I posted on my Facebook feed (and I'm sorry to admit I am much more active over there than here, what with my limited time these days) that the Stupak amendment should be stopped. A reader asked me:
"Claudia, how much concession do you think should be made to political
reality? Standing firm on abortion probably means no insurance reform."
His subsequent argument was that only those people who aren't covered by health insurance won't in the future be covered for abortions.
This is both simplifies a complicated issue and does not make the amendment any less appalling.
Let's break this down a bit. First, let's look at the language of the Stupak amendment and see what it entails:
The Stupak amendment prohibits any insurance company that is subsidized by the government to offer abortion coverage at all.
There are exceptions: the companies are allowed to cover abortion if the pregnancy would result in a threat to the life of the mother, or if the pregnancy is the result of rape or incest.
As an individual, you may purchase an additional coverage for abortion provided you are not paying for it with government monies.
So, you may think that this is not too bad. After all, the most severe conditions are covered and anything else is just bad luck, eh?
Not so fast. Not covered are procedures that put the mental and physical health of the mother over the the child.
Back in 2004, I went to the OB-Gyn at week 19 to have a check-up. I had felt awful, had been losing weight, and was totally out of sorts. The doctor could not find a heart-beat. The body had already started decomposing, so the little boy had died some time earlier. Obviously, my body did not want to terminate that pregnancy by itself. I was hospitalized, induced, gave birth to my son and then had a D&C to make sure that no harmful tissues remained inside my uterus. The whole procedure was awful, of course, but it was also dignified, I was in good hands, the doctor and nurses did everything to make this as easy as possible for me.
The three-day stay in the hospital, the induction and the D&C cost over 4,000 Euros. It was covered by my health insurance. I didn't have to pay a single cent.
Under the Stupak amendment, we would have had to pay this out of pocket since at no time was there a threat to my life. The mere fact that my body didn't expel the baby would not have been enough reason. The fact that I was not in imminent danger of dying would have disallowed my health insurance provider to pay for the abortion. I might have gone insane walking around with a dead baby inside of me, or I might have been unable to care for my two living children, I might have gotten really really sick but unless I would be in imminent danger of dying, all this is of no concern to the likes of Stupak.
That's one reason I dislike the amendment. There is no coverage for women who don't want to give birth to children who die at or shortly after birth. But this isn't the worst part.
A reader of Andrew Sullivan's Daily Dish explained it very well:
Roughly 85% of people buying in the exchange are expected to receive
some amount of affordability credit. If Stupak becomes law, no person
will be able to buy a plan in the Exchange that covers abortion. It
will force millions in the middle class to have their plans be deemed
ineligible if they currently include abortion coverage - whether or not
they qualify for subsidies.
Few women and even fewer men will sign their family plan up for
coverage if it requires a rider. Or they'll forget that it's available
after signing up for a plan years before their daughters are teenagers.
As the Bishops and their representatives in Congress told many members
of Congress last week, few women use insurance coverage for abortions.
That's probably right. But that won't help the thousands of women
each year whose ethics tell them that they need an abortion for their
health, or for their other fetus's health. The agonizing stories you
posted earlier this year -- many of them were expensive hospital
procedures, not clinic-based ones - are expensive. And many
will be out of pocket if Stupak becomes law.
And many, many of those will not be able to afford these procedures.
Women don't usually anticipate needing an abortion. It's like anticipating that you will get a hernia one day, or chronic backpain, or congestive heart failure. That's what you purchase health insurance for - to cover you in case of medical need, whatever that may be. You don't buy your health insurance by checking off the conditions you expect to develop in the next fourty years. Just like you don't expect a broken bone, or respitory arrest from H1N1 or pancreatic cancer, you don't expect that you may need to have an abortion until, well, until you actually need it. You just don't anticipate needing an abortion. I didn't, either.
Some scenarios of abortions that would not be covered are:
The abortion of a child that will die at or after birth, saving
the mother the pain of having to carry a child that she knows will die
The abortion of a child that endangers another child in the womb
- think twin-to-twin transfusion or multiple fetuses. Reduction
procedures that may save the life of one or two at the cost of another
are not covered. So what if you lose all children then? God's plan,
The abortion of a child that endangers it's mother's mental well-being.
The abortion of a child that endangers the mother's or the family's social well-being.
Furthermore, the commenter says, "The law applies only to the plans offered on the national exchange:
e.g., the subsidized plans aimed at people who don't currently have
coverage. In other words, people who currently aren't covered for abortions won't get coverage for abortions...."
If I'm right, he's thinking that a coverage without abortion is better than none at all. In that I would have to agree, although it would also infuriate me. Being poor should not mean that you have to resort to coat hangers, especially if you live in a country with excellent health care. Any procedure that is legal in the United States should be covered by health insurances offered on the exchange. The real problem, though, is that the restriction will not stay on the exchange, and people who shop on the exchange will not only be those who had no health insurance prior to the exchange.
For instance, the new health care bill allows small companies to opt out of private insurance and instead allow their employees to purchase health insurance on the exchange.
[...] 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.
De facto, the Stupak amendment is a ban on abortion for those who can't pay for it out of pocket while abortion remains legal.
I'm glad to see that the President is backpeddeling some, although I would like to see the whole "no federal funding for abortions" go away. But I'm willing to compromise. For now.