Editorial de NY TIMES sobre el aborto y la reforma de Salud de Obama

October 1, 2009
Editorial
Abortion and Health Care Reform

Critics of pending health care reforms claim they want to ensure that the government does not thrust itself between patients and doctors to dictate what medical procedures can be performed. Yet many are trying to do just that when it comes to one legal and medically valid service: abortion.

Republicans and anti-abortion Democrats in both houses of Congress are seeking to prohibit millions of Americans — those who might receive tax subsidies to help them buy insurance — from purchasing plans that would cover an abortion.

In a rational system of medical care, there would be virtually no restrictions on financing abortions. But abortion is not a rational issue, and opponents have succeeded in broadly denying the use of federal dollars to pay for them, except in the case of pregnancies that result from rape or incest or that endanger a woman’s life.

These restrictions, which constitute an improper government intrusion into Americans’ private lives, apply to the joint federal-state Medicaid program, the health insurance exchange that covers federal government employees, and health programs for military personnel, American Indians and women in prison, among others. This approach disproportionately harms poor women, who often can’t scrape together enough money for the procedure until delay has made abortions more costly and more risky.

Now abortion opponents want to apply similar restrictions to low- and middle-income Americans who would receive federal subsidies to buy coverage on the new insurance exchanges that would be created by pending health care reform bills. (These exchanges would offer an array of policies for individuals who buy their own insurance or work for small companies.)

In an effort to defuse the issue and allow health care reform to proceed, the House Energy and Commerce Committee and Senator Max Baucus, the chairman of the Senate Finance Committee, have backed a proposal that follows the spirit of the federal restrictions while allowing some leeway for people to choose plans that cover abortion on the exchanges.

This proposal would prohibit the use of federal tax subsidies to pay for almost all abortions. Health plans could provide abortion coverage provided they used only the premium money and co-payments contributed by beneficiaries and kept that money segregated from the subsidy. In every state, there would have to be at least one plan that covers abortions and one that does not.

This compromise is still far more restrictive than the rules for other tax-subsidy programs. The subsidy for employees’ contributions to their health coverage at work, for example, can be used to buy insurance that covers abortion. Roughly half of the employer-provided policies cover the procedure. Nor are there any restrictions on paying for abortions with the tax-favored health savings accounts so beloved by conservatives.

Nevertheless, conservative critics of pending reform bills want to prohibit the use of tax subsidies to buy any health insurance policy that covers abortion. Some want to require women to buy an extra insurance “rider” if they want abortion coverage, an unworkable approach given that almost no one expects to need an abortion, few women would buy the rider and, therefore, few insurance companies would even offer it.

There should be no restrictions on abortion coverage in the exchanges. Health care reformers should not retreat on this issue, but we recognize that principle is often sacrificed in Congressional bargaining. Democrats who support the compromise must find a way to prevent it from being used later to go after other tax subsidies and thus further deny Americans’ rights to make their own health-care decisions.