As health overhaul bills head toward the House and Senate floors this month, the divisive issue of abortion is threatening to derail them. Already in the House, one anti-abortion lawmaker, Rep. Bart Stupak (D-MI), says he has enough votes to block the bill's consideration unless he is allowed to offer an amendment to strengthen language in the bill banning federal abortion funding.
The issue is also causing headaches for the Catholic Church, where a long-standing opposition to abortion is running headlong into the church's equally long-standing support for a comprehensive health overhaul.
"I think in our files we have a letter from the bishops to Harry Truman urging comprehensive health care reform," says Richard Doerflinger of the U.S. Conference of Catholic Bishops, referring to the unsuccessful mid-20th century fight in Congress to pass a health overhaul bill.
The Catholic Church is not just an advocate for health care, but also a major provider. "Our Catholic charities and Catholic hospitals outlets take care of millions of people," Doerflinger says. "I think it's been estimated that one-sixth of the people who go into a hospital every year are going into a Catholic hospital."
But so far, the church hasn't been able to support either the House or Senate versions of the health bills now being readied for floor votes because of their abortion language.
"We want health care reform very, very much, but we cannot do that over children's dead bodies, to put it most bluntly," he says. "There is a fundamental issue here about whether taking life should be treated the same way as supporting and healing life."
Abortion rights supporters say the bills don't actually expand access to abortion — and they wish they would.
"This is not at all what the reproductive rights movement had hoped for in health care reform, and it's not a win for women," says Nancy Northup, president of the Center for Reproductive Rights. "It's a compromise."
Originally, says Northup, she and others wanted to see abortion covered like any other women's health service. "About 1 in 3 women in the United States has an abortion in her lifetime," she says, "and it should be a part of her reproductive health care."
But it was quickly clear that wasn't going to happen. What lawmakers decided instead was to try to craft what they called abortion-neutral language. In other words, they tried to freeze in place the status quo. Currently, the federal government doesn't pay for abortion in most cases, but many, if not most, private insurance plans do.
Abortion foes say the language included in the bills, originally offered by Rep. Lois Capps (D-CA), is not neutral, however, and favors the abortion rights side.
Douglas Johnson, federal legislative director for the National Right to Life Committee, says there are two big problems. He says a government-run public plan could end up offering abortion as a benefit, and that the federal government would provide subsidies to private insurance plans that pay for abortion.
"Both of these things would be sharp departure from decades of federal abortion policy," he says, "and so we want to apply the long-standing principles of federal law to these new programs, which would mean that the monies would not be used to support elective abortions or coverage for elective abortion."
Backers of the language currently in the bills say Johnson is overstating the case; they say the federal government would be prohibited from directly funding abortion and that money for private insurance subsidies would have to be kept separate if it's going to be used to cover abortion.
Divisions Within The Church
While that debate rages on Capitol Hill, another, quieter debate is taking place within the Catholic Church. Jon O'Brien, president of Catholics for Choice, says not everyone agrees with the bishops' hard-line position on abortion.
"American Catholics, as the polls show time and time again, disagree with the U.S. Conference of Catholic Bishops on the abortion issue," O'Brien says. "They believe in reproductive health care and see reproductive health care as a responsible part of health care."
Indeed, O'Brien says, a poll by his organization found substantial majorities of practicing U.S. Catholics favored coverage of abortion in an overhauled health system, and not just in cases of rape, incest and life endangerment for the pregnant woman, but also in cases of health risk to the woman and fetal abnormality.
O'Brien says most American Catholics see health overhaul as part of the church's social justice agenda regardless of the abortion language in the bills.
And it's not just abortion; the Catholic Church also wants a health overhaul bill to ensure access to care for everyone in the country, including illegal immigrants. That's going to be another uphill fight.