Josh Barro: Give up abortion for nationalized health care?

Throughout the health care debate, Democrats and President Obama have insisted that Americans who want to maintain their current health care coverage will be able do so. Reform, Democrats argued, would be a win-win, extending coverage to millions of uninsured Americans while depriving nobody of existing coverage they like.

But events this month have forced liberals to admit an inconvenient truth: Not only will health care reform force millions of Americans to change health insurance plans against their will, but those shifts could also cause millions of women to lose coverage for abortion.

The elephant in the room is the Stupak-Pitts Amendment, adopted by the House just before the passage of the Affordable Health Care for America Act. Stupak-Pitts would prohibit any taxpayer-subsidized health plan from covering elective abortions.

This restriction is far-reaching, because most Americans will qualify for subsidized health insurance if they don't get coverage through their employers. As a result, a large majority of policies sold through the new federal insurance exchange would be subsidized and few or none would cover abortion.

If Obama is right and everyone with existing coverage can keep it, then passionate proponents of abortion access have little to worry about. Most Americans are already covered by employer-based plans, which the amendment generally shouldn't affect -- the exchange will mostly sell individual policies.

If the exchange mostly caters to people who currently lack health insurance altogether, there's little reason to worry about reduced access to abortion.

But what if Obama is wrong, and people with existing abortion-inclusive insurance are moved, against their will, into exchange-traded plans that cannot cover abortion? Some businesses might find it's cheaper to drop insurance coverage and let their employees buy federally subsidized insurance.

Others will be allowed to buy into the exchange directly, replacing their existing plans with new ones that exclude abortion. If these trends become widespread, Stupak-Pitts could cause millions of American women to lose the abortion coverage they currently get through their employers.

Prior to Stupak-Pitts, concerns that health reform would lead firms to change or drop health coverage were mostly voiced on the right. But last week on the blog of the Center for American Progress, a staffer warned that millions of Americans might lose their existing employer-provided abortion coverage, as employers start buying insurance through the exchange.

Liberal critics of Stupak-Pitts are just admitting the obvious about health care reform. Employer-based health insurance is a legacy of tax subsidies that apply to employer-provided insurance but not individually purchased insurance.

Any system that adds subsidies for other purchase channels will reduce the portion of Americans with employer-based coverage -- and subject more Americans to whatever restrictions the government places on policies that are sold through the exchange. Now the left is realizing that some of those restrictions may be ones they do not find desirable.

Stupak-Pitts has forced liberals to admit that reform is not a win for everyone. For reform proponents, this may be an acceptable tradeoff: Extending health insurance to tens of millions of Americans who currently lack coverage is an important achievement that must be weighed against the costs of reform.

Now they must consider what losses they will accept on the road to universal coverage.

Josh Barro is a senior fellow at the Manhattan Institute.