Abortion, the Public Option and Immigration: Hairy Compromises in the Healthcare Debate and What the Senate May Do About Them

BUZZFLASH NEWS ANALYSIS
by Meg White

Now that the debate is really heating up in the Senate on the healthcare reform legislation, I thought it might be helpful to take a look at the main sticking points in the bill and try to prognosticate what Senate Majority Leader Harry Reid (D-NV) plans on doing to bring everyone together.

High on progressives' lists of problems they have with the bill center upon the red-hot topics of reproductive rights, the strength of the public plan, and citizenship requirements for those who will benefit from reforms. So, what are the chances we'll get anything remotely close to what we want to see on these three issues?

Abortion

The inclusion of a House amendment which pro-choice advocates warn will remove the possibility of any woman (regardless of her insurance type or willingness to pay for it) to receive any kind of coverage for an abortion has rallied the troops on reproductive rights.

Some fear that the amendment will essentially do an end run around Roe v. Wade by eliminating access to abortion without making the service itself illegal. While there isn't anything along the lines of the infamous Stupak-Pitts Amendment in the Senate's version of the bill, that is expected to change shortly.

What is deemed a "D.C. Lobby Day," part of a larger "week of action" is galvanizing the pro-choice forces in Washington Wednesday. The effort is organized by the Coalition to Pass Health Care Reform and Stop Stupak, which includes dozens of organizations from Catholics for Choice to the Center for Constitutional Rights to the YWCA.

Despite the wide swath of support, I worry about the preparedness of the effort. Though the coalition uses the now well-known moniker of Rep. Bart Stupak, the Michigan Democrat whose name graces the House amendment along with that of Rep. Joe Pitts (R-PA), the real effort is now shifting to moderates in the Senate. Strangely, the coalition features detailed explanations of how the Stupak Amendment would restrict the reproductive rights of middle class women in the exchange, but does not mention the plans of Sen. Ben Nelson (D-NE).

The conservative senator has said he plans to introduce the language from the Stupak Amendment into the Senate legislation, and refuses to support a final bill without such restrictions in place.

The coalition may have to change their name to Stop Nelson-Casey, alliteration be damned. A couple of weeks ago, the National Organization for Women was warning that the Senate version of the Stupak-Pitts Amendment would likely come from "Sens. Ben Nelson (D-Neb.) and Bob Casey (R-Penn.)" Which is somewhat amusing, because Sen. Casey is actually a Democrat.

I don't blame them making that mistake. Casey comes from a pedigree of liberal pro-lifers, and has expressed his desire to see Roe v. Wade overturned. Nelson is a bit more ambiguous. The editor of Life News called his pro-life bona fides into question in January in the debate over the Mexico City Policy. Nelson was the only Democrat to vote to continue President George W. Bush's vision of federal funding for family planning services abroad. But it looks like Nelson's trying to take back his anti-choice crown.

Regardless of their positions on individual issues within the reproductive rights debate, the idea of two Democrats spearheading this effort shows how remarkably strange this whole thing is. In the case of Stupak-Pitts, there was speculation that the older Republican lawmaker had convinced the younger Democrat to carry the bill based on their mutual entanglement in the ultra-right religious group known as "The Family."

In the Senate, a hypothetical Nelson-Casey Amendment wouldn't have as many procedural hurdles as Stupak-Pitts had, which only got onto the bill thanks to allowances by the House Democratic leadership. Senators generally have more power to offer amendments. Yet with the 41 signatures of pro-choice Democrats in the House who say they will not vote for final passage of the bill if it contains a Senate version of the Stupak-Pitts amendment, Reid and others may think twice about voting for its passage as an amendment.

The Public Option

There has been some criticism that the public option has ballooned well out of proportion to its importance in the final legislation. And yet, one of the most potent criticisms coming from the right centers on the cost of the bill, in terms of both funding and premium prices. As a feature proposed in order to keep costs low, close consideration of the public option is certainly warranted.

Sen. Tom Carper (D-DE) has said he's planning on offering an alternative to both the public option plan already in the Senate bill and the proposal by Sen. Olympia Snowe (R-ME) for a trigger to a public option which would go into effect after certain criteria are met.

