Why the Stupak Amendment Is a Monumental Setback for Abortion Access

If you thought that just because abortion is a constitutional right and part of basic reproductive health care it would be available in the reformed health insurance market known as the Exchange, think again. The Stupak Amendment, passed Saturday night by the House of Representatives after a compromise deal fell apart, potentially goes farther than any other federal law to restrict women's access to abortion.

The claim that it only bars federal funding for abortions is simply false. Here's what the Stupak Amendment does:

1. It effectively bans coverage for most abortions from all public and private health plans in the Exchange: In addition to prohibiting direct government funding for abortion, it also prohibits public money from being spent on any plan that covers abortion even if paid for entirely with private premiums. Therefore, no plan that covers abortion services can operate in the Exchange unless its subscribers can afford to pay 100% of their premiums with no assistance from government "affordability credits." As the vast majority of Americans in the Exchange will need to use some of these credits, it is highly unlikely any plan will want to offer abortion coverage (unless they decide to use it as a convenient proxy to discriminate against low- and moderate-income Americans who tend to have more health care needs and incur higher costs).

2. It includes only extremely narrow exceptions: Plans in the Exchange can only cover abortions in the case of rape or 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." Given insurance companies' dexterity in denying claims, we can predict what they'll do with that language. 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.

3. It allows for a useless abortion "rider": Stupak and his allies claim his Amendment doesn't ban abortion from the Exchange because it allows plans to offer and women to purchase extra, stand-alone insurance known as a rider to cover abortion services. Hopefully the irony of this is immediately apparent: Stupak wants women to plan for a completely unexpected event.

4. It allows for discrimination against abortion providers: Previously, the health care bill included an evenhanded provision that prohibited discrimination against any health care provider or facility "because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions." Now, it only protects those who are unwilling to provide such services.

One in three women will have an abortion in their lifetime. Eighty-seven percent of employer plans offer abortion coverage. None of that will matter if the Senate takes its cues from the House. In every other way, this bill will expand access to health care. But for millions of women, they are about to lose coverage they currently have and often need.

This piece was originally posted on The Wonk Room.

 

Comments

[j hig]

"Hopefully the irony of this is immediately apparent: Stupak wants women to plan for a completely unexpected event."

There's a word for this -- it's called buying "insurance". That's kind of the point after all!

[mbsq]

Women will not lose abortion coverage. You forgot the most important thing Obama says about this: If you like your plan, you can keep it. Only people without employer coverage will even be eligible for the Exchange. Women will just go from having no health insurance at all to having a good plan that just doesn't cover abortion. Abortions are on average less than $500 so I don't think this is a big deal. The argument that women cannot buy a "rider" because they cannot "plan for an unplanned event" is totally illogical. All insurance is planning for the unplanned, be it health, home, car, life, whatever. Finally, the fact that you CAN have abortion coverage if you forfeit or don't qualify for the subsidies makes this issue rather unimportant. If you value abortion enough then you will be willing to pay for it. If someone is going to have suicidal behavior without an abortion, then they will be willing to fork over the $400.

[ewoman]

You don't get it. The point is that women's bodies have become a bargaining chip on a political crap table. Again.

[jmpurser]

With the Stupak amendment this bill officially crossed the "worse than nothing" divide. From the day Obama went all out to save the insurance companies at all costs this bill was doomed to be nothing but corporate welfare but with the Stupak amendment it actually does more harm than good. Something I would have though was impossible to achieve just a year ago.

[mbsq]

No it does not do more harm than good. Women will be going from zero insurance to a plan that doesn't cover abortion but is otherwise good. Even on the individual level it does more good than harm. And overall it will be a great benefit to our society.

[juna]

I was a teenager in the '50's and I saw the results of illegal back alley or Mexican abortions: many women died, were maimed for life, and/or experienced horrific pain and suffering. This interference by the government that blocks a woman's legal right to choose would end up putting poor women right back into the same situation that was suffered so many decades ago. Shame on Nancy Pelosi for being so overjoyed about the health care bill when it limits the right to choose and discriminates against the poor.

[mbsq]

no you don't understand. back alley abortions would not be covered either. you have to pay for that too. this doesn't restrict access it just makes some people have to pay for it themselves. it's a few hundred dollars, get over it. if you're not willing to pay a few hundred then obviously it's not that important to you.

[Julia E]

mbsq, you seem to be confusing "willing" with "able." $400 is actually quite a bit of money to most people. It is NOT a small cost that can just be "forked over." Lack of access to a legal medical procedure based on inability to pay is morally reprehensible and IS a big deal.

[lldorward]

Millions of citizens are morally opposed to the Iraq War, and yet our tax dollars are being used to kill tens of thousands of the Iraqi people. How about a law prohibiting the use of any tax dollars subsidizing wars that any citizen sees as the legalized murder of innocent people?

I am a vegetarian and I assure you, I am every bit as opposed to the beef, poultry, and pork industries as anti-abortion advocates are against abortion; why not a law stipulating that no tax dollars can be spent subsidizing these industries because I and millions of my fellow citizens feel their activities are morally reprehensible?

If our government renders an activity legal, we can protest, argue our objections, even work hard to persuade our government to our point of view, but we are ALL obligated to recognize the authority of law. Anyone may disagree with it; they may find it morally reprehensible, but they cannot subvert the rights of citizens who disagree with them by subverting the laws they don't like. It is not “reasonable” that a specific group of citizens be allowed to impose their moral opinions on the other citizens unless or until EVERY citizen can ‘opt out’ of any legal government policy or law, and stipulate how and on what their individual tax dollars are spent.

