Health Care Reform
Congress is considering health care reform legislation. On November 7, the House passed its
bill, the Affordable Health Care for America Act (H.R. 3962), having first adopted the
Stupak–Pitts Amendment that maintains longstanding policy against federal funding of
abortion. Senate leadership is still preparing a bill for floor consideration. Debate could
begin as early as the week of November 16. None of the Senate committee bills has acceptable
provisions prohibiting abortion funding or mandates for abortion coverage, and none fully
protects conscience rights in health care. These serious defects in the Senate bills must be
corrected. On October 8, 2009, the U.S. Conference of Catholic Bishops sent a letter to Congress expressing disappointment over the lack of progress made as of that date on the bishops’ three priority concerns for health care reform. The letter was sent by the chairmen of the three committees with primary concern for health care reform: Bishop William Murphy, Committee on Domestic Justice and Human Development; Cardinal Justin Rigali, Committee on Pro-Life Activities; Bishop John Wester, Committee on Migration. The bishops stated: “If final legislation does not meet our principles, we will have no choice but to oppose the bill.” On the pro-life priority, the bishops reaffirm, “It is essential that the legislation clearly apply to this new program longstanding and widely supported federal restrictions on abortion funding and mandates, and protections for rights of conscience. No current bill meets this test. . . . If acceptable language in these areas cannot be found, we will have to oppose the health care bill vigorously.” For full text of the letter, see: www.usccb.org/sdwp/national/2009-10-08-healthcare-letter-congress.pdf. Senate: Two committees produced different bills.
Committee on Health, Education, Labor and Pensions (HELP):
On July 15, 2009, the Senate HELP Committee marked up its bill, the Affordable Health Choices Act (S. 1679). The committee rejected amendments to exclude federal funding or mandated coverage for abortion, to protect conscience rights, and to maintain current state laws limiting and regulating abortion. Committee on Finance: On September 16, 2009, committee chairman Sen. Max Baucus (D-MT) released his chairman’s Mark, America’s Healthy Future Act in conceptual form. On September 22, 2009, the Finance Committee began markup. Sens. Orrin Hatch (R-UT) and Michael Enzi (R-WY) submitted amendments to correct flaws in the chairman’s Mark on abortion and conscience rights. See: nchla.org/datasource/idocuments/SenFinCmteHCRamdts.pdf. On September 30, 2009, the committee rejected, 10-yes, 13-no, Hatch Amendment #C14 to restrict the use of federal funding to support abortion. The committee also rejected, 10-yes, 13-no, Hatch Amendment #C13 to prevent governmental bodies from discriminating against health care providers who decline to perform, refer for, or pay for abortions. This amendment reflects current law (called the Weldon Amendment) and is identical in wording to an amendment already accepted by the House Energy and Commerce Committee during its consideration of the House’s health care reform bill, H.R. 3200. The committee did not consider Enzi Amendment #C15 that, following current law, would have protected the conscience rights of health care providers in contexts broader than abortion. On October 13, 2009, the committee approved America’s Healthy Future Act, 14-yes, 9-no, with the text of the bill (S. 1796) being reported October 19. See: finance.senate.gov/sitepages/ Americas_ Healthy_Future_Act.html. Floor: Based on the two committee bills, Senate Democratic leadership is attempting to develop a single bill that can be brought to the Senate floor. Debate may begin the week of November 16.
House: Three committees reported different versions of a common bill, the America’s Affordable Health Choices Act (H.R. 3200). On July 17, 2009, the Committees on Education and Labor and on Ways and Means favorably reported the bill. On July 31, 2009, the House Committee on Energy and Commerce also favorably reported the measure.
Committee on Education and Labor: During committee markup, Rep. Mark Souder (R-IN) offered Amendments 31 (no abortion mandate) and 32 (no funding for abortion). Amendment 31 provided that nothing in the bill would require a group health plan to provide coverage for or access to abortion, except to save the mother’s life or in cases of rape or incest. For the text see: nchla.org/datasource/idocuments/Souder31.pdf. Amendment 32 provided that no funds appropriated through the bill may be used to pay for abortion or to pay any part of the costs of a health benefits plan that includes coverage for abortion, except to save the mother’s life or in cases of rape or incest. For the text see: nchla.org/datasource/idocuments/Souder32.pdf. Each amendment failed, 19-yes, 29-no. For the detailed vote results see: nchla.org/datasource/idocuments/7EdLaborMembersHCRVts17a.09.pdf.
