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Be Careful What You Wish For

The health care bill that the House of Representatives approved Saturday night did two things its sponsors never intended: It virtually doomed health reform legislation for this year, and it showed how to eliminate legal abortion in the United States.

We may soon see abortion opponents leading the charge for a single-payer, government-run health care system, which could refuse to provide or pay for abortions. There would be no need to overturn Roe v. Wade, the Supreme Court decision that legalized abortion nationwide in 1973. House Speaker Nancy Pelosi and other Congressional liberals, nearly all of whom support abortion rights, have been the strongest advocates of government-led health care thus far, but they could soon be running hard in the other direction.

Pelosi made a deal with the devil, from the standpoint of abortion rights supporters, to get the votes she needed to pass the bill 220-215. The devil appeared in the form of Rep. Bart Stupak, D-Mich., who led a group of about 40 anti-abortion Democrats. Pelosi acceded to Stupak’s demand that abortion be excluded from coverage under insurance policies offered via the legislation’s new “exchange,” through which individual consumers could purchase government or private plans.

This would not merely eliminate public funding for abortion coverage. Even a woman who paid 100 percent of her own premium would be unable to buy a policy that would cover abortion under the government-run public option health plan that is the centerpiece of the House bill. Plans issued by private companies under a new government-sponsored exchange would not cover abortion, either, except under a special rider or separate policy that few would seek ahead of time, even if companies were willing to offer it. Not many people, after all, plan ahead for an abortion, and insurance companies might well be leery of writing coverage for those who do.

To the horror of abortion-rights advocates, most Democrats supported Pelosi’s deal in order to advance the legislation. Pro-choice House members promised to strip the Stupak language when (and if) final legislation emerges from a House-Senate conference. But Stupak and his posse are not going away. There is no reason to believe that any legislation that includes a government-run insurance option can pass the House without support from abortion opponents, for whom removal of the Stupak restrictions would be a deal-breaker. If Pelosi could have pushed the bill through the House without Stupak, she would have done it on Saturday.

The House legislation has little chance of getting through the Senate in its current form in any event. Though Majority Leader Harry Reid, D-Nev., has come out in favor of a public option, he may need every member of his caucus in order to get it. Sen. Joe Lieberman, the ex-Democrat turned independent who still caucuses with the party, has vowed to filibuster any public option. Reid needs at least one Republican vote, and possibly several, that he does not have, and that presumes he can keep the Democratic side together once the abortion food-fight reaches his chamber. I doubt that he can.

President Obama, the father of the health care reform effort who has thus far tried to keep his political DNA out of any of his legislative offspring, lauded the “historic” House vote without mentioning the abortion deal. However, Obama praised the legislation for providing “security and stability” to those who currently have health coverage and “quality affordable options” for those who do not. He confidently predicted that he will sign some version of health reform into law by the end of the year, which implies that the Stupak restrictions do not conflict with the president’s view of “quality affordable options” for health care.

Though I do not share the president’s confidence that any legislation will emerge this year, it seems to me that the Pelosi-Stupak deal may have even more far-reaching effects. Carried to its logical political end, it could all but eliminate medical abortion in this country and, in the process, turn American politics upside down.

Since the 1970s, abortion has defined how we see ourselves politically. “Conservative” and “pro-life” mean almost the same thing; so do “liberal” and “pro-choice.” It was an odd evolution, coming only a few years after “radical” and “leftist” Catholic priests gained prominence in the anti-poverty, anti-war and other social movements of the 1960s. But it happened, thanks to the Roman Catholic Church’s resolute opposition to abortion, around which the entire pro-life movement coalesced. Republicans made common cause with pro-lifers and other social conservatives; Democrats attracted the pro-choice, socially liberal crowd.

But Democrats made room for some abortion opponents, too. Stupak, an ex-police officer from Michigan’s Upper Peninsula, was first elected in 1992 and survived a Republican sweep that targeted liberals in 1994. During more than a decade in the political wilderness, Pelosi and other liberal Democratic leaders found their way back to power by running more candidates in the Stupak mold. On Saturday night, Stupak and his coterie submitted their invoice for Democratic control of the House.

Abortion opponents now know how to sidestep Roe v. Wade without having to go through the courts. If they centralize all medical services at the federal level, they only need to control Congress, which already bends to their will on abortion. The Hyde amendment, outlawing federal funding for abortion, has been passed every year since 1976. It survived a Supreme Court challenge in Harris v. McCrae, which upheld the restrictions in 1980. To get just about everything they want, pro-life activists need only push for a single-payer system such as England’s or Canada’s.

This outcome could be even better for the pro-life side than the outright reversal of Roe v. Wade, which most likely would merely put abortion matters back into states’ hands. Many states would continue to have legal abortion. If the federal government hires or pays all the doctors, however, abortion can be taken off the table entirely.

It has, of course, been the liberals who pushed for health care reform and a vigorous public option. Now that the House has delivered, they are finding out what that really means.

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