On Health Reform, Uncertainty Breeds Peril

Many supporters of health reform believe that systemic questions, such as whether or not reform will include a public insurance option, should inform the congressional and public debates. But the truth is that Americans, unsurprisingly, seem to be most concerned about coverage specifics. After reform, what procedures will and won't be covered? Will my array of choices expand or contract?

Those fears have been artfully exploited by the increasingly enthusiastic and radical conservative anti-health reform movement. In response, today the White House launched "Health Insurance Reform Reality Check", a website modeled after "Fight the Smears," a campaign season effort to dispel rumors about Barack Obama's background and positions.

The new site is built around a simplified, eight-point explanation of how consumers will benefit from health reform. Using this messaging, the administration plans a public relations push during the congressional recess, with a focus on drumming up grassroots support via the Obama's team's email list and outreach to the liberal blogosphere. But given the intensity of anti-reform protests over the last week, there is little doubt that the president seems to be on the defensive. The continued lack of one, concrete, completed health reform bill means that opponents of reform can grandstand on a number of hypothetical issues. For example, both the House tri-committee bill and the Senate HELP committee bill create an independent council of medical experts to advise HHS on what services will be covered in the new health exchanges. Conservatives have suggested that the council — which, of course, does not yet exist — will prevent terminally ill patients from receiving life support or continuing care, or will mandate abortion coverage.

Both of those outcomes are completely improbable. Neither are on the White House's agenda. But by kicking some tough choices on coverage down the line, to after reform passes, Democrats have opened the door to this kind of scare-mongering. Uncertainty is uncomfortable, and opponents of reform — along with skeptical moderates — are exploiting that simple truth.

Nowhere is this more apparent than in the abortion debate. None of the health reform proposals in Congress threaten the Hyde Amendment, which currently prevents the federal government from funding abortions. But anti-choice legislators are not satisfied. Many women will receive government subsidies to buy health insurance after reform, and Republicans — including some senators in the all-powerful "Gang of Six" — would like those women to be banned from accessing abortion with those funds, whether they are covered through private insurance plans or a potential public option. This would be a significant curtailing of reproductive rights, since most private insurance plans currently do offer some abortion coverage.

In this case, the current reform proposals actually do maintain the oft-heralded "status quo:" Medicaid won't cover abortion, but private insurance plans will. It is reform opponents who are pushing to change the way health care is delivered, by curtailing women's ability to access abortion coverage in the private insurance market. This morning, a senior administration official, speaking on background, told me that some moderate Republicans are choosing to understand health insurance subsidies as tax credits, and thus, from a libertarian point of view, might support a woman's right to access any health procedure she wishes with that "tax credit," including abortion. And yet, this official affirmed that abortion is among the issues holding up the Senate Finance Committee — right alongside long term cost containment and debates over whether the federal or state governments will pay to expand Medicaid.

In other words, almost everything about health reform remains up in the air. Stay tuned.

cross-posted at TAPPED

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