There’s much to be enthusiastic about in the Affordable Health Care for America Act, as yesterday’s post with our first take on the bill described.   From a vantage point above the political posturing and sausage-making that dominate this stage of the legislative process, we can see that the Congress is slowly but surely moving closer to making good on President Obama’s commitment to quality, affordable health care for all.  In addition to the public option, the changes to Medicaid and Medicare and the other provisions that Lois Uttley wrote about yesterday, the bill also includes some important reproductive health initiatives.  Reproductive health, rights and justice activists have to continue to be active and vigilant to be sure that the potential progress in this area will be realized and that continuing threats will be held off.

Accessible and affordable family planning

The bill would mandate that insurers cover preventive services, and it defines preventive services in a way that could include family planning so contraceptive coverage could be a part of the essential benefits package.  But because of a change in the way the new House bill describes what is exempt from cost-sharing, insurers would be able to impose extra fees on family planning services.  This means that while other preventive health care would be provided without co-payments, women might have to pay out of their own pockets to get family planning services.  Thanks to the efforts of Senators Barbara Mikulski and Patty Murray, among others, the Senate HELP bill does better than the House bill on this, prohibiting insurers from imposing co-payments on family planning services.  Women’s health advocates will be working to get the Senate HELP provision in the final health reform bill.

Learning lessons from some of the problems women in Massachusetts faced after health reform there, the new House bill explicitly defines essential community providers to include the range of community and family planning clinics that many women have been depending on for care.  This will allow women who want to continue to receive care from the clinics and providers in their communities where they have been getting services to do that.

Antichoice movement tries to kill health reform

As expected the new House bill includes both the provider refusal language and the compromise abortion provision worked out originally in the House Energy and Commerce Committee.  The abortion provision, sometimes referred to as the Capps amendment, leaves in place existing prohibitions on use of federal Medicaid dollars to pay for abortion.  And it allows private health insurance policies, most of which now cover abortion, to continue to do so as long as they pay for it without using public subsidies.

If it is enacted, no federal funding or subsidies will be allowed for abortion services except in cases of rape, incest or threat to the life of the mother.  The long-standing Medicaid funding restriction on abortion, imposed annually as part of the appropriations process will not be affected.  But antichoice legislators are still pushing to amend the bill to add the prohibition permanently in law which would make it harder to eliminate in the future.

Reproductive justice advocates, including all of us at Raising Women’s Voices, have been critical of the Capps compromise.  We’ve argued that reproductive health care is basic care for women and that specific services should not be singled out for different treatment.  The prohibition on using federal dollars to pay for abortion care jeopardizes the health of the most economically vulnerable women.  It is fundamentally unjust and should be overturned.  But we also recognize that health care reform holds important promise for improving access to other health care for these same economically vulnerable women.  And we know that supporters of the Capps amendment, including Congresswoman Lois Capps, herself, put the compromise forward to prevent antichoice legislators from using health care reform as a vehicle to impose broad, new restrictions on access to abortion.

Antichoice activists are pulling out all the stops right now to “kill the bill.”  A Washington Post column this morning described the scene yesterday when House Speaker Nancy Pelosi was presenting the features of the new bill to reporters at the Capitol:

"In this legislation, we will immediately begin to close the doughnut hole," the speaker proclaimed.

"We won't pay for murder!" a heckler heckled.

"Prevention and wellness are an important part of this legislation," the speaker declared.

"We won't pay for murder!" the heckler repeated. Finally, police were able to silence the activists, who held a gruesome poster showing an aborted fetus and signs demanding "Kill the bill."

The Susan B. Anthony List, an antichoice political network, sent an email alert yesterday that asked readers to “Donate today to support our efforts to stop this deadly legislation.”  And antichoice legislators are insisting that they won’t allow the bill to go forward unless they can offer amendments that would transform this landmark legislation from a step forward toward the goal of quality, affordable health care for all into a bill to ban abortion.

Speaker Pelosi is standing strong against the threat.  Negotiations on this issue are ongoing and according to some reports House leaders hope to work out new language that will continue to preserve the status quo, while giving antichoice Democrats more reassurance that no federal funds will be spent on abortion services.  But if they can’t do that, there is still a danger that we could see more dangerous antichoice amendments being proposed from the floor of the House.  Stay tuned -- we’ll keep you posted on the latest news.

And in the meantime, for more details on what women want and what we will get from health reform, check out our updated fact sheet on whether the current health reform proposals meet our needs.