My Body, Their Choice

Turning health care over to the government inevitably limits individual freedom.

"My body, my choice" has long been a rallying cry for abortion-rights advocates on the left, many of whom have recently been vocal supporters of the Democratic health care reform agenda. But as abortion advocates are now discovering, abortion rights aren't as easily compatible with health care reform as they might have once thought. Turns out the more government gets involved in health care, the more difficult it becomes to truly retain choices about one's body.

When House Speaker Nancy Pelosi (D-Calif.) first scheduled the vote on health care reform, it remained unclear whether she had enough support to pass the bill. Even amongst Democrats, there were still concerns, arguably the most important of which was whether or not the bill would allow federal money to fund abortions. At the last minute, Pelosi, working with Catholic bishops and pro-life Democrats, allowed a vote on an amendment sponsored by Rep. Bart Stupak (D-Mich.).

The text of the three-page amendment was straightforward: "No funds authorized or appropriated by this Act…may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion." The amendment allowed exceptions for medical emergencies that put a woman at risk of death, and maintained that nothing in the amendment's language would prohibit a non-federal entity—whether a person or a state or local government—from purchasing supplemental coverage for abortions, provided that any such purchase isn't made using federal subsidies.

The amendment passed, and may have been the deciding factor in House passage of the bill. But now the amendment is causing trouble for Democrats in the Senate. And indeed, many liberals who support both health care reform and abortion rights now find themselves in a quandary, supporting health care reform while decrying an amendment that was likely the key to its passage.

That's because, given the scope of congressional health care reform proposals, the relatively straightforward prohibition on using federal funds to pay for abortions could have far-reaching consequences.

Most analyses of the amendment agree that the most significant effects will be in the individual insurance market. Under the reform bills now being considered, anyone who did get health insurance through his or her provider would be required to purchase it from an exchange—a government-managed marketplace of highly regulated insurers. The vast majority—an estimated 86 percent—of those who purchase their insurance this way would receive government subsidies, and thus would be barred from spending that money on any plan that covers abortion. These individuals could still purchase a separate abortion rider with their own funds, but the requirement that this be an additional (and unsubsidized) step almost certainly means that fewer individuals will end up with abortion coverage than would have otherwise.

Outside the exchange, there's some debate about whether the amendment would technically bar abortion coverage from some private, employer-provided insurance plans, though it appears less than likely. At The New Republic, Jeffrey Rosen writes that Stupak's amendment "wouldn't immediately impinge on the roughly 60 million women ages 18-64 who presently get health insurance through their jobs or their spouses' jobs." And Brian Buetler, a Talking Points Memo reporter who has written about the Stupak amendment, says that "the least-impacted women will be those whose employers (or whose spouses' employers) provide them insurance," but also notes that "over time, the reform packages under consideration allow ever larger employers to participate in the exchange."

Still, although it's not clear what the limits of Stupak's reach might be, some of the stronger warnings about its effects are clearly mistaken. At The American Prospect, for example, Ann Friedman wrote that "Stupak would actually prevent employer-based plans—ones that are not supported by your tax dollars—from covering abortion." But the analysis she links to argues that employer-provided plans could be affected because they are touched by federal funds used to pay for reinsurance and small-business wellness programs—in other words, that they would be barred from offering abortion coverage because they make use of those pesky taxpayer dollars.

For pro-choice, pro-reform liberals, this is exactly the problem: On the one hand, they support a massive expansion of government funding and bureaucratic control into nearly every corner of the health care system. On the other hand, they're incensed that the government would make rules about how that funding can be used.

It's grimly ironic: After spending much of the year ridiculing opponents of health care reform for insisting that reform would put government in between doctors and patients, they're now up in arms that government has gotten involved in decisions they believe should only be made by women and their doctors.

But if the history of bureaucracy teaches us anything, it's that what the government funds is what the government controls. Or, to put it another way: When the government gets involved in making everyone's health care decisions, it may be your body, but it won't be your choice.

Peter Suderman is an associate editor at Reason magazine.