The Stupak Stupor

We know that the House healthcare reform bill passed after an
eleventh-hour compromise (you might say betrayal) on abortion access.
We know the compromise, the Stupak-Pitts amendment, is bad. But do we
know exactly how it's bad for women (and their partners)? Here's a
quick primer on what the amendment actually means for any woman
accessing healthcare through the newly-created health insurance
exchange.

Over the summer, legislators struck an agreement on abortion
funding in which private plans offered through the health insurance
exchange couldn't use federal dollars to cover abortion care. They
could, however, cover abortion care with funds from individuals'
premiums, and the agreement, the Capps Amendment, required at least one
plan in every region to offer abortion care, and at least one not to.
As many observers predicted, the Capps Amendment didn't mollify
anti-abortion crusaders, namely the US Conference of Catholic Bishops,
which commands an outsize role in the debate over healthcare reform.

So what we ended up with was drastically worse. After the initial
compromise fell apart, Rep. Bart Stupak introduced the eponymous
amendment, under which any plan purchased with any federal subsidy
cannot cover abortion services--even with private funds. Plus, the
public plan won't cover abortion care. While plans participating in the
health insurance exchange are legally permitted to offer a version of
the plan that does cover abortion--enrollment limited to those who pay
for the entire plan without any subsidy--it's unlikely plans will go
the extra mile to offer that coverage, Planned Parenthood's Laurie
Rubiner said this morning on the Brian Lehrer Show.
That would be "awfully complex," Rubiner explained. Because the
majority of Americans purchasing insurance through the exchange would
be using affordability credits, the plan without abortion coverage will
become the "standard plan." Rubiner also cited privacy concerns over
purchasing abortion-inclusive coverage. The Wall Street Journal observed,
"Insurers may be reluctant to [set up abortion-inclusive plans] because
it could complicate how they pool risk and force them to label policies
in a way that could draw attention from abortion opponents."

At Change.org,
Jen Nedeau pointed out that even women who currently have
employer-based insurance that does cover abortion care (and 87 percent
of employer-based plans do) may ultimately be affected. "Since the plan
for the uninsured is designed to open up to everyone over time,
including large employers, it is likely that women will lose access to
abortion coverage as part of any health insurance plan available for
purchase," Nedeau explains.

In defending his amendment, Stupak made one misleading and one
outright false claim. He argued that women could purchase "abortion
riders" on top of their insurance, much like they might purchase a
dental or vision rider. Such an abortion rider doesn't exist now, and
the legislation does not provide for its creation. Rubiner pointed out
that in states where private coverage of abortion care is outlawed,
riders don't exist either. Besides, they defy logic: "Women would have
to plan for their unplanned pregnancy," Rubiner added. "It's illogical
to think they would look for a plan that includes abortion."

And for the falsehood: Stupak claimed that his amendment "goes no
farther than Hyde," the amendment banning federal Medicaid funding for
abortion care except in cases of rape, incest, or threat to the woman's
life. In fact, the amendment goes farther than Hyde in stipulating what
kind of coverage a woman can purchase with private dollars. "It's the
equivalent of arguing that women who receive abortions should not use
public buses or highways to travel to the abortion clinic," Igor Volsky at Wonk Room points out.

In the Stupak amendment, the exceptions to the coverage ban read
as follows: rape, incest or "where a woman suffers from a physical
disorder, physical injury, or physical illness that would, as certified
by a physician, place the woman in danger of death." The Center for American Progress's Jessica Arons writes,
"Given insurance companies' dexterity in denying claims, we can predict
what they'll do with that language." And in case you wonder what that
leaves out entirely: "Cases that are excluded: where the health but not
the life of the woman is threatened by the pregnancy, severe fetal
abnormalities, mental illness or anguish that will lead to suicide or
self-harm, and the numerous other reasons women need to have an
abortion."