Throughout the health care debate, Democrats and President Barack Obama have insisted that Americans who want to maintain their current health care coverage will be able do so. Reform, Democrats said, would be a win-win, extending coverage to millions of uninsured Americans and depriving nobody of existing coverage they like.
But events this month have forced liberals to admit an inconvenient truth: Not only will health care reform force millions of Americans to change health insurance plans against their will, but those shifts could also cause millions of women to lose coverage for abortion.
The elephant in the room is the Stupak-Pitts Amendment, adopted by the House just before the passage of the Affordable Health Care for America Act. Stupak-Pitts would prohibit any taxpayer-subsidized health plan from covering elective abortions.
If the exchange mostly caters to people who currently lack health insurance altogether, there’s little reason to worry about reduced access to abortion.
But what if Obama is wrong, and people with existing abortion-inclusive insurance are moved, against their will, into exchange-traded plans that cannot cover abortions? Some businesses might find it cheaper to drop insurance coverage and let their employees buy federally subsidized insurance.
Prior to Stupak-Pitts, concerns that health reform would lead firms to change or drop health coverage were mostly voiced on the right. But last week on the Center for American Progress’ blog, a staffer warned that millions of Americans could lose their existing employer-provided abortion coverage, as employers start buying insurance through the exchange.
Planned Parenthood Action put out an alert expressing the same concerns, posing the example that “a woman working for a small graphic design firm, who currently has abortion coverage through her company’s plan, would lose it under reform if the company decides to seek more affordable coverage in the exchange.” So much for Obama’s insistence that “if you like your health care plan, you will be able to keep your health care plan.”
Liberal critics of Stupak-Pitts are just admitting the obvious about health care reform. Employer-based health insurance is a legacy of tax subsidies that apply to employer-provided insurance, but not individually purchased insurance.
Any system that adds subsidies for other purchase channels will reduce the portion of Americans with employer-based coverage, and subject more Americans to whatever restrictions the government places on policies sold through the exchange. Now the left is realizing that some of those restrictions may be ones they do not find desirable.
Stupak-Pitts has forced liberals to admit that reform is not a win-win for everyone. For reform proponents, this may be an acceptable trade-off: Extending health insurance to tens of millions of Americans who currently lack coverage is an important achievement that must be weighed against the costs of reform.
Now they must consider what losses they will accept on the road to universal coverage.
Josh Barro is a senior fellow at the Manhattan Institute.