The Price of Health Reform: Abortion Rights?
Why Bart Stupak's last-minute amendment to the health care bill is even more radical than you think.
Will health care reform come at the expense of abortion rights? The Democrats’ historic health care bill squeaked through the House on Saturday only after pro-life forces scored a major victory. Despite months of wrangling over the public option and the price tag, in the end the legislation’s fate turned on an eleventh-hour push by conservative Democrats to broaden the bill's existing limits on government funding of abortion, in the form of an amendment authored by Rep. Bart Stupak (D-Mich.). Here’s what happened and what it means:
The Stupak amendment mandates that no federal funds can be used to pay for an abortion or "cover any part of any health plan" that includes coverage of an abortion, except in cases where the mother’s life is in danger or the pregnancy was the result of rape or incest.
The first part of the amendment isn't new. The 1976 Hyde Amendment already prevents the use of federal dollars to pay for most abortions. Where pro-lifers won big was on the second part, which could significantly limit the availability of private insurance plans that cover the procedure.
That’s because Stupak’s amendment doesn’t just apply to the public option—the lower-cost plan to be offered by the government. The House health care bill will also provide subsidies to help people and small businesses purchase plans on an exchange. This represents a lucrative new market for insurers: anyone earning less than $88,000 for a family of four qualifies for assistance, as well as certain small companies. But to gain access to these new customers, insurers will have to drop abortion coverage from their plans.
Around 87 percent of plans cover abortion (though not all employers choose to actually include it). But under the House bill, the Congressional Budget Office estimates that 21 million people will participate in the exchanges by 2019 and that 18 million of them will do so via government subsidies. In theory, insurers could create separate plans for women who don’t qualify for credits but still want to buy a plan on the exchange. In reality, this is unlikely to happen, meaning that even women who purchase plans entirely with their own money in the new market may be unable to obtain one that offers abortion coverage.
Over time, the goal is for many more people to join the exchanges—the bigger they are, the more effective they'll be. Not only will this put greater numbers of women in the same bind, it could affect abortion coverage in private plans outside the exchanges, too. "How big will exchanges have to be in an insurer's business model before they decide it's easier to standardize their coverage?" said Adam Sonfield, senior public policy associate of the Guttmacher Institute, a policy and research organization that focuses on reproductive health.
The Stupak amendment says that women are free to buy an optional rider to their plans that would cover abortion, as long as no money appropriated by the bill is used to pay for it. Critics call this ridiculous. People don’t think they’ll need coverage for most medical procedures until the day they actually need it; as detractors of the amendment have pointed out, no one plans for an unplanned pregnancy. Imagine if all insurance plans worked like a smorgasbord, in which you tried to guess the operations and medicines you might require sometime in the future. How many procedures would you actually fork out for in advance? Five states already have similar "rider" laws in place, but according to Sonfield, "No one seems to have come up with evidence that these plans are ever sold."
Proponents of the Stupak amendment insisted that they were simply making sure that health care reform complied with the Hyde Amendment. But by constricting private coverage for abortions, they expanded Hyde’s reach. And Stupak’s sweeping measure was hardly the only option on the table. Until around 8 p.m. on the day before the vote, House Speaker Nancy Pelosi tried to marshal her caucus around an amendment offered by Rep. Lois Capps (D-Calif.), which would have allowed women to isolate their federal subsidies in a separate account and pay for abortions out of their premiums instead. But that compromise fell through after a vigorous lobbying push by the Conference of Catholic Bishops, which instructed priests around the country to raise the issue in their churches. In the end, the Stupak amendment passed 240-194, with 64 Democrats voting in support. (Twenty-three of those Democrats ultimately voted against the health care bill.)
There are two big questions as the health care reform fight moves to the Senate. First, will the Senate mimic Stupak? So far, its leading proposal contains no equivalent provision, but abortion foes, emboldened by their biggest triumph in years, are sure to push for one. Second, if a bill passes the Senate, will the Stupak amendment be stripped out in subsequent House-Senate negotiations? House Democrats’ chief deputy whip, Rep. Diana DeGette (D-Colo.), has reportedly collected signatures from 41 Democrats vowing to oppose the final bill if the Stupak provision remains in. That’s enough to prevent legislation from passing. But 41 Democrats supported both the Stupak amendment and health care reform, which is also enough to block the legislation if all of them decided abortion financing was a deal-breaker. Following the House vote, the White House declined to condemn or support the anti-abortion provision. There’s no way to predict what will come next in this high-stakes legislative tussle, but one thing is clear: in the push to provide access to health care for all Americans, abortion is now the official political football.
