But abortion isn’t emission standards, and the Medicaid dispute was merely a warm-up for the fight ahead. Clinton’s health-reform proposal mentions only “pregnancy-related services,” but both he and the First Lady have said repeatedly that abortion would be part of the basic benefit package guaranteed to all Americans. That’s the real problem. Because the plan would subsume Medicaid and use tax dollars as subsidies, including abortion would mean throwing out the Hyde amendment. which has banned federal funding of abortion in almost all cases since 1976. There is still strong support for Hyde on Capitol Hill. Last year the House approved it 255 to 178, and the Senate 59 to 40.
Powerful Roman Catholic organizations and some key lawmakers have warned all along that health reform could be doomed if it includes abortion. Even the United States Catholic Conference. which has backed universal health care since 1919, is fighting the Clinton plan because of it. This week, on the 21st anniversary of Roe v. Wade. parishioners will begin bombarding Congress with 18 million postcards stating bluntly: “Abortion is not health care; it destroys human life…Please don’t force me to pay for abortions against my conscience.” Douglas Johnson of the National Right-to-Life Committee says many Americans who favor abortion don’t want taxes to pay for it. In a New York Times poll last April, 72 percent said abortion should not be part of the basic benefit plan.
Pro-choice groups argue that stripping abortion from the plan would be a major reduction in benefits for women, since many private insurance plans offer it now. “We should not allow extremists to damage women’s health-care needs, to take us back in time and take away choices,” says Kate Michelman of the National Abortion and Reproductive Rights Action League. She predicts that some pro-choice legislators who voted for Hyde for Years will use health reform as political cover to switch sides and that the new crop of women lawmakers will force the issue. “You have the new dynamic of women saying to the president, ‘No. You don’t have our vote if this plan discriminates against women’s health needs, and particularly those of poor women’.”
Hearings on health reform begin next week, but the abortion question will ultimately be decided on the House and Senate floor. (The rape and incest dispute may be debated again, too. Some states are threatening to defy the HHS order: the Planned Parenthood Federation of America says it will sue any state that balks.) One compromise for the healthreform plan might be to let regional alliances define “pregnancy-related services” as they see fit, with some insurance plans offering abortion as an added option. Another idea is to let women purchase insurance riders for abortion at their own expense. But pro-choice groups say that asking women, in effect, to plan ahead for unintended pregnancies is ridiculous. Prolife groups say that as long as abortion remains in the basic benefit package, insurance plans will have no choice but to offer it. And even though a “conscience clause” allows doctors and hospitals to refuse to perform abortions, insurance plans would still have to refer women to providers who will, and cover the cost. “Every Catholic diocese and hospital–even the National Right-to-Life Committee–would have to offer it,” asserts Johnson.
How hard will Clinton fight for abortion if it threatens to scuttle the entire reform plan? White House aides say he is determined to retain it. But if the debate turns nasty, Clinton could say that he has done his part by proposing abortion, and that he can’t fight the will of Congress on any one issue. “There are 20 different land mines, and each one is going to go off,” says one senior official. Given its history abortion may well be the most explosive of all.
