United States: Obama healthcare bill contains anti-abortion language

In a last-ditch, get-out-the-vote effort to convince the anti-abortion Democrats in the House to vote for a healthcare bill that contains anti-abortion language beloved by anti-abortion Democrats in the Senate, President Obama issued an executive order on Sunday promising to never, ever allow a single federal or unsegregated private dollar to pay for a single abortion in the United States (except in the cases or rape, incest or the life and health of the mother). He did this to provide Democratic congressman Bart Stupak the political cover he needed to vote for healthcare reform. Apparently, some people have said this executive order makes Stupak the hero of healthcare reform. It's a sad statement on American politics that working to defeat a piece of legislation that has the potential to bring health insurance (and thus better care) to millions of Americans – its other, many flaws aside – can ultimately lead to someone being labelled a hero. By Megan Carpentier

Until the law goes into effect in 2014 with the other provisions involving the healthcare exchange, two classes of women are covered by the Hyde Amendment and its lesser known cousin: women who are reliant on Medicaid, and women employed by (or covered by a spouse or domestic partner who is employed by) the federal government. Neither woman can have an abortion covered by their insurance company unless they wish to tell their insurer that the pregnancy is the result of rape or incest (which currently can and often is classified as a pre-existing condition, leaving one at risk of losing one's healthcare) or unless the government agrees that the abortion is necessary to save the woman's life or health. As the Washington Post showed last year, government actuaries are no more thoughtful than those at private insurers: a federal employee with a risky pregnancy who discovered that the child she carried had no brain was denied coverage for her medically-necessary abortion because the government decided her life wasn't in enough danger to warrant it. Soldiers serving abroad – who too often are sexually assaulted – had virtually no access to emergency contraception until this month because of arcane Pentagon rules, but also have little or no access to abortion services (let alone insurance coverage of it) even if they were willing and able to report a rape from which they got pregnant.

This is the new world of government oversight that Bart Stupak, Democratic senator Ben Nelson and other anti-abortion Democrats demanded, and to which President Obama and house speaker Nancy Pelosi acquiesced. When women unlucky enough not to have insurance coverage through an employer (though, as women who work for the Republican National Committee and the state of South Carolina discovered, having employer-sponsored coverage doesn't necessary mean one has abortion coverage) purchase health insurance through an exchange, they'll have to pay what one assumes is a nominal extra abortion fee (with a separate cheque!) to their insurance company for the privilege. Even if covering abortions means an insurance company saves money, as pregnancy is rather expensive, people will have to pay a nominal fee just for the sake of paying something. Worse yet, the men and women who opt into plans with abortion coverage will have that fact reflected in their financial records and their literal chequebooks – if you pay $500 to an insurance company and $2 to the same company on the same day, everyone will know what you're doing if they happen to access your records or notice you mailing two separate envelopes.

And if you choose to opt out of coverage, out of embarrassment, for financial reasons or because of your politics, woe betide you if you – or one of your dependents – is the victim or rape or incest, or has a risky pregnancy deemed medically necessary. Didn't want to have to tell someone you were raped? Cough up the money for your abortion. Actuary decides, based on established government precedent, that your life-threatening pregnancy isn't risky enough? Cough up the money for your abortion. Women (and their doctors) will no longer have the luxury of making the decisions that are best for the women involved based on her beliefs and medical history because a small group of people who consider themselves religious (and who often consider themselves in favour of small government) decided that their religious beliefs about life's origins and pregnancy should trump everything else.

Republicans often like to pretend that their ideology, above all, means that the government should be limited in its power to control and direct people's lives. And yet the provisions pushed by anti-abortion, conservative Democrats – which are, ironically, less controlling than the outright ban on abortion that many Republicans prefer – do little more than put into place many complex layers of bureaucracy and paperwork for women who will now be required to purchase healthcare in order to enforce more control over the choices they may have to make. The Republican rallying cry on healthcare last summer was that the government wanted to put bureaucrats between Americans and their doctors. With these abortion provisions, the government did exactly that – and most Republicans think it didn't go far enough.

guardian.co.uk, Monday 22 March 2010 20.40 GMT