Yes, we all know that the Senate may change the landscape of the health care debate radically. But for the moment, what I mean by "Obamacare" is the bill presently on the table, HR3200, along with the Capps Amendment much touted in the media as a "compromise" on the issue of abortion.
Let's begin with the fact that HR3200 assumes coverage for "family planning services," which would normally be taken to include abortions. Despite the references in the news to the Hyde Amendment, I can see no reason why the reference to "family planning services" in HR3200 should not be taken, if the bill were passed as-is with no amendment on the abortion issue, to overturn the Hyde Amendment and to make abortion coverage available with federal funding without any special limitation. If my readers have some specific reason why that would not happen, I will be willing to consider it, but prima facie it seems to me that HR3200 or anything similar that talks about coverage for "family planning services" had better not pass unamended, leaving it to the courts to decide on how this fits with or whether it overturns the Hyde amendment.
That being said, the Capps Amendment to HR3200 is a highly dubious solution. According to the amendment (which I have read), federal "affordability credits" (subsidies for people to buy health insurance with) cannot be used towards the actuarial cost of abortion coverage insofar as other federal law (in this case, that would be the Hyde amendment) disallows such coverage. So the Capps Amendment makes reference to other federal law and makes it clear that HR3200 doesn't overturn the Hyde amendment. However, the federal "affordability credits" and any additional premiums paid by employers or individuals can all just go to pay for the premiums of health insurance plans that do cover all abortions, including elective abortions, so in what sense can it be meaningfully said that the federal affordability credits aren't paying for the abortion coverage? It seems rather pointless just to say that we "deem" the federal dollars to be paying for some other part of the coverage--rather like pouring water into the ocean but "deeming" the water to be going to one part of the ocean rather than another.
This is particularly evident in cases where both the affordability credits and private premiums are being paid for at least as much as the cost of the abortion coverage in the premiums. In a hypothetical case like that, the statement that the federal money isn't "going for" the abortion coverage is just that--a statement. It is making no difference to what the federal government pays, and if the individual is getting the abortion coverage "bundled in" rather than deliberately buying it separately, it is making no difference to what the individual or employer pays, either.
One might argue that in the case of individuals so poor that they are paying no significant additional premiums themselves, the accounting claim here would actually have "cash value," as such individuals would get no elective abortion coverage, as is presently the case with Medicare.
But there's a difficulty there, too.
According to the Capps Amendment, the actuarial value of the additional abortion coverage (for abortions for which federal dollars cannot be used) will not be set by the insurance companies. Rather surprising, that. It will be set by the Commissioner, that ubiquitous government personage whose duties and powers are adumbrated endlessly throughout HR3200. He is not permitted to set that actuarial value lower than $12 per person per year, which I must admit (though heaven knows, I'm not an actuary) sounds pretty low to me.
Interestingly, pro-lifers have suggested that, instead of the Capps Amendment, HR3200 be amended to state expressly that "family planning services" does not include abortions, period, and that the plans purchased even partly with federal "affordability credits" will not include abortion coverage. This would leave open the option for people or employers simply to purchase entirely separate insurance supplements for abortion coverage at the price set by the insurance companies. One would think that if the advocates of the "compromise" Capps Amendment were in good faith about the claim that no federal money will go for non-exception abortions, they would welcome this idea. If the coverage were simply purchased privately from the insurance company as an entirely separate policy, its price set by the insurance company, no one could have the slightest doubt as to whether the federal affordability credits were going to pay for abortions. Problem solved. But that's not what the Capps Amendment says, and evidently no one is jumping to seize on this idea of leaving abortion coverage to be negotiated privately as an entirely separate matter between buyers and insurance companies, which is suspicious, to put it mildly.
I think there are several things going on here. One is that the pro-aborts really, really want abortion coverage in the bill and are outraged that it can't be there openly. Since the Capps Amendment was proposed as a "compromise" (Rep. Capps herself made a rather snippy comment about how everybody doesn't agree with the Catholic bishops), it shouldn't surprise us all that much if this "compromise" is what it rather looks like--an accounting dodge whereby abortion coverage will be provided from a premium "pot" in which federal dollars are indistinguishable from private dollars.
I want to add here that no one has tried anything similar with federal employees' health insurance coverage. All this time, and to the pro-aborts' annoyance, everyone has apparently considered that "no federal money for abortion" means that you can't throw federal money into a pot for premiums for a policy that covers abortions and then just declare by a sort of nominalist fiat that that part isn't paying for the abortions, that it's the employee part of the premium that is paying for the abortions. The fact that such an accounting scheme has never been approved for federally purchased health insurance policies before does rather cast doubt on its honesty in this case.
But there is something else that I think is going on, too. HR3200 is a control freak's dream. As I discuss here, the Commissioner apparently gets to decide even on what additional benefits private companies in the "health care exchange" can offer. So nothing is really just going to be left up in the air to be negotiated on the market as a separate, unregulated benefits supplement between purchasers and insurance companies. Probably the advocates of HR3200 are unwilling to call much attention to this fact, but it does constrain their options with regard to abortion coverage. If abortion coverage could be purchased like that, coverage for good benefits (like, I don't know, paying your doctor more than the government fee schedule allows, or paying for medicines or surgeries for which your QALY score doesn't qualify you, or whatever) might also be able to be purchased in that way, apart from the all-controlling power of the Commissioner and the Committee. That, in turn, would limit the ways in which the bureaucrats can control the whole system and keep overall costs down. And we couldn't have that.
Update (8/21/09): Alerted by reading NRLC's analysis of the Capps Amendment, I looked at the amendment even more closely when it discusses the "public option" and found this:
Nothing in this act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of services described in paragraph (4)(A).
The "services described in paragraph (4)(A)" are the abortions not currently allowed to be covered under Medicaid--elective abortions, in other words. NRLC interprets this to mean that the "public option" will definitely include unlimited abortion coverage. As far as I can tell, one could argue that it doesn't say that. According to this passage, the public option might or might not include it, though it seems entirely plausible that it will do so. But if it does, and if a person is forced into the public option by financial circumstances, it does appear that the person will have to pay the "extra" determined by the Commissioner for the elective abortion services. While I think NRLC may be overcalling things by saying that the public option would definitely include full abortion coverage, the other aspects of the Capps Amendment concerning paying for abortion coverage in (4)(A) with premiums does seem to mean that if that coverage is included, poor people in the "public option" will have to pay that extra bit for it. Which is pretty wild, to put it mildly.