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Health Care: Keep Your Eyes on the Prize

We've recently seen the abortion rhetoric really heat up to ridiculous proportions. Those with opposing views are being stereotyped and demonized. And facts are taking a back seat to sound bytes.
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The following is a memo Jim Wallis has provided to leaders throughout the nation concerning the ongoing issue of abortion within the health care reform debate and the need to find common ground instead of allowing a resurrection of the "culture wars" that stymie honest debate and the change needed and wanted by the American people.

The culture wars have begun again -- with a vengeance (not an exaggerated word if you've heard the hysterical and ugly rhetoric last week). Yep, it's about abortion again (sadly, in relation to the health care reform bill moving through Congress). This is precisely what a number of us were afraid could happen, and worked for months to try and avoid. But it happened anyway, and the result we were so afraid of is now a real threat -- that the abortion debate could derail and sabotage efforts to address the critical need for health care reform.

Those of us who have worked hard to find some common ground in this debate, to help forge some compromise that might let health care reform proceed for the tens of millions of low-income families who desperately need it, are still trying to find some middle ground that both sides could live with (even if not happily); but we are increasingly despairing of that happening. Because as in most wars, it's now becoming an all win-or-lose situation, and even those who sought to broker solutions are now under attack. (Have you heard what they say about bridges getting walked on?)

They say that in war, truth is the first casualty. Well, that's not just true in military conflicts, but in culture wars, too. So let's look at what happened in the process leading up to the bill voted on in the House of Representatives, what the current amendment on abortion coverage really says and means, and what the implications are for "women's health." Well, people are just making stuff up, misrepresenting in such outrageous ways that you could just call it lying. So let's try to set the record straight, figure out what really happened, and talk honestly and accurately about what the current bill would do and won't do. Then, let's discuss what common ground might be possible, or what both sides should do if it isn't possible. Let me apologize up front -- this is going to be a long article.

As everyone knows, the legislative process is always a messy one that seldom leaves anyone fully satisfied with the outcome; the unusual Saturday night vote on health care reform in the House of Representatives was no exception. But let's put what happened in perspective. Although far from perfect, the bill that was passed by the House was a huge step toward one of the greatest legislative accomplishments and victories for social justice in a generation: the passage of a substantial plan for health care expansion and reform.

The bill that came out of the House achieves many of the goals of the faith community by providing health care for 36 million more people, or almost 96% of Americans. While we still need to include everybody -- especially immigrants for whom this bill is still very inadequate -- the House vote was a major legislative achievement. Somehow the culture warriors are forgetting that. This bill is still flawed (it expands health care coverage, but does not truly tackle what will ultimately be necessary for core health care reform); but the issue of health care reform is still alive because a bill got 220 votes in the House (only two more than were necessary to pass). The House vote was a real step forward and an essential beginning to the final passage of health care reform. Now things go to the even tougher battle in the Senate.

But ironically, Saturday's vote simultaneously moved us closer both to final passage and to the possibility that abortion could still derail the process. In the last week, we've seen the abortion rhetoric really heat up to ridiculous proportions. Those with opposing views are being stereotyped and demonized. And facts are taking a back seat to sound bites.

This is an alarming turn for the worse from several months ago, when both pro-life and pro-choice advocates recognized that health insurance reform would be difficult enough to achieve without injecting the old culture wars into the debate. Because health care reform was so important to key people on both sides of the abortion debate, they agreed to the principle that existing legal precedents should be applied, and that neither side would use the health care debate to advance its abortion agenda. While it was clear that some political groups were anxious to use this divisive issue to try to kill health care reform, a number of both pro-life and pro-choice leaders were very committed to it and decided to seek common ground.

I believe there were some sincere early efforts by leaders on both sides to abide by what became known as "abortion neutrality." But somewhere along the line, the process broke down. Instead of building on the initial common ground of neutrality and bringing both sides together to hammer out compromises, many pro-life Democrats felt excluded from the conversation about how abortion would be addressed in the bill. Ultimately, they felt they were presented with a final "compromise" on abortion drafted by a predominantly pro-choice committee. Although the Capps Amendment was meant as a good faith effort to find common ground, it was drafted and finalized without enough substantive input from the pro-life community, and it failed to address many pro-life concerns. (In several situations, it even made things worse instead of better.)

