As the voting finally begins in the nominating contest between Hillary Clinton and Bernie Sanders, the issue of health care is being presented as an area of disagreement between the two candidates. I don't see it that way.
Bernie Sanders favors a single-payer system, a goal that most progressives share. As Paul Krugman put it,
"If we could start from scratch, many, perhaps most, health economists would recommend single-payer, a Medicare-type program covering everyone."
But we can't start from scratch, and that's Hillary Clinton's basic point. A push in Congress to shift to single-payer assumes that Obamacare needs to be replaced, which would, as Hillary Clinton says, put health care reform back where we started and start the clock all over again. It would take a massive realignment in Congress, with huge Democratic majorities in the House and the Senate, to pass single-payer. I'd love to see that happen, but I can't count on it.
What I can depend on, and what makes me so enthusiastic about Hillary Clinton, is her commitment and her political courage when it comes to health care. She is determined to improve the Affordable Care Act by bringing pharmaceutical costs under control, and ensuring every health plan has affordable premiums and copays. And we should all be working together to create better public option pathways that will lead to a single-payer system.
What's more, Secretary Clinton understands that reproductive health care is part and parcel of women's health, not some exotic outlier that gets forgotten or downplayed when health policy is being hammered out. Her leadership on reproductive health care goes way beyond the "I support a woman's right to choose" declaration we've come to expect from Democratic candidates. Hillary Clinton has been a leading voice in not only defending access to abortion, but in demanding public funding for abortion care like any other health care.
The primary obstacle to this objective is the 1976 Hyde Amendment that blocks Medicaid from funding abortion care. This means that for low-income women, disproportionately women of color, who rely on Medicaid, it's as if Roe v. Wade never happened.
The law's author, Illinois Rep. Henry Hyde, justified it as politically expedient, saying: "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."
The Guttmacher Institute's Heather Boonstra, who conducted an analysis of insurance coverage of abortion, called the Hyde Amendment "a pernicious law that explicitly targets the poorest and most vulnerable women." A comprehensive article at ThinkProgress said,
But it's not just women on Medicaid who are impacted by efforts to restrict public funding for abortion. In her analysis, Boonstra notes that the Hyde Amendment spawned a series of other policies that restrict abortion coverage for other populations, too. Federal employees, military personnel, federal prison inmates, poor residents of the District of Columbia, and Native American women are all subject to coverage restrictions -- which haven't always offered any exceptions in the cases of rape or incest.
When anti-choice activists proclaim "no taxpayer funding for abortion," as they do when they attack Planned Parenthood, defenders of abortion care often try to shut down the argument by saying that "settled law" like the Hyde Amendment already prohibits this and that Planned Parenthood doesn't do "taxpayer funded abortions." It takes a good deal of courage to go beyond this reasoning and spend political capital on a direct challenge to the Hyde Amendment.
Which is exactly what Hillary Clinton is doing, and why she deserves our respect and support.
As Rebecca Traister wrote recently in New York Magazine,
In the days after being formally endorsed by both Planned Parenthood and NARAL last week, Clinton brought up Hyde at a rally, describing it as a law that "[makes] it harder for low-income women to exercise their full rights." A few days later, when asked by Alicia Menendez at the Iowa Brown & Black Presidential Forum whether she would support a congressional effort to repeal Hyde, she answered "yes" unequivocally and described reproductive rights as "a fundamental human right."
After that event, Clinton answered two further questions in an interview with Fusion's Anna Holmes. Clinton told Holmes that she believes the Hyde Amendment "deprives low-income women from being able to access the full range of reproductive health services." She acknowledged that repeal of the law could be difficult in a conservative-controlled Congress, but that as president she would work to "expand the services Planned Parenthood provides," since she is "not only against defunding Planned Parenthood, but ... would like to see Planned Parenthood get even more money because it is oftentimes both the first and last resort." Need for the affordable reproductive services it provides, Clinton went on, "is only going to grow because of the pressure the courts are putting on [providers], so we will have to do what we can to provide access to quality affordable health care that includes the full range of reproductive health, including abortion."
Remarkably, Clinton wasn't done. She finished off by noting that in places where providers are being shut down, "the people who are going to suffer the most are low-income women of color," and that she's very worried about the upcoming Supreme Court decision in Whole Woman's Health v. Cole, a Texas case that will determine states' abilities to enact further debilitating restrictions on reproductive-health-care access. Clinton then proclaimed that she would treat Planned Parenthood as one of her "partners at the table, trying to figure this [crisis of access and inequality] out." Later, for emphasis, she tweeted, "I would like to see Planned Parenthood even get more funding" and "A right without the opportunity to exercise it isn't a right. Low-income women deserve health care. The Hyde Amendment should be overturned."
Hillary Clinton understands the link between access to abortion care and the economic security of millions of women (and their families), who are low-income. Hillary Clinton will make access to abortion care a priority -- something that is desperately needed by the growing number of women for whom this basic health service has been completely blocked.
I'll leave it to the press and the pundits to try and find daylight between Bernie Sanders' and Hillary Clinton's commitment to providing health care to every American. For me, it's worth noting--and applauding--Hillary Clinton's particular focus on demanding public funding for abortion care like any other health care.
That takes courage.