Abortion hijacks the US healthcare debate

Battle over amendment that may prevent women paying for terminations

The always-delicate political truce in the United States on abortion rights has been plunged into unexpected jeopardy thanks to an amendment inserted at the eleventh hour in the healthcare reform legislation approved by the House of Representatives.

Tensions that have lurked below the surface of the healthcare debate exploded into the open when more than 60 Democrats in the House approved the amendment adding new restrictions on access to abortion for women. The manoeuvre helped ensure the passage of the legislation in the House last Saturday. The US Senate is scheduled to begin debating its version of reform early next week.

President Barack Obama and other Democratic Party leaders have strived for months to keep the lid on debate about abortion, which in America becomes very emotional very fast. The President expressed anxiety that fresh political warfare on the issue could derail the wider reform effort. "This is a health care bill, not an abortion bill," he insisted during an interview with ABC News.

While the US Supreme Court returned to women the right to seek an abortion in the landmark 1973 Roe vs Wade ruling, Congress subsequently instituted a rule barring the use of federal funds for abortions. But access to abortion, particularly for poorer women, would be narrowed further under the amendment introduced to the legislation by Congressman Bart Stupak last weekend.

The Stupak amendment aims indeed to ensure that abortions will not be available under the new system to women with health coverage subsidised by Government dollars. Additionally, however, it bars insurers from including abortions in their coverage plans if they participate in proposed health insurance exchanges designed to make it easier for lower-income people and small business owners to get insurance.

It didn't take long for defenders of abortion rights to understand that this represents a change of the rules for women because the effect of the amendment would be to make it impossible for some women to obtain coverage for abortions even when they are ready to pay for it with their own money.

"There's going to be a firestorm," warned Diana DeGette, a Democrat who opposed the amendment. "Women are going to realise that a Democratic-controlled House has passed legislation that would prohibit women paying for abortions with their own funds... we're not going to let this into law."

Nancy Keenan, the President of NARAL-Pro Choice America, condemned the vote as "extremely disappointing and outrageous" and vowed that the "fight isn't over yet". Pro-choice forces are in fact galvanising themselves for action as the focus switches to the US Senate. Now that the abortion debate has gone from a simmer to a spitting boil, it is hard to see who could cool it back down again, however.

"I said all along that the inclusion of abortion as healthcare was going to be a political conflagration," noted Charmaine Yoest, president of Americans United For Life Action, who hailed the amendment's passage.

But Senator Barbara Boxer of California is among those now determined to have it erased before a final law reaches the desk of Mr Obama, something that supporters hope will happen by Christmas.

"This amendment is unfair and discriminatory toward women," she declared. "We've had a compromise in place for decades that has been fair. Anything that disrupts that compromise is a huge step back for women."

In practice, few women in the US who obtain abortions claim back the costs for them even if they have coverage, usually for reasons of privacy. But such is the determination of both sides in the debate to hold their respective ground that any tweaks to the law will always trigger a fresh outbreak of warfare. And once hostilities begin, finding the terms of a new truce is always hard.