Unfortunately, from that point forward, mistrust grew, and the rhetoric and battle lines became more pronounced. Capps might have been a fruitful starting point for dialogue and a first step toward a workable compromise. Instead, those shepherding the bill made public statements that Capps had "taken abortion off the table" and was the best the pro-life community could hope for -- take it or leave it. In response, some in the pro-life community cried foul and claimed this process demonstrated why they could never trust the pro-choice Democrats. Both sides accused the other of "moving the goal posts," "violating neutrality," and threatening to sabotage needed health care reform if they didn't get exactly what they wanted on abortion.

Nevertheless, a number of pro-life Democrats and leaders in the faith community continued to push for a return to the negotiating table and a real effort to address the outstanding issues. Though Sojourners is now under attack from some angry pro-choice zealots, we worked very hard to find a solution here and were one of the very few groups really talking to both sides. But as the rhetoric heated up and communication lines broke down, even simple fixes became nearly impossible. Because the pro-life side wasn't really invited into a real discussion about possible solutions, the "compromise" missed some important things, misread the real situation, and failed to pass the tests of maintaining current law, abortion neutrality, and the status quo.

Both sides had seemed to agree with the principle that no one should be required to fund abortion if their conscience compels them not to, and that no abortion should be paid for with federal funds. An underlying national compromise on abortion seemed to be emerging. The pro-life side reluctantly accepts that abortion is legal in America, but believes that the consciences of those who deeply oppose it must be respected; such people should not have to participate in abortion as health care providers or pay for it with their tax dollars. The pro-choice side acknowledges the conscience argument, but wants to ensure access to legal abortion and believes that such access should not be restricted by those who oppose the law on the grounds of conscience. This tacit agreement also follows public opinion in that a majority of the country doesn't want to make all abortions illegal, but doesn't want public funds to pay for it. That's what democracy says about this issue now, even though neither side of the abortion debate is happy about it. But in this case, they seemed to be accepting the compromise for the purpose of health care reform.

But as we approached the details of exactly how to achieve abortion neutrality, the common ground caved in, and the sides went to their respective corners as we ran into more and more disagreement. For example, both sides said they agreed that the legal precedent of the Hyde Amendment, which prevents federal funding for abortion with the exceptions of rape, incest, and the life of the mother, should be applied to the final health care bill. (Currently, the Hyde Amendment precludes federal funds from covering elective abortion in all government funded insurance programs like Medicaid and the Federal Health Insurance Benefit Plans.) But ultimately, there was real disagreement about what the application of Hyde should look like in the new health care reform bill.

One side said Hyde can be applied and accomplished by the strict segregation of dollars in health care options, but the other side required a separation of plans. And the weeds of this policy debate got more and more complicated the more you got into them. For a few moments at the end, it seemed as though some kind of compromise might be possible; it would involve some reasonable agreement between ensuring the unrestricted legal access that the pro-choice advocates want and the restrictions on funding that the pro-life advocates want.

There might have been the possibility of a stricter enforcement of Hyde in the "public option" (which still may or may not be part of the final bill), since much more established legal precedent exists regarding the prohibition on the federal funding of abortion. Application of Hyde would be stickier in the new "exchange," which would combine private and public elements, and where clear precedent simply does not yet exist. Most pro-life groups have strong convictions when it comes to how government programs and now the public option treat the prohibition of federal funding of abortion. But in my conversations with pro-life leaders, there was more openness to negotiate on the best framework and options for the exchange.

How to protect the consciences of both sides here -- pro-life tax payers and the women who want access to legal abortion -- is a most difficult issue to resolve. But when such compromises were suggested, they were ultimately rejected, and the outcome was more stark than it might have been.

Those shepherding this bill never invested the political capital required to resolve differences and bring the sides together. Moderates were squeezed out of the process and accused of being traitors or stooges. Worse yet, moderate pro-life forces that were really committed to health care reform were accused of not being so if they didn't go along with the deal that the pro-choice forces had worked out. When compromises were suggested, they were rejected because both sides thought they had the votes. I heard that directly from both sides. But in the end, only one side did: the pro-life side.

The problem with not compromising is that when you lose, you can end up with less than you might have gotten otherwise. The now-famous Stupak amendment is clearly closer to the pro-life community's understanding of what "neutrality" means than the pro-choice community's. But it is clearly not the caricature it is now being made into by the losing side of the vote, some of whom are now referring to it as "the coat hanger amendment" suggesting that it is designed to push women into back alleys again for illegal abortions by denying them access to legal abortion; it certainly is not.

