Health care reform is in trouble. Republicans are holding out, Blue Dogs are feuding with progressives, and now 20 House Democrats have signed a letter opposing any bill "unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan." Critics are using the specter of subsidized abortions, misleadingly but effectively, to drum up opposition to the whole health package.
This is a headache, but it might lead to a creative resolution. What if you could lock in the support of these iffy Democrats—and buy some good will among Republicans—by privatizing abortion coverage? How much would it cost? Could you raise the money from liberal donors? If you don't, will you end up raising and spending the same money or more to fund ads and lobbying in a protracted health care fight? Would you be forced into worse concessions to other congressional factions? This might be the best deal you can get.
Abortions, at an average of $413 a pop, are cheap. (They can range from $90 to $1,800 or more, depending on gestational age.) It's hard to walk through the doors of a hospital for less. It wouldn't be much of a stretch for a nonprofit organization with deep-pocketed donors to cover the cost of abortions for America's low-income women. Based on conclusions drawn from Guttmacher Institute data, a fund to provide free abortions to every woman in the United States would cost about $500 million per year. A fund limited to low-income women—those at or below 200 percent of the poverty line—would still cover most women who seek abortions, according to calculations based on the most recently available data, at a cost of just $311 million per year. * (That's 751,940 abortions multiplied by $413.)
Could private funders cover that cost? Absolutely. Individuals and foundations give more than $1 billion a year to reproductive-health charities, according to data from the Funders Network, a group that analyzes trends in reproductive-health grants. In 2007, the most recent year for which data are available, nearly $250 million was specifically earmarked for "abortion issues." Although only a small slice of those funds—about $63.7 million—went to abortion-related programs operating in the United States, a reallocation of funds from international groups to American groups or an increase in giving by donors who want to see abortions covered could bolster the total enough to pay for abortions for poor American women. *
An abortion fund wouldn't have to rely entirely on those donors, either. There's another constituency that has proven itself willing to cough up cash: supporters of health care reform. This year, they've already spent around $40 million on TV ads alone. That number will only go up as the debate bogs down in abortion and other sticking points. If these deadlocks aren't broken, the number will soar again the next time health care reform comes up. Why not skip the ad buys and shortcut the fight by putting the money in the abortion fund instead?
Progressives hate the idea of a private abortion fund. They argue that abortion is a medical procedure like any other and should be covered by any insurance plan, public or private. Nobody has to set up charities for appendectomies—why do it for abortions?
The answer is: Because it might get them everything else they want. If pro-life lawmakers seriously regard abortion as a matter of life and death, an agreement not to cover it should seal their support for health care reform. To get that agreement, they would have to waive their objections to other progressive goals: a public option, an individual mandate, and an employer mandate. Wouldn't that be a better deal for most women than what they have now?
Better yet, progressives could reduce the abortion fund's costs through family planning. Progressives believe that contraception can lower the abortion rate by preventing unplanned pregnancies. The Guttmacher Institute agrees: It estimates that extending Medicaid family-planning services to women making less than 200 percent of the poverty line would prevent 210,300 abortions. The savings from such services could equal $87 million annually. If the government did that, a private fund to cover abortions for low-income women might need as little as $57 million per year. *
Why should pro-life Democrats pledge their votes for health care reform in exchange for abortion privatization? First, it will protect pro-life taxpayers from subsidizing a procedure they detest. Second, it will show that these lawmakers really do put abortion above other concerns. Third, it will give pro-choice donors and nonprofits an extra incentive to lower the abortion rate. If the family-planning and sex-education programs these pro-choicers support through legislation don't work, the money for the resulting abortions will come out of their own pockets. This will force them to monitor the programs' effectiveness more carefully and maybe do a better job of promoting smart sexual behavior among the women they treat.
Privatization won't satisfy pro-choicers or pro-lifers. But it might secure passage of a health care bill that Americans on both sides can live with. That's worth a shot.
Correction, Aug. 14, 2009: This article originally implied that researchers at the Guttmacher Institute said providing abortions for every woman in the United States would cost about $500 million a year. This was the author's calculation, based on Guttmacher data on the average cost of an abortion ($413) and the yearly number of abortions performed in the United States, both total and for poor women. The extrapolation of a total cost of $311 million to cover abortions for poor women was also the author's, not Guttmacher's. ( Return to the corrected paragraph.)
This article also originally implied that the Guttmacher Institute had calculated the savings associated with the expansion of family-planning services. These calculations were the author's, based on Guttmacher data that specified only how many abortions are prevented by family-planning services, not how much those procedures might cost. (Return to the corrected paragraph.)
Correction, Aug. 18, 2009: This article originally stated that about $247 million that donors earmarked for abortion in 2007 was directed toward groups operating in the United States. That number includes money for both American and international groups. Because a significant percentage of reproductive-health-related donations are directed toward international groups, the amount that went toward abortion-related programs in the United States is considerably smaller, at about $63.7 million. ( Return to the corrected paragraph.)
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