Matt Yglesias

Study: Stupak Would Lead to Abortion Coverage Phaseout

Via Brian Beutler, a study from the GW School of Public Health and Health Services confirms progressive fears that over time the Stupak amendment would have quite widespread consequences for the availability of insurance coverage for abortion services. As Beutler writes “though the immediate impact of the Stupak amendment will be limited to the millions of women initially insured through a new insurance exchange, over time, as the exchanges grow, the insurance industry will scale down their abortion coverage options until they offer none at all.”

This is essentially a consequence of one of the main good things about the health care reforms being considered in congress. They not only set up insurance exchanges that will help the currently uninsured in the short-term, they’re designed to have broader implications for the future and over time reshape the health care system.

Ambivalence is a Bad Organizing Tactic

A good Jeffrey Toobin article about the Stupak Amendment ends with the observation that a lot of recent trends in abortion-related messaging have arguably left the pro-choice side disarmed to fight these skirmishes:

The President is pro-choice, and he has signalled some misgivings about the Stupak amendment. But, like many modern pro-choice Democrats, he has worked so hard to be respectful of his opponents on this issue that he sometimes seems to cede them the moral high ground. In his book “The Audacity of Hope,” he describes the “undeniably difficult issue of abortion” and ponders “the middle-aged feminist who still mourns her abortion.” Elsewhere, he announces, “Abortion vexes.” The opponents of abortion aren’t vexed—they are mobilized, focussed, and driven to succeed. The Catholic bishops took the lead in pushing for the Stupak amendment, and they squeezed legislators in a way that would do any K Street lobbyist proud. (One never sees that kind of effort on behalf of other aspects of Catholic teaching, like opposition to the death penalty.) Meanwhile, the pro-choice forces temporized. But, as Supreme Court Justice Ruth Bader Ginsburg observed not long ago, abortion rights “center on a woman’s autonomy to determine her life’s course, and thus to enjoy equal citizenship stature.” Every diminishment of that right diminishes women. With stakes of such magnitude, it is wise to weigh carefully the difference between compromise and surrender.

The crux of the matter is that whether or not “mixed feelings” about abortion are common, it’s hard to find a stable and coherent middle ground position on the issue. If aborting a fetus is morally similar to killing a person, then banning such activity clearly doesn’t diminish women. But if it’s not similar, then as Ginsburg is saying this cuts the heart of women’s status as free and equal autonomous citizens and bargaining rights away becomes very costly. But you can’t make any real sense out of the pro-choice position on a matter like this if you’re constantly apologizing for yourself. The practical consequences of the Stupak Amendment, like the Hyde Amendment before it, aren’t all that major in the macro sense. But they’re not only very major in the lives of the people directly affected, they implicate important issues of principle. But taking a principled stand only works if you’re prepared to defend the principle.

False Hope and the Stupak Amendment

One reason private health insurance tends to cover abortions is that having an abortion is a lot cheaper than having a baby. Consequently, it kinda sorta seems like the Stupak Amendment might have a limited practical impact. Thus I’ve had thoughts along the lines of this from Mark Kleiman:

But what happens when some of the women you insure get pregnant and wants to terminate? Since perinatal care plus delivery would probably cost you $2500, while a first-trimester abortion costs about $200, you’d be happy to provide the abortion coverage gratis if you thought that otherwise even as many as one in twelve of those women would choose to carry to term. You can’t provide it gratis; that’s what Stupak provides. But you could provide it cheap, even to someone who’s already pregnant. Charge $50 for the abortion-coverage rider, effective immediately.

There seem to me to be logistical questions about this. But I don’t think the profit profit motives quite add up. After all, an abortion is not a hugely expensive medical procedure, and whether or not to carry a pregnancy to term is a major life choice. Consequently, I think we should anticipate the price-elasticity of abortions to be relatively low. In other words, in a Stupaked universe most women who find themselves with an unwanted pregnancy are just going to take the financial hit, not have the baby. Under the circumstances it doesn’t really make sense for insurance companies to provide the coverage at an actuarial loss.

The big losers here, however, will be the set of poor women who really may not be able to get together the few hundred dollars that would be needed. This is, of course, entirely typical of relatively “soft” abortion restrictions. Very few people are sufficiently hardcore to push for legislative measures that would really and truly make abortions generally unavailable. Instead the tendency is to create situations that leave loopholes for the affluent while making poor women bear the burdens of middle America’s somewhat incoherent moral stance on the issue.

Too Much Ms. Nice Abortion Rights Advocate?

Dana Goldstein reviews some Monday morning quarterbacking of the abortion in heath care issue:

“Maybe we should have” created a more threatening pro-choice coalition earlier on, said [Eleanor] Smeal. She continued, “Here we are playing nice guy again, we didn’t want to make a fuss, we agreed to a compromise that was already over-generous. And then, bango! These guys go in there like gangbusters. Pelosi was held up, like by bandits. Now the women are saying, ‘That’s it, it’s enough.’”

