Must Universal Access to Health Care Entail Access to Abortion?

In 1948, Britain’s National Health Insurance (NHS) went into operation. It provided free and universal health care to all Britons. Today, Britain’s per person spending on health care is one of the lowest among industrialized nations. Such a single-payer system is the Holy Grail of many American progressives, who are critical of the new Patient Protection and Affordable Care Act because of its reliance on a labyrinth of private health plans that might leave too many people without access to affordable health care.

But for pro-life advocates any national system comes with risks attached. In 1967, the British Parliament legalized abortion, making abortions available throughout the NHS system. If you have a national system with uniform benefits and services, then, if the culture becomes more pro-abortion, the likelihood increases that that system will begin to pay for and provide abortions.

The solution offered by libertarians is a complete withdrawal of government from the health care arena, but this seems unlikely to happen. It would require repeal not only of the new Patient Protection and Affordable Health Care Act but also of Medicaid for the poor and Medicare for the retired. It is also difficult to imagine how offering tax credits to people who set up health savings accounts would be an adequate substitute. The working poor have too little discretionary income to save sufficient cash for a major health crisis; their earnings must put food on the table and keep the car running so they can get to work.

If government withdrawal from health care is unlikely and tax credits are not a feasible alternative, what options remain? For many years pro-life advocates have sought to keep abortion out of federally funded health care programs, and their efforts have often been successful. Prior to 1976, the federal Medicaid program paid for about 300,000 abortions a year. However, after the Hyde Amendment went into effect for FY 1977, the funding levels dropped dramatically. In FY 1977, 182,000 abortions were funded. In FY 1986, the number was 232; in FY 2000, 109; in FY 2004, 159.

The Hyde Amendment must be attached to the various federal health care programs such as Medicaid every year. A more lasting way to keep abortion out of federal health care programs would be for Congress to enact a permanent Hyde Amendment that would apply to all federally funded health care programs.

This article was featured in the April 2012 MCC Messenger, a quarterly insert into the diocesan newspapers.

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