Health Care Reform, At Whose Expense?

Head shot of AimeeGuest post by Aimée Thorne-Thomsen, Pro-Choice Public Education Project (PEP)

Despite the headlines and excitement over the signing of the health care bill, today is not a great day for many of us. After months, and let’s be honest, years of struggle to reform America’s decayed health care system, we got…what, exactly? Yes, young people can now stay on their parents’ insurance until they are 26, assuming that their parents have insurance. The legislation expands Medicaid to cover family planning and other preventative reproductive health care. Insurance companies will no longer be able to charge women more than men or deny coverage based on pre-existing conditions. So, yes, women and our families gain a lot from the passage of this bill but at what cost, and at whose expense? This law makes the most vulnerable among us – young women, women of color, immigrant women, low-income women, and transgender women – more vulnerable. And I don’t consider that a victory.

I have already heard it argued that this bill was the best progressives could get. I absolutely reject that. The President was elected along with majorities in both the House and the Senate to pass health care reform that removed barriers and improved access to health care, for all of us, not just the most politically palatable. Many of us who believed in the ideals of hope and change thought that we could achieve universal health care, if not in policy, then certainly in practice. That didn’t happen. Poor people, immigrants, and women, among others, were all used as bargaining tools from the very beginning.

As often is the case, women’s bodies and health, was the ultimate battleground. The Stupak Amendment and then the Nelson Amendment in the Senate banned the use of public funds for abortion. Both were unnecessary and redundant because the Hyde Amendment, which has been renewed every year since it was first introduced in 1977, remains in place. But that wasn’t enough. Stupak and Nelson went further by also barring women who would use the exchanges from getting insurance that would cover abortion. When that still did not satisfy Stupak and his anti-choice cronies, the President agreed to sign an executive order barring public funding of abortion in return for their support for the overall bill. Women’s health was traded away for a handful of votes.

Some people contend that these funding restrictions are not new, but
rather they reinforce the status quo. That thinking lends legitimacy to
the idea that the long-standing bans on federal funding for abortion
are just. The status quo is immoral and it is wrong.
Hiding behind that argument as the rationale for including it in health
care reform and then expanding it, is not only craven, it is also
unjust. These restrictions are harmful to women and their families.
They will limit access to abortion for low-income women, who tend to be
disproportionately women of color, immigrants and young, as well as
women who may purchase insurance through the exchange. These funding
bans will further codify discrimination against poor women for being
poor. Finally, they will continue to stigmatize abortion and isolate it
from women’s overall health care, because let’s be clear: abortion is
basic health care.

Other colleagues and allies in the reproductive health and
progressive movements contend that the executive order will have very
little impact; that it is largely symbolic. Well, symbols matter. And
what this symbolizes to me is that as a woman, my health needs are less
important, my ability to make my own health care decisions is suspect,
and my vote for who I believed was a pro-choice President certainly
doesn’t amount to much. Our political leaders in the White House,
Senate and House of Representatives sold out women not just in the
legislation, but in the process itself. There remain many questions
about the implementation, oversight and real-life effects of this
health care bill. However, one thing is clear. Until women’s lives and women’s health are not used as trade goods for votes, we will remain vulnerable and invisible.

Aimée Thorne-Thomsen is a long-time social justice activist with
extensive experience in leadership and communications. In her role as
Executive Director of the Pro-Choice Public Education Project (PEP),
she focuses on creating spaces for and elevating the voices of young
women in the reproductive justice movement.

Join the Conversation

  • SamLL

    I am sympathetic to your viewpoint, but you complain about the health care reform bill and then state, in bold, “The status quo is immoral and it is wrong.” In what I saw of our political process, the alternative to the current health care reform bill was the status quo, exactly.
    You and I can agree there were a lot of policies that would be better than what we achieved, but in a democratic society like ours, where the populace is polarized between very different ideologies, the important question often isn’t ‘what is the best policy’ but ‘what is the best policy that we can implement’.
    The passed health care reform bill a is major step in the right direction, and once the United States is used to it, it will become the new baseline and we can continue to improve from there. (Unless, like the Republican party, you really believe that the old status quo is what was best for the country and is a better baseline from which to operate?)
    Personally I don’t think the symbolism of an executive order reminding us that the Hyde Amendment still exists (for now) is more important than the probably tens of thousands of lives each year that will be saved by providing health insurance to those who need it. (See, for example, and
    Obviously none of the above means that we should stop agitating for further action that would improve this new baseline. I am 100% with you that we should now pressure Congress not to renew the Hyde Amendment.