What it does do is exclude health care plans in the public option from covering elective abortions; it also disallows any public subsidies from being used for plans in the new exchange which offer elective abortions. So while it represents a real departure from choice community's agenda, it is not as draconian as some are now claiming. In fact, Stupak actually tracks very closely to the original campaign promises that built the momentum for reform in the first place: that every American should have the same sort of plan that members of Congress have. The health insurance plan that is offered to every member of Congress and over eight million federal employees excludes abortion because of the Hyde amendment, and this same standard applies to federal funding for Medicaid and SCHIP. In the new "exchange," people can still purchase health care plans that offer abortion coverage (despite misleading claims by some to the contrary), but they must use their own money to do so, and can't use federal subsidies to purchase those plans. The Stupak amendment made Hyde the standard in the health care bill that was voted out of the House, and it was a strict interpretation of Hyde.

Now we face the difficult question of where we go from here. It is clear that health care reform is not possible without the support of pro-life Democrats. But at the same time, several pro-choice Democrats are now saying they will not vote for the final bill unless Stupak is removed. The accusations are flying, and people on both sides are suggesting that if they don't get everything they want, they might take their ball and go home.

I think there has been enough of the misrepresentations, name calling, and digging in of heals. Leaders who refuse to talk to their opponents are not "principled"; they maybe also be unwise or unable to actually get things done. Such leaders -- those who are unwilling to consider possible agreements and common ground in order to ensure the passage of a bill that would help so many American families -- need to take a deep breath and ask their consciences how much social justice they are willing to give up for the sake of the strictest applications of their principles.

I still think we need more expert legal opinions of what would finally constitute a fair and diligent application of the Hyde amendment to health care (since both sides have agreed to that in principle), but by somebody who doesn't have a dog in this fight. Can it only be done by segregating plans? Or are there ways to honestly segregate dollars or perhaps options, especially in the exchange?

As hard as it is, the best hope for going forward is to bring the two sides back to the table and start a conversation that should have begun in earnest months ago. My own view continues to be that abortion should not be allowed to block the passage of critically needed health care reform. The principal issue for me in the health care debate all along, and the primary mission of Sojourners in this battle, has always been the fundamental moral issue of affordability and accessibility of quality health care for the middle and low-income individuals and families who desperately need it. But it is clear now that we will not achieve those goals if we cannot figure out a way to address the concerns around abortion in this bill.

The religious community has different views on abortion. But some of the most hysterical comments from the Left this week have suggested the problem is that progressive religious groups have been listened to by the Democratic Party; some members of the Left long for the good old days when their party was avowedly secular and properly hostile to religion and all this talk about those annoying moral values voters. Well, good luck in ever winning elections in the U.S. or, more importantly, ever seeing the kind of broad social movements that make real change possible (i.e., movements for social justice which have always been based on moral values with central involvement from the faith community).

I have fought against religious fundamentalists most of my life, but it's quite sad to see this new assault of secular fundamentalism against religion of all kinds -- even against progressive religion.

Many progressive pro-life faith leaders try to uphold a "consistent ethic of life" that protects and promotes the preciousness and sacredness of life in public life and policy. Most of us don't restrict our concerns to abortion; we also apply it to the pressing issues of global health, poverty reduction, human rights advocacy, environmental protection, and even war and peace. Nor do we prefer the solution of criminalizing a tragic choice; rather, we want to work to reduce unwanted pregnancies and support low-income women to help reduce abortion in the U.S.

Most of us agree with the principle that in health care reform, federal funds should not be used to pay for abortion, and we were pleased when President Barack Obama committed himself to that principle in his address to the American people in September. We want to see the clearest language to restrict federal funding in this bill. But we believe that one of the best ways to reduce abortion is to make quality health care available for low-income mothers who need support for their choice to take their pregnancy to term, along with much better efforts at preventing unwanted pregnancies. If this bill does pass, the number of abortions in this country could be drastically decreased when we make quality health care available for those low-income mothers.

For us, the passage of real health care reform is the most important abortion reduction measure in this political debate, and passing health care reform could do more to actually reduce abortion than the things we are currently arguing about. That's our position, and that's why Sojourners is committed to working to make health care reform a reality.

