Can Vouchers Save Health Care Reform?

The issue of federal funding for abortion threatens to derail final passage of a health care bill. All sides claim the same goal: Extending the logic of the Hyde Amendment, which bans federal funds from covering abortions in any current government insurance program, to the newly configured exchanges and public option. But, translating that goal into legislative language that both pro-choice and pro-life legislators can live with has proven elusive. And, unlike other potential impediments to health care reform, the abortion issue is all about principle, moral principle at that, and so it is not easily the subject of a compromise.

Pro-life groups, most especially the nation’s Catholic bishops, were thrilled when the Stupak Amendment passed the House because it really does bar federal funds from going to pay for abortion coverage. Of course, the Stupak Amendment produced a backlash among pro-choice groups, and in the Senate, pro-life senators are in the minority. The current Senate bill tries to avoid federal funding in subsidized health insurance by "segregating" the money that comes from the government from the money contributed by the individual, and only paying for abortion coverage from the individual’s contribution. The bishops have said this "segregation" of funds is only an accounting gimmick (money is fungible) and the non-partisan group agrees with the bishops. Now, both sides have dug in and they are talking past each other, insisting that their way is the only way to achieve the goal both acknowledge they share. That means it is time to seek a new way forward, a different approach from that envisioned by either the Stupak Amendment or by the "segregated" funds approach of the Senate bill.


The most nettlesome difficulty is how to deal with insurance plans to be purchased with a mix of federal subsidies and private premiums in the proposed exchanges. Stupak says: If you get a federal subsidy you can’t buy a plan with abortion coverage. The Senate bill, as noted above, merely indicates that the federal funds will be segregated from the private funds. But, if the subsidies are calculated based on a person’s income, and given to the individual as a voucher to shop with in the exchange, why should we not let the individual choose whatever coverage they want? If they prefer a more expensive plan with abortion coverage, the voucher is not going to increase, so they really are making their own decision about what to do with their money and de facto as well as de jure they are buying their abortion coverage with their own funds. Additionally, the voucher is going to the individual, not the insurance company directly, so this arrangement does not constitute federal funding in any way.

Vouchers are currently used to cope with another complicated issue, helping poor parents pay for tuition at religious schools. There the difficulty arises from the First Amendment not the Hyde Amendment, but the idea is the same. In the health care debate, the difficulty arises from the profound ambivalence of many Americans about abortion: They do not want the procedure to be illegal but they really don’t want to encourage it with their tax dollars. The Hyde Amendment, after all, was never about saving money, it was about expressing this ambivalence about abortion. The idea of using vouchers was floated this summer, but not embraced. At the time, a spokesman for the U.S. bishops, Richard Doerflinger, told that the idea of using vouchers was "such a crazy idea it just might work." That is not an endorsement, but it is also not a veto. It is time to explore the "crazy idea."

The public option, already in great difficulty because the GOP succeeded in framing it as a "government take-over," is further complicated by the abortion issue. Again, Stupak is straightforward: the public option does not cover abortion, period. In the Senate, the Secretary of Health and Human Services has to jump through some hoops to get abortion in the public option, but it is not excluded. It should be. The public option should be as close as possible to the health care coverage congressmen receive. (This might also help Democrats sell the public option. There are worse tag lines than "Because you should have access to the same insurance your congressman gets!") Although the hysterics from pro-choice legislators like Cong. Diana DeGette and Sen. Barbara Boxer about the Stupak Amendment putting women back to the days of back alley abortions suggest otherwise, the fact is that DeGette and Boxer do not have abortion coverage in their health care because they are federal employees. Do either of them really want to equate their situation with that of women in the 1960s?

Finally, the last difficulty is the easiest to fix. The Stupak Amendment does not technically bar plans that are purchased in the exchanges completely with private funds from offering abortion coverage, but it has that effect because the insurance companies say the pool of people not receiving federal subsidies would be too small to offer such a plan. In this sense, pro-choice critics are correct that Stupak goes beyond Hyde. The law should require that the exchanges have at least one plan with abortion coverage and one plan without such coverage. And, because people with federal subsidies would be using vouchers, you do not have to separate those who are paying with their own money from the pool of those people receiving subsidies. The pools would be large enough to ensure both kinds of policies are offered.