Update: Obama nudged Congress to revise the Stupak amendment on Monday, suggesting in an interview with ABC News that he thinks it goes too far in limiting private insurance coverage of abortions. The president explained that his administration is not looking to change the existing ban on the use of federal money for abortion—ie. the Hyde Amendment—but he wanted to ensure "we’re not restricting women’s insurance choices."
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Fuzzy Math
You note that all 41 Dems who supported Stupak and then voted for the health bill would have to vote no to kill the bill. That's incorrect; only THREE need to vote if the bill doesn't include Stupak, because the 23 who already voted no will still vote no. The House bill only passed 220-215...3 swing votes would have killed it, and at least three would have voted no without Stupak.
"May"
"In reality, this is unlikely to happen, meaning that even women who purchase plans entirely with their own money in the new market may be unable to obtain one that offers abortion coverage."
This is a vague threat, one that I think strains credulity. By this reading no hospital could provide abortion ever. No clinic could either. A much more likely interpretation would be, and a much more constitutional one, that women who overwhelmingly pay for their own abortions will continue to do so and that insurance companies with Premium plans will be able to cover this elective procedure as long as it is elective. In other words the hyde amendment is in force.
Stupak Bill
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What does this mean? It means that pro-choice Democratic and Independent women all over this country are less likely to get off the couch vote for a Democrat in 2010 or Obama in 2012! We worked for this President and this majority and they have betrayed us. Can someone tell me why the Democrats are any better than the lunatic GOP fringe?
I was with you right up
to your last completely idiotic sentence.
Yeah I've always said
Yeah I've always said lunatics are the same as sane people struggling with complicated issues. And there is no reason to vote at all is there. Cause there is no government that works and if you vote you're just a sucker for "the man" like those hip rich kids what know how to sound all pimpy like cause they used to dress like a pimp at Halloween. So conclusion- anyone who votes should just vote Republican. HMMM. Wait a minute. Is crazy like a fox the same thing as lunatic fringe? Independent female - voting my conscious since the Carter Administration. Just show me a Republican presidential candidate with a conscience and I'll consider voting GOP.
"The Stupak amendment says
"The Stupak amendment says that women are free to buy an optional rider to their plans that would cover abortion, as long as no money appropriated by the bill is used to pay for it. Critics call this ridiculous. People don’t think they’ll need coverage for most medical procedures until the day they actually need it; as detractors of the amendment have pointed out, no one plans for an unplanned pregnancy. Imagine if all insurance plans worked like a smorgasbord, in which you tried to guess the operations and medicines you might require sometime in the future."
I don't like the Stupak amendment, but this part of your argument makes no sense.
"...detractors of the amendment have pointed out, no one plans for an unplanned pregnancy. Imagine if all insurance plans worked like a smorgasbord,"
That's pretty much how all my insurance plans DO work. My apartment insurance works that way, and I have to get specific riders to pay for computer gear, electronics, jewelry, and exotic sex toys. My car insurance works that way, and I pay for riders for glass, for electronics, for rental car replacement, etc.. My disability insurance works that way, and I choose what level of pay replacement I need. And my current health insurance works that way too, and I choose the levels of copay, deductible.
The problem with this bill is that it includes insurance companies and ties insurance to employers. This is a bad bill. According to Marcia Angell, MD, former editor of the NEJM (google her post at the HuffPo, this is a bad bill, that is worse than no bill, and one way to see this, is that we are calling it insurance but as you state above, you don't want it to work like insurance where we are figuring out how best to cover some unlikely event from occurring.
I don't like the Stupak amendment, but it seems easy enough to check the web for the unwanted pregnancy rider.
When my daughters will need that, I will be paying for that. Are you telling me that women are smart enough to buy car insurance, apartment insurance, trip insurance but are too stupid to understand they may want unwanted pregnancy insurance?
I can understand an argument saying that woman should not have to pay this charge, or that the rider may be too expensive for many, but I think you spit on women when you say they are so stupid.
