As various health reform bills move through House and Senate committee, coverage of reproductive health care, including but not limited to abortion care, hangs by a thread, and the drumbeat from the far right against coverage of primary reproductive health care has been growing louder. Last week, White House Advisor Tina Tchen told women's advocates from across the country, that it will be up to the grassroots to win the campaign to cover reproductive health care.

Want your basic reproductive health services covered under health reform? Want to keep the coverage for reproductive health care, contraception, and abortion care you already have? Want to ensure that you, your mother, daugher, sister, friends, neighbors and the millions of women in the United States living without health insurance get coverage for primary reproductive health care once Congress gets through serving up sausage for your health benefits?

Then it’s time for women to “bring it” and get back into campaign mode, according to Tina Tchen, director of the White House Office of Public Engagement, speaking to more than 400 attendees at the 2009 Planned Parenthood Organizing and Policy Summit last week. PPFA is one among many national and state groups, including the National Women’s Law Center, NARAL Pro-Choice America, and the National Partnership for Women and Families working “night and day” and mobilizing constituents to protect coverage of basic reproductive health care.

Tchen, who shared a panel with Representative Jan Schakowsky (D-IL) and PPFA President Cecile Richards, provided participants with a status update on health care reform and reiterated the Obama administration’s commitment to women’s health.

“I can say this directly from the White House, the President reiterated to all of us in the senior staff that health care is the most important issue,” said Tchen.

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It is the signature issue that he ran on, it is what he believes is one of the singularly most important reforms that need to be made that affects America, that affects our economy.

Tchen also reminded the group that they had elected a pro-choice president. President Obama publicly re-affirmed his support for a woman’s right to choose just days after his inauguration, on Thursday, January 22nd, the 36th anniversary of Roe v. Wade. He stated:

Roe v. Wade “not only protects women’s health and reproductive freedom, but stands for a broader principle: that government should not intrude on our most private family matters,” Obama said in a statement.

But, the PPFA panelists warned, his support for a woman’s right to choose and for access to the services needed to prevent unintended pregnancy, stem the spread of infections and ensure all women have primary reproductive health care won’t be enough to secure passage of a health reform bill that includes these essential health services.

In fact, both Republicans and conservative Democrats are pushing for restrictions in health reform legislation that could result in the loss of current benefits to millions of women.

“Health care reform must not leave women worse off than they are under our current system,” wrote Richards in a recent action alert. But as various bills move through Congress, the “steady assault from anti-choice groups has become an avalanche,” she said.

If the Right Wins, Women Will Lose

Today, the majority of American women with private or employer-provided health insurance have policies that cover both contraceptive supplies and abortion care, as well as pap smears, well-woman exams, testing and treatment for sexually transmitted infections, pregnancy care and other forms of primary, preventive reproductive health care.

A federally supported study conducted by the Guttmacher Institute assessing levels of insurance coverage for a wide range of reproductive health services found that 87 percent of typical employer-based insurance policies in 2002 covered medically necessary or appropriate abortions. It also found that 86 percent of typical plans covered all five of the leading contraceptive methods. Using different methods of collecting data, a 2003 Kaiser Family Foundation (KFF) study found that 72 percent of employees had coverage for five reversible methods of contraception (88 percent for oral contraceptives specifically) and that some 46 percent of covered workers had coverage for abortion. (Differences in the two studies are explained here.)

This coverage would be lost if reproductive health becomes the “bipartisan” bargaining chip for which it has been used by Democrats and Republicans for far too long. You know the refrain: “We need a ‘common-sense,’ ‘bipartisan’ compromise to pass this bill.” Translation: Women get thrown off the bus.

But if reproductive health care including but not limited to abortion is not covered under whatever health care reform results, we can be sure that both women and society will continue to pay a high price. There will be more infection and disease, more unintended pregnancy, and more, not fewer, abortions.

A number of recent articles on Rewire have explored in depth the social, economic and health costs of disparities in access to reproductive health care that currently exist. For example, today, roughly 16.7 million women are uninsured, and thus likely to postpone care and delay or forego important preventive care. This means preventable illness goes undiagnosed. For example, increased access to pap smears for women who do not have these services will save lives and money. The American Cancer Society estimates that in 2009, about 11,270 cases of invasive cervical cancer will be diagnosed in the United States. Non-invasive cervical cancer is estimated by some researchers to be 4 times more common than invasive cervical cancer. About 4,070 women will die from cervical cancer in the United States during 2009 according to the ACS. Early detection and early treatment = lives–and money–saved.

Poor women also rely heavily on publicly funded contraceptive services, which prevent 1.94 million unintended pregnancies, including almost 400,000 teen pregnancies, each year. These pregnancies would otherwise result in 860,000 unintended births, 810,000 abortions and 270,000 miscarriages. Taken together, all of these are critical to being able to prevent an unintended pregnancy and hence a potential abortion.

