined or subsidized health-insurance plan."

No such measure has yet received a majority in any committee. In the House Ways and Means Committee, members passed a bill in mid-July covering "family planning" services, and like the Senate bill it left to HHS to determine what that actually included. 

But the House Energy and Commerce Committee’s health care overhaul measure, passed on the night of July 31, is the first to actually address abortion. An amendment introduced by Rep. Lois Capps, a California Democrat, would leave it to private insurers to decide whether or not to cover abortion, and in the case of the federal plan, leave it up to HHS, but it would not be part of the "essential benefits package" defined by the government. However, no public money could be used to pay for abortions, even in the public plan, which would be funded with privately paid premiums; the only exceptions would be cases of rape, incest, or the mother’s life’s endangerment, much as in the current Hyde amendment. The subsidies given out to help those below certain income levels purchase insurance "are not to be used for purposes of paying for [abortion]," the provisions says.

The amendment would also require the government to make sure that each "premium rating area" of the U.S. offered, in its health insurance "exchange" where individuals could shop for coverage, at least one plan that covered abortion and one that didn’t.

Billed as a compromise between Democrats who are pro-abortion rights those who are anti-abortion, the measure passed 30-28, with two anti-abortion Dems voting for it. But groups like FRC are unhappy with it, saying that the segregation between public subsidies and private funds to pay for abortion services is meaningless. FRC head Tony Perkins says on the group’s Web site that the provision "mandated taxpayer-funded abortion." However, it does not.  

An amendment by Rep. Bart Stupak, a Michigan Democrat, to prohibit the use of federal money "to cover any part of the costs of any health plan that includes coverage of abortion" was defeated 27-31.

The various versions of the House health care overhaul bill will be combined into a single measure over the coming weeks. The Senate Finance Committee is also working on a bill.

Dr. No?

We asked FRC’s McClusky about the basis for the ad’s assertion that the federal plan wouldn’t pay for the elderly man’s surgery, which was portrayed as a rationing of care. (We’re not told what kind of surgery the man wanted to have, or why it was denied, both important details.)

McClusky cited a June 24 town hall meeting on health care that was held in the East Room of the White House and broadcast on ABC. At the event, Obama responded to a woman who said her 105-year-old mother had received a pacemaker several years earlier, despite being told by some doctors that she was too old. According to McClusky, Obama answered that under a revamped health care system, "the govenrment will look into what is best for her, whether it’s a pill or surgery or whatever." Said McClusky, "That’s rationing."

Here’s what Obama actually said. He first noted, as an aside, that individuals have choices about how to deal with their end-of-life care, by which he meant making a living will if they so desire. (See our article "False Euthanasia Claims" to see what he was not referring to.) He went on:

Obama, June 24: I don’t want bureaucracies making those decisions. But understand that those decisions are already being made in one way or another. If they’re not being made under Medicare and Medicaid, they’re being made by private insurers. …

[W]hat we can do is make sure that at least some of the waste that exists in the system that’s not making anybody’s mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know, and your mom know, that you know what, maybe this isn’t going to help, maybe you’re better off not having the surgery, but taking the painkiller. …

The point is we want to use science, we want doctors and medical experts to be making decisions that all too often right now are driven by skewed policies, by outdated means of reimbursement, or by insurance companies.

The president didn’t say that government would decide what treatments or procedures would be allowed for each individual. He said the opposite: "I don’t want bureaucracies making those decisions," and "we want doctors and medical experts to be making decisions," based on scientific evidence of what is likely to result.

We have already debunked certain claims about rationing of care in Britain or Canada, whose single-payer systems are not what Obama or members of Congress are trying to duplicate, false assertions to the contrary. We have also written about the Federal Coordinating Council for Comparative Effectiveness Research, a creation of the stimulus bill passed in February, which is empowered to coordinate research into what treatments work best and which are most cost-effective, but has no power to tell doctors what treatments and procedures to perform or prescribe.

We don’t know whether or not some form of rationing would eventually take place if one of the pending bills were to become law. We would note, as does Obama, that denials of coverage are routine among private health insurance companies and under Medicare in our current system, and we asked McClusky about that. Why would such decisions about care be more objectionable under a public plan, for instance, than they are when Aetna or UnitedHealthcare denies coverage? "We find it more troubling when the federal government is doing it," he said. "It’s the 800-lb gorilla."

by Viveca Novak

Update, August 3: On the night of July 31, after we posted this article, the House Energy and Commerce Committee passed its bill containing the Capps amendment. We have updated the article throughout to reflect this.

Sources

Tumulty, Karen. "Could Abortion Coverage Sink Health-Care Reform?" TIME. 8 July 2009.

Condon, Stephanie. "Obama: Abortion Funding Not Main Focus of Health Reform." CBSNews.com. 21 July 2009.

Dorning, Mike. "Democrats Pledge Support for Wide Access to Abortion." Chicago Tribune. 18 July 2007.

McClusky, Tom. Interview with FactCheck.org. 29 July 2009.

Remarks by the President in ABC "Prescription for America" Town Hall on Health Care. Office of the Press Secretary, The White House. 25 June 2009.

Herszenhorn, David M., and Robert Pear. "House Health Care Bill Criticized as Panel Votes for Public Plan." The New York Times. 31 July 2009.