I for one, don't believe they are as stupid as you claim. Why are you so sexist?
abortion rider
I read that some states have provisions for abortion riders in their laws, but a quick check of the insurance companies in those states showed none of them offering such a product. Unless this law mandates that rider policies must be available to women (gasp, a government incursion into private healthcare insurance), it doesn't make sense to move forward thinking this will actually occur
I'm not doubting you (okay,
I'm not doubting you (okay, maybe I am), but why wouldn't there be rider policies available?
Again, I don't agree with the Stupak amendment, but abortion is a relatively rare/low cost legal treatment, there would seem to be a ready market for it, and it seems much easier to insure than many of the catastrophic illnesses that occur to people, why wouldn't a rider policy be available?
And what would stop NOW or Planned Parenthood from stepping in and offering such insurance same as DAN offers diver insurance, AOPA offers pilot insurance, Sporting goods stores offer hiking insurance, and many non big-insurance companies offer Mexican car insurance?
You may want to consider
You may want to consider that there are a large number of disadvantaged women in this country who in fact are not able to purchase insurance riders for their apartments or anything in it. These are women who have no health insurance as the situation stands, and who if anything will be only able to afford the lower-cost public option which will now offer them no abortion coverage.
It is neither sexist nor insulting to consider these women... not everyone has the means pay either for insurance riders of for abortions out of pocket.
As I said, "I can understand
As I said, "I can understand an argument saying that woman should not have to pay this charge, or that the rider may be too expensive for many"
The argument was made by the Rachel Morris that women are too stupid to buy the rider, not that women are too poor. I agree the rider is unfair and may be too expensive for many, but I just refuse to believe women are as stupid as Rachel Morris demands they be. (And I go on to show with a simple botec that the rider cost is probably on the order of $50-100 per year.)
the problem is
The problem is not that women are too stupid to buy extra coverage, if they are not too poor to afford it, the problem is that insurance companies in places where they could do so now do not offer it, and there is no indication that they ever would. It will simply not be available as an insured procedure, meaning all costs will be out of pocket. Hopefully, the insurance policy *will* cover the costs of repairing the damage done by coathangers and back-alley quacks.
This is an idiotic sentence
"Imagine if all insurance plans worked like a smorgasbord, in which you tried to guess the operations and medicines you might require sometime in the future."
That's exactly, precisely the way it works in practice, unless yo'uve got a nice, fat, happy employer-provided insurance plan you only get to say yea or nay on.
If you have to buy your own insurance, you're shopping among available policies, some of which cover lots of this, others lots of that, etc. You have to, IOW, make an educated guess from your own medical history and that of your relatives which kinds of ills you're most likely to fall prey to. That's only NOT the case if you're so loaded, you can afford one of those comprehensive "cadillac" plans.
Get a grip on the subject s you're opining on, please.
buying separate coverage for abortion
if they keep stupak, then women will have to purchase abortion coverage separately. I don't think any woman will pay separate for abortion coverage. Also, most people don't think about abortion until they need it. "it will never happen to me. I won't need it." No one thinks they will be the one that has the anencephalic baby or baby with defects.
Also, why should poor women and middle class women have less Choices than rich women. That's what it comes down to. If you believe in equality and in Choice, then you have to support coverage of abortion. Otherwise, it's just talk. Without coverage, there is no choice. In this economy, people are deciding between meds and groceries. When government pays to continue the pregnancy and not to terminate, then the latter is not a choice.
Women aren't stupid
I would think that women who are wise and intelligent enough to find and purchase an unwanted pregnancy rider would be able to avoid an unwanted pregnancy. But I guess that wouldn't necessarily apply to their daughters.
Unconstitutional?
Someone mentioned the Stupak ammendment was unconstitutional. Does anyone have an idea if this could be true?
k.b.
I don't like the Stupak
I don't like the Stupak Amendment, but does anyone have any idea of how much the abortion rider would cost?
Guttmacher says there are 20 abortions for every 1000 women (2008) http://www.guttmacher.org/pubs/fb_induced_abortion.html
And they say the average cost of an abortion is $500 (in 2001), so let's say the average cost is $1500.
