Thirty-three years ago this fall, a bitter, race-tinged fight over abortion matched Roman Catholic bishops and the House against the nation's first popularly elected black senator, Republican Ed Brooke of Massachusetts. | REUTERS Bishops reprise old abortion fight

Thirty-three years ago this fall, a bitter, race-tinged fight over abortion matched Roman Catholic bishops and the House against the nation’s first popularly elected black senator, Republican Ed Brooke of Massachusetts.

Now, with health care reform on the line, the same male-dominated church hierarchy is dictating to the first woman speaker of the House, Democrat Nancy Pelosi, a Catholic herself and past ally for the bishops on everything from human rights in China to tax credits for low-income families.


Beneath this stark picture is a much more diverse nation — and set of political actors.

Two Americas have evolved since the late Rep. Henry Hyde (R-Ill.) first attached his famous amendment in 1976 barring federal Medicaid dollars from being used to fund abortion services for poor women. Seventeen states, representing 40 percent of the nation’s population, have exercised the option to use their own money to provide abortion services for Medicaid beneficiaries. And in these same states, women generally are far more likely to rely on their private insurance plans to help pay for abortions.

At the same time, the anti-abortion lobby remains dominant in Congress, fathering “mini-Hydes” that go beyond Medicaid to affect millions of federal workers, the military, the American Indian health service, women in federal prisons and even Peace Corps volunteers.

The bishops can make a strong case that the anti-abortion language inserted into the House health care bill extends only this central principle: Federal health dollars can’t go to pay for abortions. And for 12 years, these same restrictions have applied not just to fees for abortion services but also to any federal contributions to health plans that cover elective abortions.

“We have 53 million people already under Medicaid, and now we’re going to add about 33 million uninsured?” asked Richard Doerflinger, an associate director with the U.S. Conference of Catholic Bishops. “It applies to a new situation, but it is not qualitatively a new situation.”

Or is it?

The political reality is the anti-abortion movement has largely succeeded in Washington by applying Hyde restrictions to what are captive populations reliant on the government. Thus the U.S. Supreme Court held in 1980 that a poor woman lost nothing under Hyde since she had so little to begin with.

Health reform is very different in that the government is mandating that individuals obtain coverage, not just for their own good but also for the good of the health system generally. Expanding the risk pool is essential before requiring insurance companies to end their most onerous practices, such as excluding people with pre-existing conditions. And by cutting down on freeloaders, the hope is to slow the rise of health premiums for everyone.

It’s a shared endeavor made easier by government subsidies, but the costs are real — especially for those who don’t have employer-paid coverage.

Consider, for example, projections by Massachusetts Institute of Technology economist Jonathan Gruber for a family of four with an income of $60,640 or a single individual earning $29,780. Both stand at 275 percent of poverty and therefore qualify for tax credits to reduce their costs. But the family would still pay $5,740, or 60 percent of its premium; the single individual would pay $2,830, or 80 percent, of the cost.

That’s a far higher private contribution than is seen with Medicaid or federal workers and the military. But the House language makes no distinction, barring anyone who accepts a stipend of any size from using it to buy a policy covering abortion services.

Insurance companies marketing to individuals in the exchanges would also have to tailor their health plans to comply. And this limits the options for those who get no stipend at all.

It’s estimated that 3 million people enrolled in the exchanges will get no assistance. An additional 9 million will fall into that category as more employers buy in to cover their workers. But since the great majority of those in the exchange will get some stipend in the early years, insurance companies will be inclined to target their plans to this market and not cover abortion.

“It tells people what they can do with their own money, and it taints the private insurance market,” Susan Cohen, director of government affairs for the New York-based Guttmacher Institute, told POLITICO.

Added Sen. Sheldon Whitehouse (D-R.I.): “For the first time, what the anti-choice advocates are saying is that [the federal] dollar now has to control ... what these private-sector companies can offer. That’s new, and that’s a big intrusion into the relationship of the private citizen with his or her insurance company.”

Going forward in the Senate, the bishops will press their case hard; a new action bulletin went out Monday. But neither side in the abortion debate is a stranger to compromise.

Short of votes in 1993, Henry Hyde agreed to restore old exemptions for cases of rape and incest. Ten years later, as chairman of the House Foreign Affairs Committee, he went lighter on family planning groups — who counsel on abortion — to get to his goal: abstinence programs in the battle against AIDS in Africa.

Hyde always left governors some flexibility — a distinction that could be important now, depending on what role states finally have in running the insurance exchanges. And even in the case of health care for federal workers, anti-abortion senators embraced a compromise in 1993 under which the government would shoulder the administrative costs so plans could cover abortions through separate riders demanding an added premium.

This proposal narrowly failed on a procedural vote. But it was a more generous approach — from the standpoint of abortion rights — than the House language and could yet make such riders more viable, especially if small-business employers chose to buy them for their workers in the exchanges.

In striking her bargain with the bishops, Pelosi may have underestimated the anger it provoked among her women friends. But she had little choice if health care was to move forward, and she was looking for an ally going into the Senate.

Church leaders appear to have played to this desire by tapping Cardinal Theodore McCarrick, the retired archbishop from Washington and a longtime force in the USCCB, to make a call to Pelosi from Rome. The two had overlapped before because of their common interest in international policy. And in a 2007 interview with the Catholic News Service, McCarrick praised Pelosi for being someone “you can always talk to” and “a very bright lady who understands politics more than most people in Washington do.”

The speaker refuses to discuss their conversation. McCarrick, back in Baltimore meetings this week, indicated through a representative that he is also uncomfortable talking about the phone call at this time.

But the bishops are the first to admit they are far closer to the speaker than to the Senate on the major issues of subsidies for the poor and treatment of immigrants — two flash points for Pelosi’s left. And the big question for House Democrats now is whether they will see some of the same muscle that was applied to them on abortion.

“The bishops are willing and eager to meet and talk with whoever wants to about our issues and concerns about passing genuine health care reform,” said Kathy Saile, director of domestic policy. “The bishops see it as a moral imperative and national priority.”

Monday’s bulletin to the Senate began with abortion but then added: “Health care must be made more affordable and accessible to those in need, and immigrants must not lose or be denied health care coverage.”

“We need more than a bulletin,” said a House Democratic aide.

Speaking in Baltimore on Monday, Chicago Cardinal Francis George, president of the USCCB, defended its tactics, saying the church must ensure that “issues that are moral questions before they become political remain moral questions when they become political.”

Watching it all with a special perspective is Rep. Dale Kildee (D-Mich.), who once studied for the priesthood and counseled the bishops to hold firm with the speaker and fellow leaders.

“They were wearing down. I told them time is on our side,” Kildee told POLITICO. “The Catholic Church is great at politics. They’ve been around for 2,000 years. If you go to the Vatican library, you can find correspondence between the pope and Genghis Khan.”

“What about the separation of church and state?” a reporter asked.

“In law,” Kildee said, smiling broadly. “Not in politics between the church and politically minded people.”