Monday, November 09, 2009

Health insurance and lessons in government funding

The House of Representatives passed the health insurance bill Saturday night, moving near-universal health insurance in the US the farthest it has ever progressed in the 60 years since Truman first tried to enact it. But in order to pass, Speaker Pelosi had to allow a vote on an amendment to the bill that prevents any plan in the "public exchange" from covering expenses for abortions (except in cases of incest, rape, or threat to the health of the mother).

Had the unamended bill passed, no federal money would have been allowed to be spent on abortions. Insurance plans that covered abortions would have had to segregate public and private funds, using only private funds to pay for abortions. The amendment says the plans in the exchange will not be able to pay for abortions at all. The public exchange will include any public option, should it survive passage in the Senate, as well as private plans offered as individual policies or small group plans.

Not all private plans cover abortion, and current federally subsidized plans like Medicaid and the federal employee plan also do not cover abortion. The insurance exchange has potential to grow in the future to include a large portion of the population, including many families who will pay entirely with their own funds and no federal subsidy. Even these families will not be able to buy a plan that covers abortion and will have to pay out of pocket should they ever find themselves in need of one.

Much of the credit for passage of the abortion amendment belongs to a high-profile lobbying effort by Catholic bishops, who said they would oppose any legislation that didn't ban abortion coverage for insurance policies offered in the public exchange. They lined up a bloc of Democrats big enough to defeat the bill (along with all the Republicans) if it did not ban abortions.

This is an interesting position for the Catholic bishops to take. If federal money touches an insurance policy (or even if it doesn't, but the policy is in the public exchange), then it violates the conscience of some taxpayers to be funding (or not funding) abortions. This is exactly the opposite of the Catholic Church's argument concerning school vouchers.

Many primarily urban school districts have school voucher plans that allow poor children or children from underperforming schools to use public vouchers to attend private schools. Many of these schools are Catholic. The Catholic schools and their supporters argue that public money flowing to religious schools does not violate the establishment clause of the first amendment because the government is not making the decision; individual voucher recipients are. The Supreme Court, in the Zelman case, accepted this argument and upheld the practice in a 5-4 vote in 2002.

So families are entitled to freedom of conscience when using public money to pay tuition at private schools. This is not establishment of religion. This is not an offense to taxpayers who are not Catholic (or not other denominations whose schools might receive voucher funding). But when families use vouchers partially funded with public money (or not funded at all with public money) to buy insurance, the policies must comply with Catholic tenets. The recipients of public money (or not recipients) are not entitled to freedom of conscience when making a decision about their own health insurance.

Some people opposed to school vouchers make the argument that the Catholic Church should oppose funding tuition at religious schools via public vouchers, because the public financing may lead to restrictions on the funds that will permit government influence over the religious schools' curricula.

I think this argument is mostly disingenuous, made by people who aren't religious, but the possibility is there. This should also be a warning to the political left when they argue for expansion of government-funded services. As seen with the public-exchange abortion ban, government micromanagement is hard to avoid.

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