So we have $30,000 in abortion costs each year to be covered by 1000 women, or a rider of about $30.00 plus some outrageous markup. Call it a $100 rider based on 2001 costs multiplied by three and a 200% markup.
Does that sound at all in the ballpark?
"How many procedures would you actually fork out for in advance?"
How many car accidents do you fork out for in advance? Huh? WTF?
unpacking Stupak
It is a rather complex task to analyze the cost of abortion coverage. How many pregnancies would be carried to term if insurance didn't cover the cost of an abortion? Pregnancies carried to term are the most costly for the insurer.
How many pregnancies carried on as a result of having no abortion coverage would be spontaneously aborted (miscarried), resulting in somewhat greater cost to the insurer than an elective abortion?
The problem with this "math"
is that even if the premium is only $100/year, you're asking women to pay it every year during their child-bearing years. For most women that's at least 30 years. Unless a woman expected to have multiple unplanned pregnancies, it would be cheaper to just pay for the abortion. Like not buying collision insurance on your car because the premium is close to the value of your car so the risk is manageable. If the pool of women buying abortion insurance goes down significantly because a lot of women decide to take the risk, then the cost for the women who could afford $100 a year, but not $1500 all at once so they purchase the insurance, would be much higher.
rebate
Women who sign up for abortion coverage should get REBATES from the insurers. Abortion is much cheaper than carrying a pregnancy to term. Abortion is usually cheaper as an elective procedure than when it occurs spontaneously (miscarriage).
Can someone find out if
Can someone find out if Viagra and other male-enhancement drugs will be allowed on this GREAT (cough) new health plan?
The Democrats, per usual roll over. How pathetic.
My understanding is that they
absolutely are covered. And it's not just abortion for women. Many, if not most, insurers do not fully cover women's routine reproductive health needs, and this bill says zippo about requiring them to do so.
Bill Also Repeals the Children's Health Insurance Program
Shockingly, the bill also repeals the Children's Health Insurance Program (CHIP). So much for protecting the rights of women and children.
My quick google news google
My quick google news google doesn't turn up anything showing that CHIP is impacted. It's a very interesting claim. Can you provide a citation please?
Are we turning into
Are we turning into Afghanistan or Saudi Arabia where women have no rights whatsoever, except to work like animals and reproduce. The C street "church" produced this amendment re: abortion. Rep. Stupak lives at "C" Street and is a very good friend of right wing Republican Rep. Pitts, who co-sponcered this amendment.
The Democratic Party is starting to produce it's own brand of right wing zealots that we all need to look out for. Kudos to the 41 women of the Congress who have promised not to vote for the bill unless the amendment is removed.
Stupak needs to be
defeated in 2010. I will not only support a primary challenge, I've emailed him I will support and contribute even to a Republican opponent. Might as well have a real GOPer in that seat as a fake Democrat.
abortion and the health care bill
Sounds like the bill will not cover the "procedure" called an abortion. The medical "procedure" is not the only answer ... what does the bill say regarding The Morning After Pill?... come on... there are options!
Annie
morning after pill is NOT an abortifacent
Please do NOT confuse the "morning after pill" aka Plan B with RU486. The "morning after pill" does NOT cause an abortion. If a woman is pregnant and takes it,
NOTHING happens. In fact in JAMA 10/06 it states roughly "there is no evidence that Plan B has any effects after fertilization and in fact the evidence is to the contrary." Thus, once the sperm/egg hook up, Plan B (the morning after pill) does NOTHING.
Also, Plan B is now over the counter. so the question is will the plan cover over the counter stuff? usually, no.
whose options?
Why are you or anyone else with me in my doctor's office making decisions about what medical care I can get? The options are MY options, not yours!
Afghanistan, corporate
Afghanistan, corporate welfare, now Stupak... Dems seem to be hell bent on driving the progressives away.
Stop IT!
Fuzzy math indeed. The average cost of a 1st trimester abortion is less than 500 dollars in most states for women without insurance of any kind. Up to 1000 dollars for second trimester. It is mind-boggling to derail health care reform for everyone over this kind of selfish, special interest procedure. It's a LOW COST PROCEDURE, people! The average cost of repairing a broken arm for people without insurance averages nearly 10K. More in many regions of the country.
The greater good, folks. The greater good!
My Point EXACTLY!
