July 22, 2009

I know the White House wants no part of this discussion, and the media wants no part of this discussion, but without a public insurance option providing the same kind of coverage that private insurance provides, particularly for women, you don't really have legitimate competition.

Up to this point, the administration has avoided discussing this issue directly, despite increasingly frenzied congressional debate on abortion's place in health reform. During President Obama's July 1 health-care “town hall” event in Annandale, Virginia, the topic of women’s health care never came up; the White House had preselected many of the audience questions. In a March interview with the Christian Broadcasting Network’s David Brody, chief White House domestic policy adviser Melody Barnes -- who once sat on the board of Planned Parenthood -- claimed she had never spoken to the president about whether or not abortion services should be covered under a universal health-care system. “We haven't proposed a specifics benefits package or a particular health-care proposal, so we're going to be engaging with Congress to have this conversation,” she said.

If there's one question I wish I could have asked in yesterday's town hall meeting it would have been about this. Clinton apparently was pretty adamant that public plans cover what most private plans cover in 1993. About 90% of all private insurance companies cover abortions, a legal medical service available to women. If you follow the Hyde Amendment, which restricts abortion services through Medicaid, in the public plan, you basically both deny legal services to women and make the public plan significantly less attractive to them. And as I wrote last week, the idea that this would represent "government funded abortions" is a lie:

In addition, the entire premise of Matthews' critique, ripped from the pages of The Weekly Standard, is just wrong. As the just-released House Tri-Committee bill describes, the public insurance option is completely self-sustaining and pays for everything out of its own premiums. There's public money involved in the sense that the Health and Human Services Secretary would have to hire administrators, but basically this is a self-funded insurance program.


Public option must be financially self-sustaining, as private plans are.

Public option will need to build start-up costs and contingency funds into its rates and adjust premiums annually in order to assure its financial viability, as private plans do.

As Goldstein notes, the Hyde Amendment, that law from the 70s that Tweety cites, "is not under threat from any of the proposed House or Senate health reform bills." Meaning that Medicaid and other public health programs will continue to deny legal abortion services as part of their coverage. It's sad that Democrats are already conceding that, but Republicans want more. Not only do they want reproductive choice banned from a self-sustaining public option, they want it banned from any private insurance company that offers coverage inside these "insurance exchanges" designed to provide small businesses and individuals more choice and greater purchasing power to receive health insurance. As said before, 90% of all private insurers include abortion services in their coverage. Anti-choice Republicans don't just want to follow existing law, they want to create new policy that says anyone the federal government does business with cannot offer abortion services as part of their coverage to consumers. The Hyde Amendment already discriminates against poor women who cannot afford health insurance; the anti-choicers would extend that.

I'm sorry this is a messy matter, and everyone feels icky about it, but this is not a common-ground issue. Either women have the right to choose their own medical care or they don't. Leaving them out in the cold is not good enough.

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