A Look At How Health Bill May Change Abortion

Abortion has become the flashpoint in the health care debate. NPR's Julie Rovner talks to host Melissa Block about who is using these services, how the services are paid for, and what would change under the language approved by the House in the health overhaul bill it passed late Saturday night.

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MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

MELISSA BLOCK, host:

And I'm Melissa Block.

The latest chapter in the health care overhaul saga has raised big questions about controversial language on abortion. It was added to the House bill last weekend.

To help us answer some of those questions, we're joined by NPR health policy correspondent Julie Rovner. Hey, Julie.

JULIE ROVNER: Hey, Melissa.

BLOCK: And, first of all, Julie, there's a disagreement about what the language added to the House bill on Saturday would do. Can you help us set us straight there?

ROVNER: Yes. It really has two separate parts and they both affect health plans in the new insurance marketplaces that would be created in the bill called health exchanges.

Now, the first part would ban all abortions performed directly with public money in the new government-sponsored public plan. This is basically making permanent the so-called Hyde Amendment, which since 1977, has been renewed by Congress every year to ban federal funding of abortions except in limited cases: rape, incest, life of the woman.

The second part bans abortions in private health insurance plans for women receiving public subsidies. This is where the dispute is. Backers of the amendment say insurance companies could still offer plans that provide abortion as a benefit to people who buy policies with their own money. But opponents say there are other provisions in the bill that would make that basically impossible. So, the net result is that there would be no plans in the insurance exchanges that offer abortion coverage at all.

BLOCK: Julie, if you are a woman, say, who has private insurance now, switching over to the exchange to buy a policy with your own money, what would the implications be if you have abortion coverage in your insurance right now?

ROVNER: Well, of course, many women do have abortion coverage right now. There are studies that differ, but basically it's somewhere between 50 and 80 percent. So, obviously if you were to go into this exchange and not get it anymore, you know, many people say it wouldn't make that much of a difference. There's a disputed statistic about how many abortions are directly billed to insurance. It's something like 13 percent.

But there's really a distinction here between first trimester abortions and second trimester abortions. The vast majority of abortions are done early in pregnancy in the first trimester. They're normally done in abortion clinics. They're fairly inexpensive, a couple of hundred dollars.

But while there's no statistics specifically on this, I talked to a number of people today, and they say that probably most of the insurance coverage used for abortions are for later abortions that are done for probably for medical reasons, either fetal abnormalities or pregnant women with health problems. Those are abortions that are usually done in hospitals and cost thousands of dollars. Those are the ones that you want probably the insurance for and there is no provision in these - there's no exception. Those would be banned, too.

BLOCK: Under the House bill.

ROVNER: Yes, under the House bill.

BLOCK: Julie, talk a bit about how the language came to be in the bill in the first place.

ROVNER: Well, this was controversial in and of itself. There was originally what was thought to be a compromise that kind of froze the status quo - no federal funding, direct funding for abortion. But late Friday night, the Conference of Catholic Bishops, which didn't like that language, was in Speaker Nancy Pelosi's office trying to cut a deal. They couldn't.

By then, there were so many conservative Democrats who were siding with the bishops that Speaker Pelosi had no choice but to allow this language that was ultimately adopted to be offered. That infuriated the pro-choice Democratic women in the House. They even complained about the Catholic Church with its tax-exempt status doing direct lobbying.

Here's what the chairman of the House Rules Committee Louise Slaughter of New York, who was the one who had to allow the amendment, had to say about it.

Representative LOUISE SLAUGHTER (Democrat, New York; Chairman, House Rules Committee): ...Episcopalian, and I was stunned to find out how much effect the Catholic Church has on my beliefs in my life.

BLOCK: And, Julie, this now goes to the Senate. What kind of abortion language is in the Senate bill now and what's likely to happen there?

ROVNER: Well, again, the Senate bill just has that language that would ban direct federal funding of abortion. There are already some pro-life Democrats who are talking about adding this House language. And, you know, the president has already come out and said that he doesn't like the House language. It violates what he was saying, if you like the coverage you have, you could keep it. There are 40 House pro-choice Democrats who say they won't vote for final bill unless this language is taken out. It's going to be tricky. They're going to have to find a compromise.

BLOCK: Okay. NPR health policy correspondent Julie Rovner. Thanks so much.

ROVNER: You're welcome.

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