[GardenerNorCal]

With the latest news stories of rape kits that haven't been analyzed because of cost concerns, and now this it's becoming clear that the attitude of this country has once again swung around to the position that women are merely chattel.

It's time to push for the ratification of ERA.
Section 1. Equality of rights under the law shall not be denied or abridged by the United States or by any state on account of sex.

Had this amendment been ratified we wouldn't be having this discussion.

[alilamos]

Is Viagra covered by insurance?

[Artemis34]

Don't care about abortion?

What are you going to do when some religious sect wants to start changing your life?

What if the Catholc Church has to approve divorces for non-beilievers and Catholics alike? When they take birth control pills and condems off the market? When Mormons get porhibition reinstated and you can't hoist a beer?

If you aren't prepared to spend you life genuflecting in magic underpants you better think aobut this.

[gayleg]

You're wrong. Most private insurance companies do provide coverage for abortions. Mine certainly does.

There's way too much misinformation on this thread.

[NotARhetoricalQuestion]

Who's wrong? Isn't this what the author says?

[radioarpad]

"Hopefully the irony of this is immediately apparent: Stupak wants women to plan for a completely unexpected event."

I'm sure people who buy fire insurance don't expect to have his or her house burn down, and if they do, they're going to have some real problems with the insurer. Second, unless there's an epidemic of parenthogenesis going around, one cannot say that a pregnancy is a COMPLETELY unexpected event. With proper precautions, it is an unlikely occurence, just like your house burning down, and the whole point of insurance is to cover those types of events.

[NotARhetoricalQuestion]

But in this culture, there's a certain stigma to purchasing "abortion insurance."

[LLT]

Well, perhaps they should start whittling down ALL medical policies to cover only one individual medically necessary procedure. You might get cancer? Let's see -- that'll be chemo insurance and radiation insurance and of course you'll need policies for each surgical procedure you may need, etc. Have heart disease or diabetes in the family? Wow, well that's another whole bunch of policies you're going to need. How about ortho? How's your back or your knee? And of course you need insurance for each diagnostic test in order to find out what treatment policies you're going to need. And so on and so on.

Oh yeah, it's exactly the same as "fire insurance."

[Factonfact]

Wonder why given cheap and readily available birth control pills, morning after pills, contraceptives of all kinds and mountains of freely available birth control information and all the preaching and carrying on in this nation that there remain so many unwanted pregnacies. (And I exclude from consideration those pregnacies that are set forth in the bill.)

[NotARhetoricalQuestion]

Lack of access. Lack of education. For starters.

Birth control pills aren't "cheap", BTW. Not all insurers pay for them.

[LLT]

Does Bush era fed funding for "abstinence only" education ring any bells?

[loel1044]

To write that one out of three women will have an abortion is simply not an accurate statement. The aboriton rate is based on the number of abortions per 1000 fertile women in any given year. Thus multiple abortions during a woman's lifetime would have to be determined---the statement obviously assumes that no woman would have more than one abortion.

[mom22cherubs]

What about cases where the health of the mother is at risk, or when the fetus has genetic abnormalities, severe birth defects or spinal bifida (sp). Women have to terminate pregnancies for a variety of reasons. Not all of them can be planned for. I have friends who have had to terminate WANTED pregnancies due to health issues. These were not immediately life threatening to the mother but being forced to carry a dead fetus for months and deliver a stillborn is barbaric.

[TXWMN]

No one is ever forced to carry a dead baby. Been there done that. The mother would be induced to deliver the child or if it is early and the baby has already died but no passed (it's called a miscarriage) a DnC is performed. There is no abortion under those circumstances.

In most cases abortion is elective. What insurance covers elective procedures?

[gayleg]

You're either lying or your ill informed.

Women are sent home to wait for a miscarriage now in several states thanks to the Partial birth abortion fiasco of the Supreme court.

They banned the only safe procedure for extracting a larger fetus. The remaining procedure is too difficult and dangerous for most doctors to perform so they send women home with dead babies inside them.

[Artemis34]

Wrong. They are calling the treatment of fetal demise an abortion.

This was a large part of Dr. Tiller's practice.

In cases of fetal demise, the life of the woman my be endangered by sepsis and other complications.

And with Doctors liker Tiller m u r d e r e d, there are fewer and fewer doctors willing to risk their lives to save the lives of women in need.

[ibwilliamsi]

I believe that women without money and without access and without insurance already don't have a choice.

[Artemis34]

Since federal funding is already denied under the current federal of law (Hyde Amendment), 17 states have stepped in to fund abortions for poor women on Medicaid.

I'm not sure how this would be impacted by Stupak. He was say no "public" rather than no "federal" funds.

[manyamile]

.education and contraception( for women/couples who want to prevent/delay pregnancy) is most cost effective
2.in cases where contraception fails, abortion, especially first trimester, is still less expensive , medically , than preand post natal care, delivery, and childrearing.
3.I think education and gyn care reduces costs, reduces # of unwanted pregnancies, encourages and allows earlier decisions regarding pregnancy,(fewer late term abortions)..and of course provides care for women who choose childbirth.
This is one area where insurers , healthcare professionals and rational women agree.
so how did this get so far off track?