"I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman. Unfortunately, the only vehicle available is the...Medicaid bill."
Those were the words of Illinois Sen. Henry Hyde, on the floor of Congress in 1977. Just four years earlier, Roe v. Wade had legalized abortion across the country. Almost immediately, opponents of reproductive rights began seeking out ways to limit access to the procedure. One of their major early successes was the Hyde Amendment, which, ever since 1976, has banned Medicaid -- the federal health insurance program for poor women and children -- from paying for abortions, except in the most extreme cases when a woman's physical health or life is in danger. Medicaid covers 7 million American women, or 12 percent of women of reproductive age. Federal employees, members of the U.S. military, Peace Corps volunteers, and prisoners are also barred from using their government health coverage to access abortion.
Will current health care reform efforts mean that for the first time since Roe, federal government dollars will pay directly for abortions? It's unlikely. But the religious right and its Republican enablers want grassroots conservatives to believe it will, hoping the resulting outcry will scuttle attempts to reform our expensive health care system and provide coverage for 47 million uninsured Americans. They are playing the abortion card.
In a widely circulated July 5 Washington Times op-ed, Family Research Council president Tony Perkins wrote, "The House health reform plan covers 'family planning,' the well-worn buzz word that includes abortion unless specified to the contrary, and given the Democratic Party's commitment to abortion, it would be naive to assume, unless there is an explicit prohibition in the bill, that Health and Human Services Secretary Kathleen Sebelius will not use her discretion to fund abortions with taxpayers' money." In a letter to Congress, National Right to Life Committee legislative director Douglas Johnson warned, "A vote for this legislation, as drafted, is a vote for tax-subsidized abortion on demand."
This rhetoric is beyond hyperbolic -- it is downright deceptive. "When federal law discusses family planning, it never includes abortion," says Adam Sonfield, a senior policy associate at the Guttmacher Institute, which researches sexual and reproductive health. "The federal government would never talk about it in that way."
In actuality, "family planning" language refers exclusively to contraceptive services, in part because of the Hyde Amendment. Yet so politicized is reproductive health, that even to offer birth control to poor women who do not meet Medicaid's strict eligibility requirements, individual states must apply for a waiver from the federal government. Only half of states have done so. Though the legislative details are still being ironed out, the Health and Human Services secretary, when choosing what services to cover under any potential public insurance plan, will likely be bound by all of the existing laws that prevent the federal government from financing abortion, and that make even family planning coverage cumbersome.
None of these restrictions would be explicitly overturned by any of the health reform proposals currently being considered in Congress. Far from cackling as they sneakily lobby for "abortion-on-demand" legislation, women's health advocates are actually rather anxious. In the Senate, anti-choice Republicans say they will oppose any health reform plan that subsidizes abortion coverage or even includes, in the proposed health insurance exchanges, private insurers that cover abortion. Currently, 87 percent of health plans offer some abortion services. That means if Democrats capitulate, the majority of women who currently have abortion coverage could lose it. The result would be a near-blanket restriction on women's access to insurance-subsidized abortion, one far more radical than the Hyde Amendment.
As for Hyde, many reproductive health care advocates admit, reluctantly, that it's not on their lobbying agenda at the moment; they are simply too busy playing defense on health reform. After all, even some Democrats, including Vice President Joe Biden, have a history of support for Hyde. "Though it's a goal, when we lobby and count votes around here, we still don't have the have the votes to repeal Hyde," NARAL Pro Choice America President Nancy Keenan says.
Sonfield agrees, "Hyde is discriminatory against poor women, and we'd like to see it overturned. But it does not seem to be a political priority right now."
Considering this ambiguous landscape for reproductive rights, it is no coincidence that Planned Parenthood has launched a nationwide television advertising campaign defending its record as a preventive health care provider for American women. Republicans would like nothing more than to use health reform to withhold from the organization its $300 million in federal support, which clinics use to provide services such as cancer screenings, pre-natal care, and sex-ed for teenagers.
Reproductive rights are under threat in the health reform debate, not ascendant. Hand-wringing from the religious right has obscured that truth. But in playing the abortion card, the real goal of anti-choicers is not only to maintain existing restrictions on abortion access, but to use health reform as a vehicle to expand them to the majority of American women. If such efforts lead to legislative impasse, many conservatives will be delighted. After all, they've never really put any political muscle behind fixing our inadequate health care system.
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Dana Goldstein is an associate editor and writer at 
