House Committee tackles role of abortion in health care reform

While much of Iowa slept, members of the U.S. House Committee on Energy and Commerce continued to debate possible amendments to health care reform. At least two of the amendments passed late Thursday provide a clearer picture of how wedge-issue abortion services will be handled.

U.S. Rep. Lois Capps (D-CA) introduced an amendment that specifically states that abortion coverage cannot be named by any subsequent health benefits advisory board or the Department of Health and Human Services as an essential service. The language of this amendment effectively destroys any possibility of health care reform containing a “hidden abortion mandate.”

The Capps amendment, which goes on to make clear that covering abortion services will never be required or prohibited for any health care plan, maintains the status quo prescribed by the Hyde Amendment. Only certain abortions — in cases of rape, incest or medical necessity, for instance — could be obtained using taxpayer funds. The amendment also prevents health benefit providers from making assessments of health care facilities or providers based on their “willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions.” There is also a new sub-section that would prevent anything within health care reform from treading on existing state laws governing abortion, either the use of state funds to provide abortions or state-mandated restrictions on abortion.

The Amendment does, however, direct the organizers of the newly established Health Insurance Exchange to assure the option of both a plan that covers abortion services and one that does not.

The Capps Amendment was passed by a vote of 30 to 28. Six Democrats on the committee joined Republicans to oppose it.

The amendment that drew the most controversy within the committee, however, was offered by U.S. Reps. Joe Pitts (R-PA), Bart Stupak (D-MI) and Roy Blunt (R-MO). Language within the amendment, which was only one paragraph in length, was straight-forward enough:

Sec. ____ LIMITATION ON ABORTION MANDATES

No provision of this Act (or any amendment made by this Act) shall impose, or shall be construed to impose, any requirement for coverage of abortion, or access to abortion, or to authorize or permit the recommendation for, or imposition of, any such requirement by or through the Health Benefits Advisory Committee, the Secretary of Health and Human Services, the Health Choices Commissioner, or any other government or quasi-government entity, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of forcible rape or incest.

On initial consideration of this amendment, the committee members agreed by a 31 to 27 vote to include it. The approval was made possible by eight Democrats who joined Republicans voting in favor. However, a few hours after passage, Committee Chairman Henry Waxman (D-CA) made a motion for the committee to reconsider the amendment, and only Stupak of Michigan broke ranks with Democrats to oppose reconsideration.

When the amendment was given reconsideration, it was defeated by a vote of 30 to 29. Waxman, who voted in favor initially (likely so that he could bring the amendment back before the committee), voted against. U.S. Rep. Bart Gordon (D-TN) changed his vote to oppose the amendment during reconsideration, and U.S. Rep. Zack Space (D-OH), who had not voted initially, also voted against.

A third amendment, offered by Stupak, Pitts and U.S. Rep. Lee Terry (R-NE), also followed a curious path before being adopted by the committee in a voice-only vote. Stupak, who filed the amendment Thursday morning, withdrew it Thursday evening. Although it is unclear how the amendment came up for consideration after it was withdrawn, it has become a part of this committee’s health care reform bill.

The Stupak amendment, like the Capps amendment, provides “conscience” and anti-discrimination language for physicians, other health care professionals, hospitals, provider-sponsored organizations, health maintenance organization, health insurance plans or any other health-affiliated (but presumably not already stated) facilities, plans or organizations. It reinterates that health care reform will have no impact on “conscientious objection,” and names the Office for Civil Rights as the government entity that will investigate any complaints.

U.S. Rep. Bruce Braley (D-IA) partnered with Stupak on a non-abortion-related amendment that was adopted Thursday by the committee. The Braley-Stupak amendment addresses the qualifications required for an individual to serve as director of food services in a nursing facility accepting Medicaid. It was passed by voice consensus.

While the committee considered a host of amendments during its work session on Thursday, a particularly radical one, submitted by U.S. Rep. Anthony Weiner (D-NY), sought to elimate Medicare, defined in the amendment as single-payer system and socialized medicine. It was the only amendment before the committee with a completely unanimous vote, albeit a unanimous vote against.

Weiner, who favors a single-payer system, described the amendment to the New York Daily News as “put-up or shut-up” for Republicans and Blue Dog Democrats who have been voicing concerns about government-run health care. As Weiner likely knew before the amendment was submitted, no one on the committee — not even those who publicly warn constituents about socialized medicine — wanted to have his or her name associated with a bill ending Medicare.