Committee on Ways and Means: During committee markup, Rep. Sam Johnson (R-TX) offered an amendment to exclude an abortion mandate. No part of the bill would impose any requirement to cover or provide access to abortion or permit such a mandate by the Health Benefits Advisory Committee, the Secretary of HHS, the Health Choices Commissioner, or other governmental entity, except to save the mother’s life or in cases of rape or incest. For the text see: nchla.org/datasource/idocuments/Johnson_Abortion.pdf. The Johnson Amendment was defeated, 18-yes, 23-no. Rep. Eric Cantor (R-VA) offered an amendment to ensure that no public funds would go to plans that pay for abortion. The Cantor Amendment was defeated, 19-yes, 22-no. For the vote details see: nchla.org/datasource/idocuments/7WayMeanComHCRVts17b.09.pdf.
Committee on Energy and Commerce: After a hiatus, the Committee on Energy and Commerce resumed its markup on July 30, 2009. Reps. Bart Stupak (D-MI) and Joseph Pitts (R-PA) were prepared to offer amendments to exclude abortion mandates, prevent federal funding of abortion, uphold state laws that regulate abortion, and protect the conscience rights of health care providers. On July 29, 2009, Cardinal Justin Rigali, chairman of the bishops’ Committee on Pro-Life Activities, sent a letter to the committee, urging support of the Stupak/Pitts amendments. See: nchla.org/datasource/idocuments/ltrhousenrgycomm.pdf.
(1) Capps Amendment: On July 30, 2009, Rep. Lois Capps (D-CA) offered a “compromise” amendment that was backed by committee chair, Rep. Henry Waxman (D-CA). See: nchla.org/datasource/idocuments/hr3200_capps_1.pdf. The amendment yielded some ground to pro-life concerns about mandated abortion coverage in private plans, preemption of state abortion laws, and retention of federal conscience laws. However, it weakened the application of the Hyde Amendment funding restrictions and had provisions to ensure that abortion is included in the public (government-run) plan. For a full critique of this amendment see, "Myths and Facts: The Capps Amendment to H.R. 3962" at www.usccb.org/prolife/issues/healthcare/capps_3962.pdf. The Capps amendment passed by the narrow margin, 30-yes, 28-no. Six Democrats voted against the amendment: Reps. Bart Stupak (D-MI), Mike Ross (D-AR), Jim Matheson (D-UT), Charlie Melancon (D-LA), John Barrow (D-GA), and Baron Hill (D-IN). Rep. Mike Doyle (D-PA), who was one of 20 Democrats who signed a letter stating they would vote against any health care reform bill that did not exclude abortion, voted in favor of the Capps amendment. All Republican members of the committee voted against the Capps amendment, except Rep. Tim Murphy (R-PA), for whom no vote is listed.
(2) Pitts Amendment -- Exclude Abortion Mandate: Also sponsored by Reps. Stupak and Roy Blunt (R-MO), this amendment excluded any mandate for abortion coverage, except to save the mother’s life and in cases of rape or incest. See: nchla.org/datasource/idocuments/hr3200_pitts_1.pdf. At first the Pitts amendment passed, 31-yes, 27-no. See: nchla.org/datasource/idocuments/hr3200_pitts_1_rc.pdf. Rep. Waxman moved to reconsider the vote. On the second vote, the Pitts Amendment failed, 29-yes, 30-no. On both votes, all Republicans voted “yes” as did the six Democrats who voted against the Capps amendment. Reps. Waxman and Bart Gordon (D-TN) “yes” on the first vote, “no” on the second. Presumably, Rep. Waxman’s first “yes” vote with the majority gave him the option to move to reconsider the vote.
(3) Stupak Amendment -- Protection of Conscience Rights: Also sponsored by Reps. Pitts and Lee Terry (R-NE), this amendment provided for protection of conscience rights. After dropping a section that would accommodate conscience protection beyond the abortion context, the amendment was approved by voice vote. See: nchla.org/datasource/idocuments/hr3200_0730_stupak_1.pdf .
On July 31, 2009, the House Energy and Commerce Committee continued markup.
(4) Stupak Amendment -- Prevent Abortion Funding: Also sponsored by Rep. Pitts, this amendment specified that no funds authorized by the Act may be use to pay for any abortion or cover the costs of any health plan that includes coverage for abortion, except to save the mother’s life or in cases of rape or incest. See: nchla.org/datasource/idocuments/hr3200_stupak_1.pdf . The Stupak amendment failed, 27-yes, 31-no. All Republicans voted “yes.” Rep. John Shimkus (R-IL) switched his "yes" vote to a “no” for the procedural reason of retaining the right to request a reconsideration of the vote at a later date. All Democrats voted “no,” except Reps. Stupak, Ross, Matheson, Melancon, and Barrow, who voted “yes,” and Rep. Hill, who did not vote. For the key roll calls on the Capps, Pitts, and Stupak (abortion funding) amendments, see: nchla.org/datasource/idocuments/7HCR.EandCvotes30.31d.09.pdf.