  • supremepizza

    “And what this symbolizes to me is that as a woman, my health needs are less important, my ability to make my own health care decisions is suspect, and my vote for who I believed was a pro-choice President certainly doesn’t amount to much.”
    Well, BO certainly never ran against the Hyde Amendment, and neither did Hillary. You can be pro-choice without thinking that the public should pay for abortion. I think it would be unjust to force someone, like my mother, who thinks that abortion is murder to pay for it.
    And while I’m certainly pro-choice I also recognize that there’s more to women’s health than reproductive health. There are any number of health problems affect women ranging from migraines to osteoporosis…We barely got this bill as it is. I’m glad we got it. It may not be perfect but Rome wasn’t built in a day.

  • cattrack2

    “Poor people, immigrants, and women, among others, were all used as bargaining tools from the very beginning.”
    There’s no small number of middle class people who also feel that they were used as bargaining chips. Its far from clear that this bill will either improve access to health care for the middle class, or reduce their cost of health care. On Friday AT&T took a $1B charge as a result of the bill. That $1B will come from the health care of its employees. And since the funding scheme for health care reform makes it financially unsustainable as well, there’s likely to be a tax squeeze on the middle class in future years too.

  • aka spike the cat

    I might not mind being squeezed if there is something to show for it. Let’s just hope the US doesn’t invade anybody else for the time being.

  • supremepizza

    “The passed health care reform bill is a major step in the right direction, and once the United States is used to it, it will become the new baseline and we can continue to improve from there.”
    You hit the nail on the head. Ironically, this bill is actually to the right of the bill proposed by Richard Nixon but declined by Teddy Kennedy and the Dems because “it wasn’t good enough.” Shortly before he died Kennedy remarked that in retrospect he should’ve taken that deal in a heartbeat.
    To your point, that bill would’ve created a baseline & we’ve lost 40 years of improving that baseline because at the time we weren’t pragmatic. I’m glad BO learned from the past.

  • ClinicEscort

    BO certainly never ran against the Hyde Amendment
    Except he kind of did.
    I’m real sorry about your mom’s feelings, but surely they aren’t any more important than MY feelings on the many, many immoralities my tax dollars fund against my will. War, capital punishment, non-point-source pollution, abstinence-only sex ed (which repro health advocates thought we’d killed but GUESS WHAT’S BACK, thanks to healthcare reform, to the tune of $50 million per year)? I could go on, but there’s no point. Everyone’s list is different. Privileging lists that contain abortion is BS.

  • sillyrabbittrix

    THANK YOU ClinicEscort! I was just about to reply to supremepizza when I saw yours.
    I morally oppose war, particularly the Iraq and Afghanistan wars, yet I am unable to hold my taxes from paying for those, along with the thousands of deaths that result.
    This is such dangerous thinking; if a legal health procedure for women is confirmed by pro-choice advocates as being “controversial” and acknowledge that those who oppose should be able to keep their tax dollars from funding it, where does it stop? Soon funding for birth control, condoms, tubal ligations, etc will be cut from government funding due to people being “morally opposed” to them. Then what? Do we get to a point where no medical intervention at all will be funded by our government because there are people who are morally opposed to any intervention of “God’s plan”?
    Just please think for a few minutes about what is being said here. Discrimination and segregation of a group of people is NOT OK just because there is a group of people that are “morally opposed” to it. This is a legal procedure. Or else we open up some serious flood-gates with that argument.

  • sillyrabbittrix

    Thank you so much for this post!! This is EXACTLY what I’ve been trying to articulate since the EO, but have not been this successful.
    “I have already heard it argued that this bill was the best progressives could get. I absolutely reject that.” Amen. Thank you.