It’s hard to know for sure, but I’m inclined to agree with this second-guessing. A persistent liberal failure in terms of legislative tactics seems to me to be the repeated belief that if you try to make a compromise proposal, that the compromise will be adopted and then you’ll get half a loaf. The reality of the way the legislative bargaining process works, it seems to me, is that you make a proposal and then a bloc of moderate legislators demands concessions. Whatever you propose, you then have to make concessions since the moderates wouldn’t be moderate if they didn’t make the liberals make concessions. So you might as well have had the bill start with a sweeping expansion of abortion rights—require that all Exchange plans offer a full suite of reproductive health services. Then you start bargaining.

Would that have worked? I don’t know. But the public option example strikes me as encouraging. It looks like if there’s a public option in the final bill, it’ll be a shadow of its original self. But had the proposal started with something like the “level playing field” public option then there’d be nothing left.

Real and Fake Sticking Points

I think Mickey Kaus makes an excellent point here about alleged “sticking points” in health care. The crux of the matter is that in any negotiation you need to distinguish between a dispute that could wreck a deal between two parties who genuinely want a deal, and a dispute that provides a convenient pretext for parties who on some level don’t want a deal. So specifically on health care it seems extremely unlikely that if there are 218 House Democrats and 60 Senate Democrats who honest-to-God want a universal health care bill passed that disagreements about abortion could prevent that from happening.

But insofar as there are members who don’t want to take the political risk of voting “yes” on a comprehensive health care reform bill, but also don’t want to be seen as spiking the initiative, then developing a hard line position on abortion can be convenient. Like say Ben Nelson and Bob Casey say they can’t vote for health care unless it contains Stupak language, and then Joe Lieberman (Freedom of Choice Act cosponsor!) and Olympia Snowe say they can’t vote for health care unless it doesn’t contain Stupak language. Well, then health care dies. And yet nobody has to take the blame for having killed it if a constituent gets mad.

The Silence of the Anti-Abortion Activists

If you want to start your day off on a sour note, pay some attention not just to the substantive harm Bart Stupak did to the health care reform bill over the weekend, and think about how little political benefit he got while doing it. What his amendment did, in essence, was take pre-existing compromise language that would have preserved the legal status quo for abortion (itself slanted toward arbitrary deligitimization of abortion as a medical procedure) and change it such that now the House bill, if enacted, would be a step backwards in terms of access to abortion.

So far, so bad. But you get what you get. Stupak is in the Congressional Pro-Life Caucus and evidently he’s serious about it. Given an opportunity to restrict access to abortion, he seized the opportunity. But at least his fellow anti-choicers should appreciate his efforts, right? Now that he’s turned health care reform into an abortion-restricting bill, they’ll be supporting the bill, right? Even if no House Republicans could be persuaded to vote “yes” then surely single-issue anti-abortion activists will support it, right? Wrong! With the exception of Democrats for Life, pro-life organizations are praising Stupak but denouncing the bill anyway, citing imaginary provisions to euthanize seniors. The US Conference of Catholic Bishops sent out a press release urging passage of the Stupak amendment, but no release urging passage of the amended bill.

NARAL President Nancy Keenan on Abortion and Health Reform

Yesterday came the news that the Senate Finance Committee might include language preventing Exchange-participating insurers from offering coverage for abortions in pursuit of Republican support for overall health care reform. It strikes me as a strange tactical idea because the two Republicans most likely to support reform, Senators Susan Collins and Olympia Snowe of Maine are both pro-choice, and that’s all the Republicans you need. But this trial balloon highlights the fact that health care reform is full of angles related to reproductive rights. Dana Goldstein has an enlightening interview with NARAL President Nancy Keenan on this subject in which she warns that “that many, many women could lose the coverage they presently have.”

Bishops, Baptists Organizing Against Contraception

It’s precisely because of stances like this that it’s very hard to take the “abortion is murder” crowd seriously when they say abortion is murder. Their revealed behavior indicates that they don’t actually find abortion especially problematic, but just place it on a spectrum containing a general aversion to women controlling their own sexuality:

But more conservative religious groups working with the White House Office of Faith-Based and Neighborhood Partnerships say they would be forced to oppose such a plan—even though they support the abortion reduction part—because they oppose federal dollars for contraception and comprehensive sex education. This camp, which includes such formidable organizations as the U.S. Council of Catholic Bishops and the Southern Baptist Convention, is pressuring the White House to decouple the two parts of the plan into separate bills. One bill would focus entirely on preventing unwanted pregnancy, while the other would focus on supporting pregnant women.

Atrios sees this as a reason to mock those who advocate seeking “common ground” with abortion proponents. I think we’re arguably seeing here the real fruits of seeking common ground in good faith—their real views are smoked out.