Carper's plan reportedly resembles something of a compromise; a "fast trigger," if you will (Carper has referred to it as the "hammer" option). The criticism of Snowe's trigger proposal often comes down the the fact that the conditions which she deems necessary to meet before a public option is to be triggered (low or no competition in insurance markets, prohibitively high premiums, etc.) have already come to pass in many insurance markets around the nation. So it seems logical that in a market where the public option is already necessary to ensure competition, the public option be automatically triggered, rather than instituting the year or longer waiting period prior to allowing the public option to do its job. The Carper Amendment, to be released next week, will propose this along with the ability of states to opt in, even where the trigger benchmarks have not been met.

The Hill also reports some changes other than the so-called hammer, in Carper's forthcoming proposal:

The bill would establish a national public insurance program founded by the government but managed by a non-governmental board. In addition, the plan would be unable to access any taxpayer dollars beyond its initial seed money. This public option would operate alongside private insurance and, potentially, the nonprofit healthcare cooperatives and state-based public plans authorized by Reid's bill.

Senate opponents of the public plan -- notably Snowe, Nelson, Connecticut Independent Joe Lieberman, Max Baucus (D-MT), Mary Landrieu (D-LA), Blanche Lincoln (D-AR) and Kent Conrad (D-ND) -- all hypocritically profess to be concerned about the cost of reform. Yet the Congressional Budget Office scoring makes it clear on several separate occasions that the public option would tamp down costs.

With its fondness for compromises, the Senate may indeed favor this plan, which appears to allow both sides to "save face." However, I wouldn't put it past Republicans to slam the amendment's "national public insurance program" as government-run healthcare, and threaten to torpedo the one Republican vote that the compromise might bring. While it may not be worth it in the long run, it's still better than the trigger offered by Snowe, and is more likely to attract Democrats who have said they will not vote for reform that doesn't include a public option.

Immigration

Immigration has been dialed down as a topic among progressives in the healthcare debate, but it is worth a look here because of its similarities to both the reproductive rights and public option debates.

Like abortion, the issue of immigration has been folded into what is known as a "message amendment" designed to tackle hot-button issues within the larger legislation. And much like the public option problem, this is a case where fiscal conservatives are shooting themselves in the wallet with their ideological guns.

The Senate bill is tougher on immigrants than the one that passed the House. Reid's language explicitly excludes undocumented workers from obtaining insurance in the exchange even if they pay for it themselves without any subsidy. Both bills continue the practice of denying legal residents who aren't yet citizens access to government-subsidized health insurance for five years.

Conservatives are spending a whole bunch of floor time complaining about how illegals are "bilking" the system, but they refuse to see the cost savings, as well as safety implications, of allowing immigrants to buy into the plan.

Contrary to popular belief, immigrants are more likely to be healthy and less likely to place a burden on the healthcare industry than citizens, much of that due to their younger social profile. Furthermore, they already contribute to the tax base and their function of enlarging the numbers of healthy people in the benefit pool would be a helpful agent in keeping costs down.

Under the current Senate legislation, immigrants will continue to utilize emergency rooms and free clinics as their only real access to healthcare, at a high cost mostly borne by taxpayers.

In fact, some sociological research suggests that, in the case of Mexican immigrants at least, the intention is never to come to the U.S. to receive medical care, and is more often the opposite, with healthcare decisions put off until temporary workers can return to their home country for care.

Finally, preventing a whole segment of society from accessing preventive care is a dangerous choice in the age of potentially devastating epidemics. Swine flu does not check one's immigration status prior to infecting.

So, from the cost-savings, homeland security and human decency points of view, Congress would do well to reconsider. Thing is, they probably won't.

There isn't a serious opposition from the left to the anti-immigrant language in the bill. In fact, things might even become more restrictive, as Republicans push for a system of verifying citizenship that will likely make insurance premiums more expensive, while at the same time accidentally flagging legal citizens who happen to have honest paperwork mistakes.

Of course, there's no guarantee we'll get anything out of the healthcare debate, much less get what we want. But that's no reason to stop watching.

BUZZFLASH NEWS ANALYSIS

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