Bernie’s Medicare-for-All Plan Must Include Abortion Coverage

Progressive should unite behind single-payer health care – but our plan must include overturning Hyde, or it will come at the cost of reproductive rights. Anything less would be a betrayal of the women who voted them into office.

After the Republicans garbage-fire of a health care bill failed last week in a dramatic 2 AM vote, progressives have an opportunity to propose bold new ideas on healthcare – and Democrats are finally warming to Medicare-For-All (also known as “single payer”).Elizabeth Warren enthusiastically endorses it, and other 2020 hopefuls like Corey Booker and Kamala Harris have (vaguely) voiced their support. Some states are even taking action: this June, Nevada’s Democratic state legislature passed a bill that would allow any state resident to opt into Medicaid. Senate Minority Leader Chuck Schumer has even said single-payer is “on the table,” signaling that the Democratic establishment is more open than ever to truly universal coverage.

I’m watching this with a lot of excitement. 28 million people in America are still uninsured today, and those of us who are insured are struggling under exorbitant premiums, massive deductibles and soaring drug prices. The status quo is unacceptable, but it’s also the inevitable consequence of a system that treats health care as a commodity, not a right. Single payer could change that.

Single-payer refers to systems where everyone, regardless of their income, gets insurance through a publicly-funded program (like Medicare or Medicaid). It already works in countries  around the world – for example, Canada, Taiwan, and the UK rely on single-payer for universal coverage. Medicare-for-All would be an incredible win for women’s health – if we simultaneously overturn a federal anti-choice law known as “the Hyde Amendment,” which keeps abortion out of reach for many low-income people who need it.

The Hyde Amendment bans any federal funding from paying for abortion care or coverage – and if federal funding can’t cover abortion, the federal insurance plans offered by a Medicare-for-All plan wouldn’t cover abortion either.

This isn’t a huge problem for Medicare recipients because the program is designed for seniors who are no longer of childbearing age. But if you’re on Medicaid and need an abortion, you have to come up with the money out of your own pocket. The average abortion costs $470. Without insurance, abortion may be prohibitively expensive for a home-health-aide or retail worker making $25,000 a year. You may have a constitutional right to choose – but that right doesn’t mean much if the Hyde Amendment denies you the ability to afford an abortion.

With momentum growing for  single payer, Bernie Sanders just announced that he plans to release a comprehensive Medicare-for-All bill. We don’t know what the details are yet: it may  allow people to opt in to Medicare or Medicaid, like the Nevada plan, or it might look like a House bill that would require most people to move swiftly off their private insurance plans and onto publicly-run plans. If a bill like that passed, but Hyde wasn’t repealed, millions of people would be moved off of private insurance plans that currently cover abortion – and onto a federal plan that can’t.

That means Bernie’s forthcoming Medicare-for-All plan must include repealing the Hyde Amendment. Access to abortion – the ability to decide when, or if, to become a parent – is fundamental to women’s bodily autonomy, necessary for our economic security, and an essential form of health care. If single-payer plan doesn’t include reproductive health, it’s not actually health care for all.

Repeal is theoretically straightforward, because Hyde isn’t a permanent law. The Hyde Amendment is a rider that’s been attached to the budget every year since 1976. Congress could always just pass a budget without it, and any Congress with enough progressive Democrats to move on single payer should end the Hyde Amendment immediately.

But Hyde has been in the budget every year for the last 40 years, even when Democrats have been in charge of both the House and the Senate. In fact, Democrats have faced a remarkably similar choice before. In 2011, anti-choice Democrats in the House threatened to sink the Affordable Care Act over the Stupak Amendment, which banned plans on federal insurance exchanges to cover abortion. Over loud protests from reproductive rights groups, the House passed the amendment – caving to anti-choice Democrats, and sending the message that women’s reproductive health care was less of priority than everyone else’s.

This is especially salient when both establishment Democrats and Bernie himself have said they’re willing to thrown their support behind anti-choice candidates. On Monday, the Democratic Congressional Campaign Committee announced they would fund anti-choice candidates – bankrolling the very Democrats who would be an obstacle to repealing Hyde. To his credit, Bernie has called to repeal Hyde and has a sterling pro-choice voting record. But he infamously backed Heath Mello, an Omaha Democrat who sponsored a 20-week abortion ban in 2010; under criticism, he told NPR that Democrats “can’t just exclude people who disagree with us on one issue.” On abortion access, both establishment, centrist Democrats and the progressive Left are showing a disturbing willingness to betray the women, especially the women of color, who are their base. (As an aside: imagine what would happen if Democrats focused on getting us excited for the midterms, instead of trading our rights away.)

In this context, I have real concerns about whether single-payer advocates could cave under pressure from the anti-choice movement. After all, that’s precisely what happened with the Stupak amendment. I’m not alone in my concerns: in 2016, NARAL Colorado opposed a ballot initiative to establish single payer in the state, because it would move 550,000 Colorado women out of private plans which included abortion coverage onto state-funded plans that could not, because of a state-level Hyde law.

The Colorado bill failed, and we should learn a lesson from it. Any single-payer bill that doesn’t include abortion coverage risks dividing the progressive base against itself, and in doing so, jeopardizing its passage. That would be a tremendous, and totally avoidable, loss for women’s health.

Some Medicare-for-All advocates may want to avoid a fight over abortion, to make passing single-payer a little bit easier. I get that: it’s a moral monstrosity that millions of people are uninsured in the richest country on Earth. But abortion access is non-negotiable; without it, women and people with uteruses can’t control our economic futures, our health care outcomes, or even our own bodies.

Single-payer advocates are already demanding that Democrats think big and act boldly. So while we’re working for a radical transformation of the Party, let’s demand that our representatives have the political courage to avoid the false choice between reproductive health care and single-payer. We want a guarantee that the next Medicare-for-All package includes a plan to #BeBoldEndHyde.

Photo credit: Andrew Seaman (Reuters)