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Editorial

What's the deal on healthcare?

Favors and exceptions may get a bill through the Senate, but that doesn't make them good policy.

December 22, 2009

To overcome a Republican filibuster on healthcare reform, Senate Majority Leader Harry Reid (D-Nev.) struck a final deal over the weekend with centrist Sen. Ben Nelson (D-Neb.) to limit funding for abortion and ease some of the burdens on his state imposed by the bill. The abortion language drew rebukes from both sides, yet Nelson's efforts to win special treatment for Nebraska and one of its health insurance companies prompted even sharper attacks. The critics included Nebraska Republican Sen. Mike Johanns, who said, "There should be no special deals, no carve-outs for anyone in this healthcare bill; not for states, not for insurance companies, not for individual senators."

Johanns is right on principle, but he doesn't have precedent on his side. Lawmakers routinely plead for favors for their home state. Their costs are high, their weather is bad, their constituents are hard-pressed -- the rationales go on and on. The more congressional leaders need their votes, the more likely the requests are to be granted. And thanks to the united opposition from Republicans, Reid needed the support of all 58 Democrats and both independents in the Senate to push the healthcare bill through. He wound up striking deals with multiple senators on an array of their favorite healthcare causes.

Nelson's compromise on abortion is partly a gimmick -- his language would allow women to use federal insurance subsidies to help pay for policies that included abortion coverage, as long as they wrote a separate check for the portion of the premium related to that coverage. But it also would open a new front in the legislative fight over abortion, allowing states to pass laws barring insurers from including abortion coverage in policies for individuals and small businesses. The result could be a significant setback for abortion rights in states where social conservatives dominate the legislature.

Why let states ban abortion coverage just for women not fortunate enough to work for an employer who provides it? That doesn't make much sense. Nor is it good policy to contort federal funding formulas to benefit a handful of states, as the Senate bill would do. It's reassuring that most of the pet projects included in the lengthy amendment Reid offered Saturday would advance worthwhile goals, such as giving lower-income workers more insurance options, advancing preventive care and helping develop treatments for rare diseases. But we can't help but share Johanns' quixotic wish for a more thorough vetting and a fairer process.

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