Public Opinion on Abortion

There’s been a lot of talk lately about a couple of polls that seem to indicate rising popularity of the “pro-life” self-ascription. John Sides helps us put this in context with some time-series data from the National Election Survey:

There has been some discussion about abortion during recent years. Please tell me which one of these opinions best agrees with your view:

1. By law, abortion should never be permitted.

2. The law should permit abortion only in case of rape, incest, or when the woman’s life is in danger.

3. The law should permit abortion for reasons other than rape, incest, or danger to the woman’s life, but only after the need for the abortion has been established.

4. By law, a woman should always be able to obtain an abortion as a matter of personal choice.

Looks like not much is happening in terms of trends. It continues to be the case that the orthodox conservative position on abortion is extremely unpopular, but that the orthodox liberal position doesn’t command majority support either. At the link you can see data from the General Social Survey that leads to a similar conclusion.

Going Pro-Life

Raymond Hernandez for The New York Times takes a look at pro-life Democratic candidates:

Kelli Conlin, the president of the National Institute for Reproductive Health, called the recruitment strategy misguided, saying that surveys conducted by her organization showed that even some Republicans express support for abortion rights when her group described the consequences of outlawing the procedure.

“The movement to recruit anti-choice candidates ignores the larger reality that this is a pro-choice nation,” she said. “It misses the larger point.” (Polls show a divided nation on the issue: A 2008 CNN-Opinion Research poll found that 53 percent of Americans characterized themselves as “pro-choice,” versus 44 as “pro-life;” a 2007 poll by the same organization showed the numbers reversed, 45-50.)

The Times uses Senator Bob Casey (D-PA) as the poster child for this trend, but he actually seems like an outlier example. Pro-choice Democrats regularly win statewide in Pennsylvania — Clinton in 1992 & 1996, Gore in 2000, Rendell in 2002 & 2006, Kerry in 2004 — and, indeed, pro-choice Republicans like Arlen Specter and Tom Ridge have a good record in the state as well. In a place like that, pro-choice voters are naturally going to have a strong preference for a pro-choice candidate. But the fact that Casey’s opponent was Rick Santorum nevertheless left Casey as clearly the more socially and culturally liberal candidate.

The main subject of the article is the rather different case of recruiting pro-life candidates to run in districts or states that are so strongly anti-choice as to make it highly unlikely a pro-choice candidate could win. To me, that seems like a very different calculation. What’s more, it’s clearly a calculation that makes national polling on abortion rights irrelevant.

Could or Would John McCain Ban Abortion?

A new Barack Obama ad tries to get pro-choice voters alarmed about John McCain’s steadfastly anti-choice record. An announcer argues that “as president, John McCain will make abortion illegal” then shows a snippet of Meet The Press where McCain tells Tim Russert that he favors “a constitutional amendment to ban all abortions.” The ad concludes: “We can’t let John McCain take away our right to choose. We can’t let him take us back.”

Brendan Nyhan says this “distorts” McCain’s position and deems the overall product “misleading.” What’s wrong with it?

The president can’t make abortion illegal. If John McCain appointed new conservative Supreme Court justices (who must be confirmed by the Democratic Senate), it is possible that the Court could decide to overturn Roe v. Wade. In that case, the issue would be returned to the states, who would each create their own abortion policies through the legislative process. The odds of McCain successfully passing a constitutional amendment to create a national ban on abortion are zero — there is simply no way he “will make abortion illegal.”

For one thing, conservative members of congress regularly seek to pass federal legislation restricting reproductive freedoms (”partial birth” abortion bans, etc.) and I see no reason to think that would change if Roe were overturned. And more broadly, the idea that it’s unfairly deceptive to characterize McCain’s position on abortion accurately — he favors outlawing abortion throughout the country — on the grounds that it’s extremely unlikely that McCain would be able to deliver legislatively on his policy preferences seems like an odd standard. Democrats will almost certainly have a congressional majority in 2009 which makes it very unlikely that any aspect of his domestic agenda will pass precisely as proposed. Does that make it unfair to critique his domestic policy proposals?

Flip-Flopping on Abortion

In all likelihood the origin of the myth that John McCain is pro-choice is that it really is true that despite McCain’s solid pro-life record, back in 2000 he suggested modifying the Republican plank to call for the criminalization of abortions except in cases of rape, incest, or where failure to abort would kill the mother. That would be a far cry from the pro-choice position, but it would be somewhat more moderate than the current platform’s commitment to blanket criminalization. Then he lost the primary, his views swung to the left on a variety of views, and then starting with George W. Bush’s re-election campaign he swung his views on taxes, immigration, and a series of other issues back to the hard right. But as of April 2007 he was still mavericky on abortion:

Senator John McCain, R-Ariz., told ABC News Saturday that he still wants to change the GOP’s abortion platform to explicitly recognize exceptions for rape, incest, and the life of the mother.

But now his campaign says they won’t try to change the platform after all. Instead, the plan is to just try to avoid accepting any responsibility for his repeated cave-ins to conservative dogma.