A Lasting Victory?

The Affordable Health Care for America Act, passed by the House of Representatives on Nov. 7, is both an achievement and a mere first step. It is an achievement because no other administration has moved this far toward universal health care, although many presidents and candidates aspired to this, beginning with Theodore Roosevelt in 1912. The passage of the House bill by a vote of 220 to 215 could become more than a transitory victory, but its lasting significance depends on what is learned from the 11th-hour effort to win passage of the reform bill. It will also depend on the contents of the Senate bill and the final House-Senate conference bill.

Should it become law, H.R. 3962 would offer the nation benefits historic in scope:

• mandated coverage for 96 percent of American citizens, including 36 million of those currently uninsured;

• federal subsidies to help persons with low-incomes afford the premiums;

• an employer mandate to provide health insurance for workers, with an exemption for small businesses (currently 160 million workers have employer-sponsored plans);

• limitations on insurers, who could sell only policies that meet government standards and could no longer refuse coverage to persons with pre-existing conditions, cap lifetime coverage, drop policyholders who become seriously ill or charge co-pays for preventive care; and parents’ policies could cover children up to age 27.

The bill would also expand Medicaid and streamline Medicare. It would be funded by a “millionaire’s tax,” reducing the deficit by millions over 10 years, according to the Congressional Budget Office. A public option would be one of many choices in a government-sponsored marketplace set up for small businesses and others without insurance. But the public option and government-subsidized plans in the marketplace would not pay for or subsidize elective abortions.

Ironically, it was an amendment to prohibit taxpayer funding for elective abortions, sponsored by Representative Bart Stupak, Democrat of Michigan, and Joseph R. Pitts, Republican of Pennsylvania, that secured the bill’s passage and provided its most bipartisan moment. The amendment passed 240 to 194, with support from 176 Republicans and 64 Democrats. At the last roll call, however, a single Republican voted for the bill: Anh Cao of New Orleans, who said restrictions on abortion were essential to his vote.

One lesson to be learned is that Democrats and Republicans can work together to continue to limit federal financing for elective abortion, though it is not easy.

A second lesson is that the U.S. Conference of Catholic Bishops and the Catholic Health Association can accomplish much by working behind the scenes with legislators. This is a more constructive, successful approach than public attacks questioning the faith of Catholic lawmakers. According to published reports, personal calls by Cardinal Francis George to the Senate minority leader, John Boehner, and by Cardinal Theodore McCarrick to House Speaker Nancy Pelosi appear to have been well timed and effective. The bishops “command respect because they have a good social-justice record,” said Representative Michael F. Doyle, a Pennsylvania Democrat and one of several Catholic leaders behind the amendment. “They actually wanted to pass the bill. That’s why they had status.”

Yet the bishops’ ultimatum to lawmakers—“If the final legislation does not meet our principles, we will have no choice but to oppose the bill”—succeeded only after legislators prepared an amendment that secured votes, and after Speaker Pelosi allowed the amendment on the floor once she saw there were too few votes to pass the bill without it.

Now opponents claim erroneously that the amendment violates “abortion neutrality” by keeping women from buying even a private policy with abortion coverage on the exchange. Not so. H.R. 3962 would allow insurers to offer supplemental abortion coverage, which women could buy without support from taxpayers. Nor is the financing ban unprecedented. It already applies to Medicare, Medicaid, S-chip and health insurance for federal employees, including members of Congress. Still, a group of legislators threatens to oppose the final bill if the amendment is retained. Lesson three: Brinkmanship is a two-edged sword.

For supporters of health care reform, the next step is crucial: passage of a strong Senate bill. Given that 60 votes are needed to prevent a filibuster, it is reasonable to assume the Senate bill too will exclude federal funding for abortion. Building bipartisan support will take at least as much time, energy, money and attention from Catholic leaders as passage of the House bill did. That commitment could finally achieve near-universal health coverage and major improvement in health care for generations of Americans.

This article appears in November 30 2009.