I am Pro-Choice and I totally agree with what you're saying. This might be a step back in a way, but come on we can get it back later if we need to. It is far more important to save the lives of the people that who have no control over their situations right now.
You never regain freedoms you lose
You obviously have no idea how long it took to get Roe V. Wade passed. Once you give up your freedoms you don't get them back. I wouldn't be so blithe about just letting this go if I were you. I'm postmenopausal, it's no longer my problem. But we fought many years so you could have this right. It's sad to see people so cavalier about it.
There is more than just the
There is more than just the cost of the procedure. There are travel costs, having to spend the night in a hotel (or your car if you can't afford a hotel) where the abortion is going to be done because of that idiotic 24 hour waiting period, the cost of child care if there are other children that have to be taken care of while the woman is gone. Add food to that, and the costs rack up.
Most poor women don't live right next to a clinic. They have to travel many miles to one, possibly to another state.
Come on. You didn't see some
Come on. You didn't see some conservative subterfuge coming? Do the Dems even consider strategy? ...the endgame? How a party can be continue to be blindsided by the presence of politics in politics, is aggravating as hell. Have they not been paying attention for four decades?
Okay, so has Shtupak
Okay, so has Shtupak offered legislation taking Viagra off the drug formulary for the public and private options. Ofcourse these manly men can buy a rider for you know if they do need Viagra at some point. I'm sure Shtupak has offered legislation of this kind correct?
Stupak amendment
This will just bring us back to where we were before Roe vs. Wade: Middle class (whats left of them) and rich women will just get on a jet - it always used to be either Mexicana or Swissair when I was in high school (early 60s) - and fly off and get rid of it. Poor women - who always seem to be the ones who bear the brunt of religious fanaticism - will continue having unwanted babies....and then the right will wail about how much this is costing "them" for these peoples "irresponsibility".
I can live with Stupak for now
While I do not like the Stupak Amendment, when I step back and look at this in perspective I feel I can live with it. There are so many people out there suffering from genetic disorders, fatal illnesses beyond their control, major injuries they were not responsible for inflicting on themselves that I think it's time we focus on them. Women (and men) who get themselves in these situations, while they do deserve compassion and rights, may need to take a back seat right now.
I have a genetic disorder and haven't been able to see a doctor or be treated steadily for years because I have no health insurance. The quotes I have been given from multiple insurance companies are all around $700 a month if they decide to cover me at all. I don't have any control over my disorder and it does get progressively worse.
Now I'm hearing that an abortion procedure is actually only $500-$1500 and this is what's holding up my chances for health insurance? It makes my want to cry. Call me selfish if you want but I am pro-choice. I am just tired of having to take a back seat those people who made choices and ended up where they are.
"made choices and ended up where they are?" NOT!!
what about someone who has an anencephalic fetus that threatens her future fertility? under stupak, she has to pay the $10k or so for the late term "partial birth" abortion to remove it, so that her future fertility is not jeopardized.
what about someone with a fetus with genetic abnormalities? or fetal abnormalities?
When you don't fund abortion, it's not a choice for the poor and middle class.
The conservatives should NOT be making the democrats split up over "we can't let the whole healthcare thing go down b/c of abortion."
Abortion should not be even being discussed. It is currently covered by 87% of private insurance. It is part of comprehensive reproductive healthcare. It costs less for an abortion than prenatal care and welfare.
Covering abortion is the moral choice (rich and poor should be able to make the same choices when it comes to a pregnancy)
Don't be angry about pro-choicers for losing healthcare reform. Be angry at the dems who didn't squish the amendment or the Repubs for bringing abortion up.
back to the dark ages
For gods sake, tax the f'n churches already. They are supposed to stay out of politics in return for their free ride. What is this, 15th century England, that the bishops get to dictate the content of our laws?
Agreed!
Carlin would be proud!
The head butt pro....butting one head at a time.
You folks are idiot nut
You folks are idiot nut jobs.
I know you like to cry about how you are victims of men, but the Stupak amendment was voted FOR by at least 17 women, two of whom are Democrats.
You pretend to be about human rights, but then you like to shame men about their sexuality. If a man said something like women have no human health rights to achieve an orgasm, all we'd hear about is the misogyny.
