As the health reform debate played out in the House this summer and fall, the way "women's advocates played the game" was "extremely nice," which probably contributed to the passage of the restrictive Stupak amendment to the chamber's health reform bill (HR 3962), author Sharon Lerner writes in an opinion piece in The Nation. According to Lerner, "Stupak is even more of an insult to pro-choice groups when you consider what they really wanted: to have abortion be treated as an integral part of health care." She notes that initially, "hoping not to muddy the overall health reform process," advocates tried "to leave abortion politics out of the legislation." Lerner writes that this approach "was eminently reasonable; health reform, after all, was a much bigger issue. Why did abortion have to get mentioned at all?"

Though it may seem surprising that "the well-organized and well-funded women's health movement" could not defeat the amendment, Lerner notes that the House "still doesn't have a pro-choice majority," despite the gains of the last two elections. When Rep. Lois Capps (D-Calif.) introduced an amendment over the summer that was seen as middle ground, women's groups "once again chose to be cooperative and agreed to the compromise," even though they really "didn't like it," Lerner writes. This might have been the groups' "tragic misstep," according to Lerner. By not criticizing Capps, they were signaling a willingness to make further concessions, she argues. The groups also "held their fire" when birth control and some other women's health services were not included in the list of basic benefits that insurers are obligated to cover, Lerner adds.

Health reform gave women's groups a chance to have a seat at the negotiating table, but that "paradoxically meant limiting their demands," Lerner says. Frances Kissling, a visiting fellow at the Center for Bioethics, said, "There was this enormous feeling that if health care failed because of abortion, on our side, we would be blamed, ... and then we would never get out of the hole of not being important."

The weekend of the House debate, the U.S. Conference of Catholic Bishops seized control of the issue, Lerner continues. While the bishops "put their feet down at the last minute," women's groups "stayed away from such gamesmanship," recognizing that health reform has many other important goals, such as providing low-income women with coverage and prohibiting insurers from charging women more than men based on gender. "I don't want to get down in the gutter with our opponents," Laura MacCleery of the Center for Reproductive Rights said.

Though being more vocal and aggressive might have improved women's groups' bargaining position, that strategy might also have ultimately backfired, Lerner writes. "It's impossible to know," she says, adding, "Whatever the answer, pro-choice groups clearly must rock the boat this time around" (Lerner, The Nation, 11/23).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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