Those of us who are lifelong pro-life Democrats were heartened when President Obama said he sought "common ground" on abortion and pledged that health care reform would not entail government funding of abortion. We were willing to look the other way on the Mexico City policy and we understood that the decision on embryonic stem cells would have occurred if John McCain had won the election too. As well, it is difficult to see how passing health care with abortion funding will help the Democrats: They stand to lose enough seats in next year’s midterm elections without also replacing a group of pro-life Democratic legislators with pro-life Republican congressmen. If Speaker Nancy Pelosi wants to remain Speaker, she needs to have Democrats representing more conservative districts like NC-14 and VA-5 and MI-1, currently represented by pro-life Democrats Health Shuler, Tom Perriello and Bart Stupak, respectively.

Catholic social teaching is unambiguous when it comes to the fact that health care is a right not a privilege. In today’s political climate, there is simply no alternative to the current legislation making its way to the President’s desk. It would be criminal to see this goal derailed because legislators can’t find a way to achieve what they all admit they want: health care coverage that does not include federal funding of abortion, especially when all that is needed is some creative thinking and a new approach. Instead of getting dug in, both sides need to reach out.


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Brian Thompson
9 years 1 month ago
The voucher idea seems halfway decent, thiugh I think the stupack solution really is superior: no abortion funding for anyone usuing a subsidy, unless they purchase a separate rider. I understand the market objection that such a poulation would be too small to be worth adapting to. However, there is a solition to that which would potentially make more money for the evil health insurance companies. If the companies drop everyone's abortion coverage, and require everyone to use riders, they might be able to pick up some extra dough, even if all the people with half a formed conscience decline buying a rider.
In all fairness though, the pure Stupack solution really is the only consistent application of Hyde I have seen in this debate up until this voucher thing was suggested. All other proposals have not been in consistent with the status quo.
Also, I admit that my ultimate goal would be complete illegalization of all forms of murder (I include euthanasia) and criminalization of those who provide such "services" and prey upon people in dire circumstances. I see the first step at that as doing whatever I can to starve a billlion dollar industry of as much money as possible.
However, health care is a right and so I would be willing to make a lot of concessions. I don't think the government is the proper vehicle to ensure this right, for example, but I am willing to accept excessive entangement of the government if it truly helps maintain high standards of care and extends that high standard to others. Indeed, I am willing to give what ground is absolutely necessarry short of encoraging or being forced to participate in an evil that shames the body count of Stalin and a certain other totalitarian (indeed all other major 20th century slaughters combined, excluding Mao-who equals our tally on his own).
John Hayes
9 years 1 month ago
"If they prefer a more expensive plan with abortion coverage, the voucher is not going to increase, so they really are making their own decision about what to do with their money and de facto as well as de jure they are buying their abortion coverage with their own funds."
Some things I have read indicate that a plan including abortion would not be more expensive than one without - because the medical costs of a typical childbirth are more than a typical abortion. In order to ensure that some money is segregated, the current Senate plan requires that no offset be used in the calculations.  
However, the voucher proposal should work or not morally regardless of whether the policy costs more with abortion coverage. The principle remains that the government gives the client a certain amount of money to buy health insurance regardless of what policy is bought.
If that is an acceptable solution, I would not then get hung up on the issue of whether the government and the client send separate checks to the insurance company each month or whether the client pays the government which then sends one multi-million dollar payment to the insurance company each month. I have heard arguments that if the client's premium money passes through the government, the government becomes complicit in a resulting abortion. Since the routing of the money doesn't affect the end result, it isn't obvious to me that that is so. 
Brian Thompson
9 years 1 month ago
Yeah, John, I did not look at it from that angle...
I suppose vouchers are just as unacceptable. Well I am back to being undivided with the Stupack solution.
Stephanie Hunter
9 years 1 month ago
I agree that vouchers are an idea that deserves consideration.  The biggest piece of hte public option is figuring out how it will be administered.  They have a great system in Ohio that's stayed in the black and served those who need it for years.  I think it should b eexpanded to the rest of the nation.
Michael Liddy
9 years 1 month ago
That is too big a change to the bills at this point in the process - nobody will even entertain it.
david power
9 years 1 month ago
It is disturbing to think that in a christian nation nourished on the teaching of Christ which includes the story of the good samaritan people are against the giving of aid to immigrants with health problems.If the same people say "strike me from His memory" then I conclude, but if the same is done in the spirit that the Gospel should take a back seat while ideology battles this one out Christians should place the Cross before those whose hearts have hardened.What do people think ,the Mexicans go and get some illness just to take advantage of free medical care?There is no need to go beyond a rereading of the words of Christ.God bless and challenge America!


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