On July 31, 2009, the House Energy and Commerce Committee favorably reported H.R. 3200, 31-yes, 28-no. On August 11, 2009, Cardinal Justin Rigali sent a letter to the House of Representatives in which he commented on the version of H.R. 3200 approved by the House Energy and Commerce Committee. As amended, the bill will not preempt certain state laws regulating abortion and will have no effect on existing federal conscience protection rights. However, the Cardinal noted, the bill remains seriously deficient on two other fundamental issues: (1) The legislation delegates to the Secretary of Health and Human Services the power to make unlimited abortion a mandated benefit in the public health insurance plan. (2) The committee rejected an amendment to incorporate longstanding federal abortion funding policies in the bill. Instead they created a paper separation between federal funding and abortion. Federal funds will subsidize the public plan as well as private health plans that include abortion on demand, but anyone who purchases these plans is required to pay a premium to cover all abortions beyond those eligible for funding under the current Hyde Amendment. Further, those who purchase the public plan will be forced to pay directly and specifically for abortion coverage. Most Americans do not want abortion in their health coverage. “By what right, then, and by what precedent, would Congress make abortion coverage into a nationwide norm, or force Americans to subsidize it as a condition for participating in a public health program?” See: nchla.org/datasource/idocuments/RigaliHCRLtr081109.pdf. Floor: Democratic leadership needed to resolve the differences between the three committee-passed versions of the America's Affordable Health Choices Act (H.R. 3200). On October 29, 2009, leadership introduced its bill, the Affordable Health Care for America Act (H.R. 3962). See: docs.house.gov/rules/health/111_ahcaa.pdf. This bill retained the unacceptable features on abortion and conscience protection that were in the earlier committee bills. H.R. 3962 was referred to eight committees. On Saturday, November 7, 2009, the House debated H.R.3962. After much discussion, leadership agreed to a Rule allowing a vote on the Stupak-Pitts Amendment that maintained the longstanding policy against federal funding of abortion. For the text of this amendment, see: nchla.org/datasource/idocuments/StupakPitts.hr3962.11.7.09.pdf. In addition to Reps. Bart Stupak (D-MI) and Joseph Pitts (R-PA), the pro-life amendment was cosponsored by Reps. Brad Ellsworth (D-IN), Marcy Kaptur (D-OH), Kathy Dahlkemper (D-PA), Dan Lipinski (D-IL), and Chris Smith (R-NJ). The Rule was approved. After debate, the Stupak-Pitts Amendment was agreed to, 240-yes, 194-no, 1-present (Roll Call 884). Sixty-four Democrats joined 176
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Republicans in passing this amendment. Rep. John Shadegg (R-AZ) voted "present." Thereafter, H.R. 3962 passed by the narrow margin of 220-yes, 215-no (Roll Call 887). For an explanation of the Stupak-Pitts Amendment, see: "What Does the Stupak Amendment Really Do?" at: nchla.org/datasource/idocuments/WhatDoesTheStupakAmendmentDov2.pdf.
On June 25, 2009, 20 House Democrats sent a letter to Speaker Nancy Pelosi (D-CA) stating that mandated coverage for abortion in any health care reform plan is unacceptable and that “we cannot support any health care reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan.” For the full text of letter and signatories, see: nchla.org/datasource/idocuments/dem062509healthletter.pdf. On September 28, 2009, Reps. Bart Stupak (D-MI) and Joseph Pitts (R-PA) sent to Speaker Rep. Nancy Pelosi (D-CA) and Rules Committee Chairwoman Rep. Louise Slaughter (D-NY) a letter signed by 183 Members, requesting that the rule governing House floor debate on health care reform allow Members to vote on a Stupak/Pitts amendment on government funding for abortion. For text of letter and signatories, see: nchla.org/datasource/idocuments/StupakPittsLtr092809.pdf. On October 23, 2009, Rep. Alan Mollohan (D-WV) announced that he and 28 other Democratic Representatives had sent a letter to Speaker Nancy Pelosi (D-CA) requesting that the Hyde Amendment be included in the House’s health care reform bill. See: nchla.org/datasource/idocuments/10MollohanHCR.Let.23.09d.pdf. Action Resources: For an NCHLA Action Alert urging pro-life constituents to contact their Representatives and Senators, see: nchla.org/actiondisplay.asp?ID=279. E-mails can be sent through NCHLA’s Grassroots Action Center. More Information: For fact sheets helpful in critiquing the health care reform bills, see: - “Myths and Facts: The Capps Amendment to H.R. 3962,” at: www.usccb.org/prolife/issues/healthcare/capps_3962.pdf.
- “Abortion and Conscience Problems in Health Care Reform Bills,” at: www.usccb.org/prolife/issues/healthcare/capps_102309.pdf.
- “Current Policy on Federal Abortion Funding,” at: www.usccb.org/prolife/issues/healthcare/abortion_funding_102309.pdf.
For general resources, see: www.usccb.org/healthcare.
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