Not surprisingly, the groups experiencing the highest rates of unintended pregnancy have the least secure access to contraception. Of the 36.2 million women in the United States who expressed a need for birth control in 2006, 17.5 million were in need of publicly funded services and supplies, more than 71 percent of which were adults and the vast majority of which were already parents.

Yet in 2006, only about half (54 percent) of those in need of publicly funded birth control actually had access to services provided by Medicaid, Title X and other sources of government funding. Indeed, as Elisabeth Sowecke wrote here just this week, the number of women who qualify for but are as yet unable to access Medicaid-funded abortion services is large and growing. This denial of care represents a particularly insidious level of discrimination against both the women and their families and a violation of basic human rights.

The reality of these costs also are not lost on the governors of some of the largest states, whose budgets are reeling from a combination of high unemployment and growing demands on social safety nets, including Medicaid.

Today, 16 governors, led by Governor Ted Strickland of Ohio, sent a letter to congressional leaders urging them to support the inclusion of the Medicaid Family Planning State Option in health care reform. This critical provision provides basic preventive health care, including breast and cervical cancer screenings and contraception, to millions of women and is currently in President Obama’s fiscal year 2010 budget.

“Currently, 27 states have sought and recieved federal waivers to expand eligibility for family planning services,” wrote the governors.

States have repeatedly demonstrated that expanding health care coverage for women in this way also results in significant cost savings. Expanding the Medicaid Family Planning State Option would allow states to expand Medicaid coverage for family planning services, without a waiver, to those who don’t otherwise qualify for full Medicaid benefits. These cost savings could help states avoid additional cuts to critical health programs and allow them to use the savings for other pressing needs. The Medicaid Family Planning State Option will also save federal funds. The Congressional Budget Office determined that the Medicaid Family Planning State Option saves the federal government $200 million over five years and $700 million over 10 years.

Where’s the Opposition?

Irrespective of the cost savings, these benefits are in fact in danger at the hands of a majority-male Congress whose coverage for Viagra remains well-protected.

Some of the opposition comes from likely suspects and is based on misinformation campaigns that belie their true purpose. Republicans in Congress, like Senator Orrin Hatch and Representative Mike Pence–who introduced an amendment today to the House appropriations bills to defund Planned Parenthood–just can’t seem to get the connection between increased access to prevention services, improved health and reduced need for abortions, the women’s right they love to hate.

And it is no surprise that groups like Family Research Council and the National Right to Life Committee are against not only funding for abortion services, but also for contraception. FRC, for example, continues to perpetuate myths about an amendment to the Senate Health, Education, Labor and Pension (HELP) Committee health reform bill originally sponsored by Senator Barbara Mikulski (D-MD). This amendment, which passed as part of that bill, would ensure coverage of well-woman care, HIV prevention and testing, pap smears, pregnancy care, and contraceptive supplies. FRC continues to claim it forces taxpayers to pay for abortions for the first time in 30 years.

It does not address abortion coverage. At all.

Watch Your Frenemies

But then there are Democrats who may either “cut a deal” on coverage of abortion services or who oppose it outright.

For example: while the House and Senate HELP Committees have passed their bills, and neither of those includes any restrictions on coverage of reproductive health care, Tchen noted:

This was not easy to achieve in committee and won’t be easy to hold on to the Senate floor or on the House floor. And the President can not do it alone. His efforts alone will not be enough. It will take each of you to raise your voices when you go home and here in DC and to spread the word.

In fact, as of this writing, trouble may be brewing in the Senate Finance Committee and is boiling up in the House Energy and Commerce Committee. Senate Finance has been promising a bill “for weeks” according to one source, but nothing has as yet materialized publicly. Meanwhile, Senator Max Baucus (D-MT), chairman of Committee has according to Dana Goldstein, “indicated some openness to compromising on abortion rights in exchange for Republican support for a final reform bill.” While Baucus’s office underscores his pro-choice position, co-Chair Charles Grassley (R-IA) is not pro-choice, and in the still largely old boys club that is the Senate, that “bipartisan” thing trumps women’s rights every time.

“Republicans on the Senate Finance Committee are pushing for language in health care reform legislation that would eliminate coverage for abortion services,” stated a coalition of religious groups that support abortion rights. “If this happens, many women could lose coverage for abortion services that their private insurance currently includes. Plus, millions of uninsured women will still lack a basic health care service despite having been promised a better quality of life,” says Rev. Carlton Veazey, president and CEO, Religious Coalition for Reproductive Choice.

“If these senators are allowed to deny coverage of abortion services,” Veazey continued,

the burden will inevitably fall on low-income women and widen the huge gap in health status and access to health care services that reforms are meant to remedy. Compared to their higher-income counterparts, low-income women are four times as likely to have an unintended pregnancy and five times as likely to have an unintended birth.

