The House of Representatives passed a historic health care reform bill on Nov. 7. By a vote of 220-215 the Democrats ushered in health reform legislation, the likes of which haven't been seen since Medicare passed in 1965.
Like many others in the labor, progressive and left movements, I see the bill, Affordable Health Care for America Act, HR 3962, as not the end of the monumental battle to guarantee health care for all, but a significant step along that road. It curbs the enormous influence the insurance giants have over the country's health care system. And that's a start.
In the first place, the bill would crackdown on the insurance industry by banning lifetime limits and coverage denials based on preexisting conditions. The bill would end a federal antitrust exemption that has for decades protected the industry from federal investigations.
The bill would create a government-run insurance option to compete with private plans on a new insurance exchange for people who don't have employer coverage.
It puts in place mandates for the individual and employers to buy and offer, respectively, health insurance. At the same time the bill would offer subsidies to help households earning up to $88,000 in annual income for a family of four purchase coverage.
The bill would expand Medicaid and provide free health care to all Americans with incomes below 150 percent of the federal poverty level.
To pay for the trillion dollar cost over 10 years the bill places a surcharge on taxpayers who earn more than $500,000 a year, or $1 million a year for families. And would cut waste in both Medicaid and Medicare, mainly by phasing out the Bush administration's privatization debacle of Medicare, called Medicare Advantage. This program was a giveaway to insurance corporations.
The bill also would end premium disparity based on health status and sex. Turns out, women are charged more for the same coverage than men. When it comes to pre-existing conditions - they cannot list pregnancy, c-section, rape and domestic violence.
All of which are tremendous victories. All of which have been hailed by Democratic lawmakers, along with the labor movement, civil rights organizations and health care reform advocates.
But, and there is a but.
There is something really disturbing that came alongside those victories.
A bi-partisan amendment, which passed, that would severely restrict women's reproductive health, beyond anything so far to date. Called the Stupak amendment, named after the Michigan Democrat who introduced it, the restrictions go beyond the 33-year-old Hyde Amendment which bans any federal dollars going to pay for pregnancy terminations. It would bar women who get any federal subsidy for health insurance from getting access to abortion even if it's paid with her own money.
To add to that something disturbing happened during the health bill discussion. When members of the House Women's Caucus attempted to take the floor to highlight why this bill overall was good for women, Republicans interrupted and blocked them.
It got so bad, Rep. Mary Jo Kilroy of Ohio accused the Republicans of censoring her remarks and blocking her right to make them.
The Republicans who shouted down the caucus members were men. It was like they were setting the stage for the Stupak amendment. Don't let women have a voice about health care, their actions seemed to say.
The Stupak amendment was passed by a 240-194 vote with 64 Democrats voting with all 176 Republicans. (Only one Republican voted for the health care bill in the end.)
Out of the 64 Democrats that voted for the amendment, only two were women. Out of the entire 176 Republican caucus, only 18 are women.
There is a major gender disconnect here. And women - 50 percent of the population, 40 percent of the breadwinners in the country - are underrepresented in the Congress and it was really apparent what such under-representation means in this vote.
But let's take it another step.
Pro-choice advocates in and out of Congress had agreed early on that this health care reform bill was about health care, and the fight on reproductive rights would be in another arena. Federal prohibitions like the Hyde Amendment would stay in place.
In fact, on Friday, Nov. 6, every major women's organization sent out last minute e-mails urging their members and supporters to call Congress to support the health reform bill, even with shortcomings. It was a very mature and politically astute approach.
For example the National Organization For Women urged its supporters to get their congressional representatives on board despite severe abortion restrictions. In fact, NOW said, a compromise measure called the Capps Amendment was part of the bill that came out of the House Energy and Commerce Committee. It was seen "as necessary to get the larger bill out."
According to NOW's analysis of the Capps Amendment, "abortion would be prohibited from being included in a list of Minimum Benefits Coverage, a listing that will be determined by an appointed committee of experts and consumers at some future date."
Further, the Capps Amendment was to ensure that at least one of the private insurance options in every premium rating level must include abortion coverage beyond rape, life or incest, and at least one of the private plans must exclude abortion in the newly established insurance exchanges and that in each region of the country, there is at least one plan in the Health Exchange that offers abortion services, but also one plan in the Health Exchange that does not offer abortion coverage, according to NOW's analysis.
State laws regarding abortion coverage, funding and referrals would have been untouched.
"Last minute restrictions adopted in the rule required to bring the House health care reform bill to the floor will explicitly prohibit federal funding for abortion services, guarantee patient access to insurance plans that do not cover abortions and require federal health officials to hire private contractors to handle payments to abortion providers," NOW said. "These restrictions represent a compromise to allow the full bill to go forward and were reached after days of negotiation with conservative abortion rights opponents in both parties."
NOW went on to report that members from the Congressional Pro-Choice Caucus were "not pleased with the language but would not oppose it" in order to get support from a few additional Democratic anti-choice House members and to reach the "magic number of 218 votes."
So what happened between Friday morning and Saturday?
Some reports point to a last minute show down with anti-choice advocates insisting on the Stupak amendment going to the floor for a vote. With backs against the wall, Pelosi and the House leadership, reports say, had to let it go to the floor. The Hill reported a shouting match between Reps. George Miller and Rosa De Lauro, both Pelosi confidants, over the decision late Friday night.
Women are a core part of the coalition that helped elect Barack Obama and put a dagger through the heart of the ultra-right's control of politics in this country. Women are a core part of the coalition that will bring to life positive change in this country, including and especially curbing the power of mega-corporations and banks.
It's not easy to keep a diverse and multi-class coalition together on key interests like health care reform, climate change, education or economic recovery. But it's necessary. The Stupak amendment threatens that coalition.
There was already language agreed to that would have prevented any tax dollars going to pay for abortion procedures. It wasn't an easy thing to do but pro-choice advocates agreed to it for the greater good. Then in the eleventh hour, a monkey wrench. Somebody threw it. Seems to me, it played right into the interests of the big insurance companies, desperate to derail major health reform and muck up the political landscape as much as possible as the bill goes onto the Senate. On top of the main political hurdles to overcome in the Senate to get to health reform - the public option and how to pay for it, taxing the rich vs. taxing health plans - abortion, one of the most controversial issues of our time, gets added to the mix.
President Obama said the Stupak amendment must not stand. He is a pro-choice president. Women's groups have demanded the Stupak language be stripped in the final bill. The insurance companies and ultra-right attempt to stop health care reform from going through is not going to happen. Women, and the whole coalition, won't let it.
Why did Stupak and the 63 other Democrats join with all the Republicans in this "bridge too far?" There is much political parsing over that. Whatever the reasons, it only plays into the hands of the insurance giants and the ultra-right. And that won't win health reform.