And then you pretend that should the amendment pass no one will offer you insurance, but the actual facts from the Guttmacher institute shows that NOW and Planned Parenthood could start offering a profitable plan TOMORROW for $40 per year per woman.
Maybe that leaves some women out, so why don't you start a charity for them -- I'll gladly donate.
But your logic just ain't there. Viagra is not abortion. If orgasm is good for women, then, yeah, men should be able to be treated for sexual dysfunction too. And should the Stupak amendment make it to a final bill, insurance will be available for $40 per year from NOW, from Planned Parenthood, from about three dozen Stanford MBAs some male, some female.
So stop pretending you're any sort of victim made to breed like cows. There actually are victims out there, and all you are are a bunch of whiny assed titty babies.
you folks
I Vow to leave this World in better condition than I found it.the thing is what if women were trying to make it illegal for men to achieve orgasm ?? would the stupak go through then... how much control would they let the Catholic Church have then...
i for one am not ready to give anymore of my rights up..the church took coontraception and now they want stronger than Hyde..
women have worked hard to get where we are , the right to vote, work,be promoted to a higher position than a man at work,( even thought we still have not got equal pay yet.) and so many more hurdles we have had to jump and jump..
i will not give up easily and no other woman should either.
i bet the women voting for the stupak are old or have the means to take care of it..
oh they do..our elected officials have had abortion coverage sense 1991... when this became public knowledge they said they were going to have it removed...
kinda hypocritical of them if you ask me...
There can be a substitute amendment
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Stupak claims all the purpose of the amendment is to extend the Hyde Amendment. My understanding is the Hyde Amendment is broad enough it may already apply to anything passed unless explicitly stated not to apply in the HCR bill. In any case, the status quo can be maintained by substituting in conference the language "The pertinent provisions of this bill shall conform with the provisions of [insert real US Code citation of Hyde Amendment]." Or words to that effect.
Then next year or in 2011, after we pass HCR, push to repeal the Hyde amendment. Tie the Stupid Amendment to it's supposed model and then repeal both by attacking the model which is more clearly an injustice. Hyde was a "wedge issue" vote; now make defending it a wedge issue back at the Republicans
This is what you get when
This is what you get when you hand over health care to govt. control -- its politicization.
Ironically, it's the Left that wants to give government this level of control, yet is already freaking out before the bill is even signed into law! This isone of the most compelling intellectual cases for limited government: why would one want to hand over the instrumentalities of 1/6th of our economy to governent when one fears what the "other side" (politically speaking) will do with such instrumentalities if and when it assumes power? Or, in this case, even before it assumes power?
I support abortion on demand
I support abortion on demand - no apologies.
I also support keeping insurers from paying for abortions. It's an ELECTIVE procedure, like a nose job or breast implant - if that's the compromise it takes to get a health insurance bill passed.
Come on my fellow liberals - don't get all extreme like the TEAliban. It's an acceptable comprimise!
I'm with you....
I will ALWAYS support a woman's right to an abortion.
But it IS an elective procedure..which..quite honestly...I'm SURPRISED was EVER covered by ANY insurance.
As long as RvW is left in tact I can live with the procedure as elective.
I think we should spend our energy working for Planned Parenthood so that they can offer the services to everyone. If we do this our poorer sisters WILL be able to find the services they need.
Regarding HCR...I sure don't want this to be a deal breaker for us. There are SO MANY less fortunate who deserve the same health services that I am lucky enough to have. In order for them to have the same advantages as I...I'm willing to give these stupid old white guys/gals their stupid Amendment.
price of abortions
in reading many many comments on various articles on this topic, i am coming across so many comments where people say basically, abortion is such an inexpensive procedure, why do we even need this? the people who read the nyt, wapo, mj seem to be incapable of grasping the fact that there are thousands and thousands of women in this country for whom $300, $500, $1000 are huge amounts of money that they just can't get their hands on.
now it would be no big deal for me now to pay for an abortion, but back in 1984 i couldn't scrape together the couple hundred it cost then. thank god that the state of california was paying for them back then.
look outside. there are millions of people who are poor, poorer than they ever imagined they would be. not everyone has someone to turn to, to bail them out. for women who need abortions the most, for whom having a child would be a total disaster, the cost can be insurmountable. for them it's not a cheap procedure.
Thank you
The reflexive elitism is nauseating.