“As people of faith, we believe that health care reform should expand coverage to provide for the basic services that every human being deserves; it should not deny essential services to half of the population and aggravate the troubling disparities in health care affecting minorities and low-income individuals,” Veazey adds.

In the House, Congressman Bart Stupak (D-MI) (who this week helpfully tried to re-insert funding for abstinence-only-until-marriage programs into the House appropriations bill) has threatened to halt passage of legislation unless it explicitly “excludes public funds for abortions.” Stupak claims to have 39 House Democrats in line to vote against passage. Today’s Congress Daily reports that:

Stupak said he will consider voting against the health reform bill if leaders do not allow a floor vote on an amendment that explicitly prohibits using public funds for abortions. If the vote is not allowed, he and other Democrats opposing abortion rights will likely vote against the rule allowing consideration of the health reform bill, he said.

Even the Senate HELP Committee–which as noted above has passed its bill–debated a half-dozen abortion-related amendments, defeating most on identical 12-11 votes, including one that would have barred people who get government insurance subsidies from buying private insurance plans that include abortion coverage.

In fact, even the “contraceptive option” was deemed to controversial for at least one Democrat. Senator Bob Casey (D-PA) voted against the Mikulski Amendment ensuring coverage of contraception and of essential service providers. Calls to his office inquiring as to the reason for his vote against contraceptive coverage were not returned.

Public v. Private: Confusing the Issues

The basic argument for those who are trying to completely eliminate even the possibility of coverage for abortion services under health care reform is that “no public funds should be allocated for abortions” because “we don’t do that.”

But that is, not surprisingly, a misleading argument because health reform is intended to completely transform insurance coverage and to expand the range of essential coverage, and as noted earlier, most private plans today already cover these services.

In order to ensure all Americans are covered, most health reform proposals include options for “insurance exchanges” and other methods through which the federal government might partially subsidize the costs of insurance coverage for those without employer-based insurance, or those who can not afford to pay out-of-pocket for an insurance policy. What the Republicans and the Democrats opposed to continuing current coverage (including current abortion coverage) for women want to do is to elminate the possibility of coverage from either subsidized or private plans whether or not the federal government is subsidizing a particular person.

This is sort of like applying the “global gag rule” to private insurance plans because even if you are paying for 90 percent of your policy, the restrictions apply both to the federally funded portion (10 percent) as well as to the 90 percent of the policy you pay for. Moreover, some analysts believe the implication is that even in cases where you pay for 100 percent of the policy you choose, if the federal government is involved in any way in that insurance plan by subsidizing others, your coverage would still be restricted.

Sen. Sheldon Whitehouse (D-RI) told NPR last week that not letting people use what might be very small subsidies to buy private coverage was going too far.

“The next step in this logic will be to require anybody seeking these services to walk to the clinic, lest they use federal highways, supported by federal highway funds,” he said.

What is more: The public is against having the Senate or the House dictate their medical choices.

A survey conducted by the Mellman Group for the National Women’s Law Center of 1,000 likely voters found that:

Voters overwhelmingly support the broad outlines of reform and requiring coverage of women’s reproductive health services. Seventy-one percent of voters support requiring health plans to cover women’s reproductive health services, as opposed to 21 percent opposing this coverage.

Absent coverage for women’s reproductive health services, majorities oppose reform. If reform eliminated current insurance coverage of reproductive health services such as birth control or abortion, nearly two-thirds (60%) would oppose the plan and nearly half (47%) would oppose it strongly.

Voters want an independent commission to make coverage decisions, not politicians. A strong majority of voters (75 percent) prefer that an independent commission of citizens and medical professionals make decisions about what should be covered under reform rather than the President and Congress. Fully 73 percent of voters want an independent commission to decide whether abortion should be covered, while just 16 percent want the President and Congress involved.

Even in the face of opposition arguments, majorities support requiring coverage of abortions under reform. After hearing strong arguments both for and against covering abortion under reform, two-thirds (66 percent) support coverage, agreeing that health care, not politics, should drive coverage decisions. A majority of voters (72 percent) reported that they would feel angry if Congress mandated by law that abortion would not be covered under a national health care plan.

Voters want rules to stop insurance companies from discriminating against women. Even in the face of industry claims of too much government interference, 62 percent agree that reform should establish new rules to treat everyone fairly and stop discrimination, while far fewer (32 percent) side with opponents’ claims.

Where does it go from here?

Even despite the evidence, the benefits and the clear public support for women to continue making their own medical decisions with their families and their doctors, and for full coverage of these services, anti-choice activists and politicians continue to play the same political shell games with women’s health and lives.

So groups are heeding the call to “bring it.”

And you can join them.

Here are links to action by some of the organizations mobilizing to ensure reproductive health services remain available to women and their families:

Planned Parenthood Action Fund

National Women’s Law Center

NARAL Pro-Choice America

National Partnership for Women and Families