(RNS) — Former U.S. Rep. Bart Stupak helped lead the fight to pass the Affordable Care Act back in 2009. RNS readers may recall the Michigan Democrat's firm resolve to pass the act with protections for pregnant women and for prenatal children.
President Obama’s signature legislative accomplishment — and perhaps the most important legislation of the last two generation of any kind — would not have passed without the support of pro-life Democrats led by Stupak. In his just-released book, "For All Americans: The Dramatic Story Behind the Stupak Amendment and the Historic Passage of Obamacare," Stupak gives the definitive account of how everything came together.
I asked Stupak to tease out some of those details, explore their implications for the current health care debate and share his thoughts about the future of pro-life Democrats. The interview has been edited for length and clarity.
Given all the political debate over health care in recent weeks and months, you must be having flashbacks to your own battle to pass that Affordable Care Act (ACA) in 2009.
Yes, there are brief flashbacks triggered by the current debate on repealing the Affordable Care Act. However, in 2009 Democrats started with a concept that all Americans are entitled to health care and endured a 12-month sojourn to create a national health plan. This year, the House and the Senate were simply attempting to repeal the Affordable Care Act without a viable substitute. The current debates are centered on politics and not substantive policy.
The principles I fought for, providing all Americans with access to quality, affordable health care while protecting the sanctity of life, have a greater, deeper moral significance than simply repealing and replacing the Affordable Care Act.
There are, of course, significant problems with the ACA. Some on the left saw the ACA as a preliminary step to a single-payer, Medicare-for-all system. Do you favor moving in that direction or should we keep the system pretty much as it is and try to fix its problems?
Any health care plan that is designed to cover millions of Americans will require legislative changes as the strengths and weakness of the plan are unearthed when it is applied to the general population. Take Medicare, for example. Since its passage in 1965, it has undergone numerous significant changes. Within six years of its passage, Medicare was changed to include people with disabilities and end-stage renal disease.
It has been seven years since the enactment of the ACA and although Democrats and Republicans highlight weaknesses in the plan, Republicans refuse to make the necessary changes to fix the act. Instead, Republicans have voted close to 60 times to repeal and replace the ACA without success. The Republican Party should abandon their futile efforts and work with Democrats to provide quality and affordable health care for all Americans.
I do believe that as changes are made to the ACA it will morph into a Medicare for all for individuals.
Some of the biggest debates over the ACA were proxy debates over abortion, and these are detailed in quite interesting ways in your book. How do you see the abortion wars figuring into the current debate over health care?
In the congressional debates to repeal and replace the Affordable Care Act there have been limited comments on abortion because of the executive order that I and other right-to-life Democrats negotiated with President Obama to prevent taxpayer-funded abortions. Due to President Obama’s general adherence to the executive order that taxpayer money cannot be used to pay for abortions, the Republican Party has not found it necessary to enact a law stating that there will be no taxpayer-funded abortions under the ACA.
However, the Affordable Care Act’s essential benefit package requires all insurance policies to include preventive and wellness contraception services such as abortifacients or the “morning after pill.” The inclusion of abortifacients in the contraception services violates the executive order that prevents taxpayer money for abortion services.
With the assistance of Democrats for Life, I opposed the inclusion of abortifacients as an essential benefit and in violation of the executive order negotiated with President Obama. In my U.S. Supreme Court brief in the related Hobby Lobby Supreme Court case, I successfully pointed out that abortifacients are not allowed under the executive order.
A full quarter of the House Democratic caucus voted for your pro-life amendment to the ACA in 2009 and it was clear that without pro-life Democrats the ACA would never have passed. Because of attacks from abortion rights activists on the left and pro-life activists on the right, pro-life Democrats have been decimated since the 2010 midterm elections. How do you see the future relationship between pro-lifers and the Democratic Party?
Recently, Democratic Party National Chairman Tom Perez espoused a pro-choice litmus test for all Democratic candidates. Most elected Democratic leaders disavowed Perez’s comments. In an editorial, I have asked Chairman Perez, “What happened to the all-inclusive Democratic Party that I used to know?” The party that welcomed diversity and differences of opinion, aided and encouraged the weakest in society and protected those who could not protect themselves — including the unborn. What happened to that principle of the Democratic Party? I have not received an answer from the chairman.
For pro-life Democrats, Perez’s comments exposed just how far the Democratic Party has fallen. The Democratic Party is no longer the “big-tent party.” I fear the Democratic Party has become the “pro-abortion rights” party. If Democrats establish a litmus test on this single issue, surely they will turn away voters in key states and districts in 2018 and become a permanent minority party without an effective voice on economic and social policies. If a litmus test is followed, pro-life Democrats will not be affiliated with the Democratic Party.
You led a principled pro-life fight for health care for all and skillfully got it done in the face of fierce opposition from multiple sides. Today, however, we are most often forced to choose between (1) principled candidates who can't get anything done and (2) candidates who can get things done but often sell out their principles. How do we get more candidates who, like you, combine genuine commitment to principle with the political skills and will necessary to get things done?
Excellent question. Your question is another reminder of how difficult it has become to govern on policies driven by principles and not politics. I believe that federal elected officials should always cast their vote based on the merits of the legislation and the principles upon which our country was founded. Our Christian country was founded on moral, ethical, social and economic justice. As voters, we must hold candidates to these American values and principles. I believe President Kennedy said it best in his inaugural address: " ... Let us go forth to lead the land we love, asking His blessing and His help, but knowing that here on earth God’s work must truly be our own.” God’s work must truly be our own and I hope that I have lived up to this principle.
(Charles C. Camosy is associate professor of theological and social ethics at Fordham University and author of “Beyond the Abortion Wars: A Way Forward for a New Generation.” The views expressed in this opinion piece do not necessarily reflect those of Religion News Service)