In assessing whether President Obama fulfilled this promise, we need to look several elements of reproductive health: improving overall health care coverage for women, birth control coverage and abortion services. Obama has made substantial gains in two and compromised in the other.
When we last updated this promise, Congress was on the verge of passing President Barack Obama"s signature health care legislation, the Patient Protection and Affordable Care Act, into law. One of the bill"s most formidable obstacles in securing passage was a group of anti-abortion House Democrats, led by Rep. Bart Stupak, D-Mich.
Rep. Stupak and Rep. Joseph Pitts, R-Penn., crafted the Stupak-Pitts Amendment that prohibited federal funds from paying for abortions in the health insurance exchanges set up by the legislation. This action was to insure the new bill would uphold the Hyde Amendment, a legislative provision first instituted in 1976 that bans the use of federal funds in paying for most abortion procedures through Medicaid. The Stupak-Pitts amendment passed the House of Representatives but was not included in the Senate"s version of the bill.
Stupak and his coalition threatened to vote against the Senate version if it did not contain similar abortion funding restrictions. As a compromise, Obama issued Executive Order 13535, in which the president assured abortion critics that no federal money would go toward funding abortions in the new health exchanges. In other words, President Obama"s executive order was a promise that he would continue to enforce the Hyde Amendment's provisions.
The final law did, however, contain an amendment championed by Sen. Ben Nelson, D-Neb., another Democrat. This amendment requires that insurance companies in the exchange that provide abortion coverage must collect two separate payments from each person who purchases the plan. One portion of this payment goes toward general health concerns while the other goes toward a fund specifically for abortion services. The abortion fund, however, must be paid exclusively by the buyer.
Groups that support abortion rights weren't thrilled with that, but they were pleased the bill did not contain Stupak's amendment.
"(W)e regret that a pro-choice president of a pro-choice nation was forced to sign an Executive Order that further codifies the proposed anti-choice language in the health care reform bill, originally proposed by Senator Ben Nelson of Nebraska," said Cecile Richards, President of Planned Parenthood in a press release about he health care bill"s passage. "What the president"s executive order did not do is include the complete and total ban on private health insurance coverage for abortion that Congressman Bart Stupak (D–MI) had insisted upon. So while we regret that this proposed Executive Order has given the imprimatur of the president to Senator Nelson"s language, it is critically important to note that it does not include the Stupak abortion ban."
A provision in the health care law grants Secretary of Health and Human Services (HHS) Kathleen Sebelius the power to implement regulations when it comes to women"s preventive care. On August 1, 2011 Sebelius announced a new HHS regulation, which stipulated that health insurance companies, starting a year from that date, will be required to fully cover birth control pills without requiring a co-payment. HHS argues that, because of co-payment costs, women"s preventive services are underused. The HHS guidelines, based on recommendations by the Institute of Medicine, also apply to tests for the human papillomavirus (HPV), screenings for gestational diabetes and some counseling services. These guidelines apply to all insurance companies, not only those in the insurance health exchanges.
It is unclear whether emergency contraceptives, commonly known as the "morning-after pill", will be covered. The guidelines state that health insurance companies must cover contraceptives "as prescribed." Many emergency contraceptives can be bought over the counter and may be ineligible.
A Kaiser Family Foundation poll found that two-thirds of Americans agreed with the HHS decision. The mandate, nevertheless, attracted criticism from conservative lawmakers and pundits and religious groups.
"Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible," said the United States Conference of Catholic Bishops in a statement.
"What the president"s just said, is now all of us have to pay that co-pay for other people"s birth control and for other people"s morning-after pills," said Rep. Michele Bachmann, R-Minn., a candidate for the Republican presidential nomination.
Anticipating such objections, the HHS allows religious institutions to choose whether insurance offered to their employees includes these changes.
We asked Planned Parenthood for its thoughts on where Obama stood in terms of delivering on his promise. "President Obama has been a champion for women"s health. From passing historic legislation that will expand health care access to millions more women to ensuring that women have access to vital preventive health care with no co-pays or additional costs, the Obama administration has stood strong for women"s health and made a significant difference in the lives of women," said Planned Parenthood spokesperson Tait Sye in a statement to PolitiFact.
President Barack Obama stated that he would make women"s reproductive health care a centerpiece of his reform legislation. Although "at the heart" is nebulous phrase, we find that the health care legislation, and particularly the new HHS guidelines, shows the importance that the administration places on women"s health. We rate this as a Promise Kept.