The solution to the abortion divide will not be found by simply drawing lines in the sand or demonizing opponents. Nor will it be found by dismissing the very real and legitimate concerns on both sides. Instead, our only hope is to find the grace and forgiveness to see our opponents as they really are -- not close-minded, extreme monsters, but our brothers and sisters who are fighting this battle. They're not fighting to be against us, but because they care about their own principles.

"Neutrality" on abortion is possible, and it is mandatory now in order to pass this bill. The stakes are too high for us to fail, and too many people are counting on their leaders to figure this out -- to not walk away from the table or refuse to do the hard work that will be required. We cannot allow our differences over abortion to derail health care reform because, as important as the issue of abortion is, it cannot be allowed to be the issue that prevents millions of families from finally getting insured.

Whether every American woman has a health plan that pays for abortion or not, tens of millions of currently uninsured women in this country will be much better off with health insurance than without. Therefore a focus on "women's health" cannot just be restricted to access to abortion. Of the 36 million people who will get health care reform in this bill, about half are women -- that's a great victory for women's health, as women are too often among the poorest and least-insured people in the U.S. Of that half -- or let's say of the 18 million women who will get health insurance for the first time -- a much smaller number are of child bearing age. And a much smaller number than that will have an unintended pregnancy in which they want to seek abortion as the solution. More than 85% of those women, if present numbers hold up, will pay for the abortion with private funds, and only 13% will use health care plans to pay for it. That gets us down to a much smaller number of women than the "millions" who some people are now claiming will be affected by this new bill's amendment on abortion. I would humbly suggest that both sides in this debate need to remember the very small number of women who in real life will be involved in this dilemma, compared to the impact on a very large number of women who will be denied their "health" if the reform bill does not pass. Principles are obviously important to people on both sides of this debate, but we all need to be very careful when our principles relate more to symbols than to substance.

If we really wanted to add more substance to women's health in this bill, we could start by requiring mandatory pre-natal and post-natal care for all plans, as Congressman Tom Perriello has been pleading. We could also take the two bills in Congress that seek to reduce abortion by supporting low-income women in all kinds of practical ways -- one with support for contraception and one without. This would be a good time to just pass both bills whose measures are not mutually exclusive.

So my prayer (and we had better all be praying about this one) is that as this debate moves to the Senate, each side will take a long pause and remember what is at stake. Many of us in the faith community will continue to work with all sides to both achieve abortion neutrality and ensure that the promise of health care reform is not denied to the millions of Americans who are counting on us to find a way.

I continue to hope that we can still find some principled compromise, to secure and hold some common ground, if at all possible, for the sake of passing health care reform. But if no agreement can be reached, there will likely be a vote again on this in the Senate bill, and one side will win and one side will lose. Without any agreement, the issues will be ultimately be resolved on the House and Senate floors. Or they'll be resolved in the subsequent conference committees -- where rules, amendments, and bills will be voted up or down. In the end, these votes should be the results of the democratic process.

If we are to pass health care in the Senate, and then again in both chambers, people of faith and good will on both sides will most likely have to agree to compromises, and do the best they can to uphold their principles in health care reform; or they will just cast their votes. But I believe it is a moral imperative that no legislators turn their backs on the tens of millions of Americans who are counting on them to pass health care reform. Regardless of where things fall out in the Senate, or during a final vote, no one should walk away simply because of abortion. Support of accessible, affordable health care is also an issue of life. And providing health care for low income people who need it will indeed provide critically needed health care for women, who are disproportionately poor, and disproportionately uninsured.

I have some hope that our political leaders on both sides will come back to the table, regardless of where the Senate bill or conference committee report lands on this issue. Indeed, I am asking them to do that. Health care is too important to too many, and we have all been working for too long for any of us to walk away from this issue.

So whatever the outcome, by an agreed compromise or by open and fair floor or committee votes, I hope and pray that neither side in the country -- pro-life or pro-choice -- walks away from critically needed health care reform. Either make an agreement or live with the outcome of the vote. But don't walk away! Health care reform is fundamentally an issue of social and economic justice -- one of the most critical moral issues of our time, and itself an issue of "life." It's time to do what we have sung in social movements for decades now: "Keep Your Eyes on the Prize." And hold on. Hold on.

Jim Wallis is the author of The Great Awakening, Editor-in-Chief of Sojourners and blogs at

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