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ON THE CAMPAIGN TRAIL, Barack Obama did not shy away from the issue of abortion, pledging, “ON THIS FUNDAMENTAL ISSUE, I WILL NOT YIELD.” In the context of health reform, though, the president and his staff have been reluctant to directly address reproductive rights.

AT STAKE is not only whether a potential public plan covers contraception or abortion but also whether ex-isting private health insurers, 87 percent of which cur-rently offer some abortion access, will be able to con-tinue to do so once they are operating within the new health-insurance exchanges.

ANOTHER RISK is that even if abortion services are covered, health clinics that provide abortion -- such as the Planned Parenthood network -- could be barred from participating in the exchange, meaning they would not be able to offer insured services to patients in either public or private plans.

FOR MILLIONS OF AMERICAN WOMEN, insurance-subsidized abortion is already off limits.

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facts:For millions of American women, insurance-subsidized abortion is already off limits.

Women are more vulnerable to high health care costs because women’s reproductive health requires more regular contact with health care providers, including visits for yearly Pap tests, mammograms, and obstetric care. WOWomen of childbearing age spend 68 percent more in out-of-pocket health care costs than men, in part because of reproductive health-related supplies and services.

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In September 1993, as Hillary Clinton lobbied Congress to pass her health-reform bill, she plainly addressed the looming controversy over reproductive care. “It will include pregnancy-related services, and that will include abortion, as insurance policies currently do,” she told the Senate Finance Committee. Conservatives were incensed. But as the history books record, it was industry pressure and legislative malaise that killed Hillarycare, not debate over women’s rights.

On the campaign trail, Barack Obama did not shy away from the issue of abortion, pledging, “On this fundamental issue, I will not yield.” In the context of health reform, though, the president and his staff have been reluctant to directly address reproductive rights. In a March inter-view with the Christian Broadcasting Network’s David Brody, the White House’s chief domestic policy adviser, Melody Barnes -- who once sat on the board of Planned Parenthood -- claimed she had never spoken to the president about whether abortion services should be covered under a universal health-care system. “We haven’t proposed a specific benefits package or a particular health-care proposal, so we’re going to be engag-ing with Congress to have this conversation,” she said. When Office of Management and Budget Director Peter Orszag was asked by Fox News in July whether the public insurance plan should cover abortion, he was vague. “I’m not prepared to rule it out,” he said. The president finally addressed the issue himself in a July 21 interview with Katie Couric, in which he bucked reproductive rights groups by saying he would con-sider deferring to the “tradition” of “not financing abortions as part of government-funded health care.”

Perhaps in response to the failure of the Clintons’ highly detailed plan, Obama’s strategy has been to leave the nuts and bolts of health reform up to the legislative branch, saying only that the resulting bill must fulfill three goals: lower costs, provide Americans with more health choices, and assure quality. That lack of detail has shoved Congress deep into the weeds. Predictably, the president’s vagueness hasn’t prevented anti-choicers from seizing upon the possible inclusion of reproductive-health services as a vehicle to activate their base against reform. “A vote for this legislation, as drafted, is a vote for tax-subsidized abortion on demand,” wrote Douglas Johnson, the National Right to Life Committee legisla-tive director, in a letter to Congress. That message penetrated. At a July 14 press conference, Rep. Joe Pitts, a Republican from Pennsylvania, claimed health reform undermined Americans’ “right to life. Let’s make it explicit that no American should be forced to finance abortions.” As

the health-care debate reached a fever pitch in the weeks before Con-gress’ summer recess, Fox News featured daily segments on the threat of “subsidized abortion.”

Meanwhile, Obama declared in his July 18 radio address that he would not sign any reform bill that did not include a public health-insurance program. A public plan is central to progressives’ goals of lowering costs by giving private insurers real, high-quality competition. A government-funded insurance option might, eventually, serve as the shell for a sin-gle-payer health-care system similar to those of Western Europe. But if Congress acquiesces to abortion opponents and passes a public plan that does not provide reproductive-health services comparable to what Americans can purchase in the private market or obtain through their employer, it will be a weaker plan with a smaller constituency. After all, the typical woman spends five years of her life pregnant, or trying to become so, but a full 30 years avoiding pregnancy. Without good repro-ductive-health coverage and strong buy-in from women -- who use more health care than men -- it is difficult to see how a public plan would gain strength over time.

Contrary to conservative hand-wringing, reproductive rights have been under constant assault in the health-reform debate. At stake is not only whether a potential public plan covers contraception or abortion but also whether existing private health insurers, 87 percent of which cur-rently offer some abortion access, will be able to continue to do so once they are operating within the new health-insurance exchanges. The ex-changes will house both public and private plans after reform and will be regulated by the federal government.

This increased government intervention in the health sector both excites and terrifies advocates for better reproductive care. The potential upside is that through a public plan, an expansion of Medicaid, and more com-petition among private insurers, many more women will be able to afford good reproductive health care. But the potential downside is stark: A politicization of which reproductive-health services insurers can cover, meaning that under anti-choice administrations, abortion and even con-traceptive limitations or bans could become the norm.

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