  • Opheelia

    From the start, pro-choicers were at a disadvantage in this debate. Most of us wanted health care reform to pass, and were passionate about access to safe abortion within a bill we supported. The other side, however, largely did NOT want this bill to pass, and used abortion as a divisive issue to split off anti-choicers who supported health reform as a whole. Yes, we lost a LOT on the abortion front. And I’m not happy about it. I believe it places women’s lives at risk, and the fact that safe access to abortion was used as a bargaining chip is disgusting. But it’s not surprising. In many ways, including and beyond abortion, this was not the law I wanted. However, I’m not convinced that passing it was wrong.

  • cattrack2

    In a democracy everyone has a list of things the gov’t shouldn’t be spending money on (Bridge to Nowhere anyone?) and both Reps & Dems have long, long lists of “stupid” budget items. There’s a qualitative difference, tho, between directly life & death issues and other issues.
    As we have Conscientious Objector status for people who object to killing people in war, we have statutes to prevent pro-life people’s taxes from being used on abortion. Unfortunately no similar “conscience” protections exist wrt Capital Punishment funding. That said two wrongs still don’t make a right.

  • Lilith Luffles

    Funny thing for me is, we had an anti-choice activist come rant in my human sexuality class about how half of the money used to pay for abortions are tax dollars, and that sadly that number will go up soon. I’m still trying to figure out what her source is.

  • aznemesis

    I just cannot believe the level of apologism for Barack Obama. He has screwed women to the rafters since he first began putting together a “transition” team, yet there are still those supporting him. He hid away like a coward to sign this executive order because he is just that–a coward. Kucinich and the so-called “left wing” of the Democratic party folded like a house of fucking cards, while Obama used women as the bargaining chip. When do you Obama and Democratic apologists finally admit that there is not one thing that has happend under this man that would not have happened under a “right”-wing Republican? Obama ran on a lot of things that turned out to be lies. Being “pro-choice” is just one of the many.
    When so-called “healthcare reform” was being debated, some man on one of the purportedly “feminist” sites commented that it was okay if the bill banned abortion coverage, since the Great Obama would just veto that part. I asked why he trusted this man so implicitly, given his track record. I also asked if he, as a man, would be willing to use his own healthcare as a bargaining chip. I’m not happy to be proven more than right. Veto an anti-female “healthcare-reform” bill? Ha! Not only did he not–he actually made further decrees against women’s reproductive health. Anyone who believes a word out of this man’s mouth is an even bigger fool than I believed before this bill passed. What does he have to do to get you to pull your heads out of your nether regions and see him for what he is: another Democrat who will use “marginalized” groups to get elected, then promptly turn his back on them the minute he gets to Pennsylvania Avenue.
    As for this bill, it is nothing but a big give-away to big pharma and the insurance companies. The “exchange” is another way for public money to go to private companies. Insurance companies have carte blanche to continue raising their rates. When those rates hit a certain amount, you will be paying income taxes on your health insurance. Pharma was given the right to keep generics off the market even longer. No cheap drugs will be allowed in the country via import. Working families have no choice but to give money to large insurance companies–or be punished by the feds! Insurance companies still get to decide what they will cover and what they won’t. Obama put a gag on single-payer proponents from the word go. All this crap and he attacks women’s reproductive rights on top of it? Where is the good part of this?
    I have been without healthcare for large portions of my adult life. It’s not fun. I ended up losing an ovary because of a lack of healthcare. I still wouldn’t trade the healthcare or reproductive rights of other women for my own benefit. Anyone who would? Is not someone I care to be in a movement with.
    The fact that people support this man is a big reason I have such disdain for mainstream feminism. I despise “progressives” because of their anti-feminist bullshit. I despise mainstream “feminists” because they will roll over for any Democrat at the drop of a hat, no matter how many women get hurt. Abortion isn’t even an issue for me anymore. I had a ligation over a year ago, at the same time that I lost one of my ovaries. Yet, I’ll be damned if I’ll let anyone gut women’s reproductive rights, then congratulate him for doing so. If you’ll do that, I don’t know how you can call yourself a feminist.
    Oh, and someone’s mama doesn’t want to pay for abortion, huh? I don’t want to pay for torture, for dropping bombs on children in developing countries, for Guantanamo Bay, for “extraordinary rendition,” for overthrowing and undermining democratically elected leftist governments in Latin America, for the declared wars or the undeclared wars the U.S. has carried out for decades. When do I get my executive order freeing me of all that?