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Responding to The New England Journal of Medicine



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An article by Patrick Whelan that appeared in The New England Journal of Medicine this week has supporters of Obamacare swooning. This article analyzes abortion trends since the enactment of Commonwealth Care in Massachusetts in 2006. The analysis purportedly shows that Massachusetts system of near-universal health care, with subsidies for insurance plans that covered abortion, did not dramatically increase abortion rates. The author then uses this example to argue that the proposed health-care-reform plans would have little effect on the incidence of abortion. However, Whelan’s analysis is superficial and provides little useful information about how Obamacare would effect abortion rates nationally.

Since 2000, the number of abortions in Massachusetts have declined at a slow but steady pace. After the enactment of Commonwealth Care in 2006, this decline continued at a similar pace through 2008, the last year for which data is available. At first glance, it appears that the enactment of Commonwealth Care did little to affect abortion trends in Massachusetts. However, some background information is helpful here. First, 2005 is the most recent year for which national abortion data is available. The fact that abortion rates in Massachusetts cannot be compared to the national trend or to abortion rates in other states is a key shortcoming of this article.

Furthermore, prior to the enactment of Commonwealth Care, a comparatively high percentage of Massachusetts residents already had health insurance. The coverage rate among nonelderly adults went up by 8 percentage points between 2006 and 2008. While that is a non-trivial increase, an 8 percentage-point gain may not have a large impact on overall abortion rates. It would be interesting to see how Commonwealth Care affected the number of Massachusetts residents who had insurance plans which covered abortion. However, that information is not available.

Whelan tries to shed doubt on the broader question about whether direct subsidies for abortion increase abortion rates. He states that “there exists controversy about whether the availability of state Medicaid funding for abortion increases abortion rates.” However, in reality, there is no controversy. A comprehensive literature review that was done by the Alan Guttmacher Institute finds that 20 of 24 academic studies indicate that Medicaid funding for abortion increases abortion rates. Furthermore, Guttmacher’s researchers agree that the best best research on the topic indicates that Medicaid funding for abortion increases abortion rates.  Interestingly, instead of citing a peer-reviewed study, the only study that Whelan cites is infamous 2008 Catholics in Alliance for the Common Good study, which did not appear in a peer-reviewed journal.

What is especially disappointing is The New England Journal of Medicine’s decision to influence the ongoing debate over health-care reform at such a crucial time. The New England Journal of Medicine is a flagship peer-reviewed journal which typically presents the findings of analytically rigorous and thorough research on a range of medical and public-health issues. The fact that The New England Journal of Medicine has lent its credibility and prestige to a fairly superficial analysis of Massachusetts abortion trends causes one to seriously doubt their credibility and objectivity.

Overall, regardless of the effect of Obama-care on short-term abortion trends, the pro-life movement still has plenty of good reasons to oppose health-care reform. If abortion is categorized as a federal health benefit, then that could jeopardize countless state-level pro-life laws. Any federal funding of abortion would create all kinds of ways for abortion providers to stay open by obtaining more federal funds. As always, the pro-life movement would do well to be diligent.

– Michael New is an assistant professor of political science at The University of Alabama and a Fellow at the Witherspoon Institute in Princeton, N.J.



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