The Stupak amendment, deconstructed [UPDATED]
I've encountered a fair amount of confusion about the abortion language the House actually adopted on Saturday. Read it for yourself here -- it's a little more than three pages in large type, much of it spent removing abortion-related provisions in the underlying bill. The amendment by Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.) would restrict only the new insurance marketplace (a.k.a. the "exchange") that the bill would create for uninsured individuals and small businesses. It would have no direct effect on the group insurance policies that cover many American workers and their families. Whether it would have an indirect effect on those policies, however, is an open question. Feel free to offer your speculation in the comment section below.
Specifically, the Stupak amendment would prohibit federal dollars from being used to buy any policy offered through the exchange that covered abortions other than those related to rape, incest or danger to the mother's life. It also would require insurers that offered elective abortion coverage through the exchange to also offer policies "identical in every respect" except that they did not cover such abortions.
The main effects of the amendment would be to stop anyone receiving a federal subsidy from buying a comprehensive health insurance policy that covered elective abortions, and to bar the proposed government-run insurance plan (a.k.a. the "public option") from covering such procedures. The amendment would allow insurers to offer "supplemental" policies that covered abortions, but their customers could not use federal subsidies to buy them.
Prior to the Stupak amendment, the House bill would have required insurers to jump through some accounting hoops to segregate the money collected for coverage that was mandated by the bill -- and eligible for subsidies -- from coverage for elective abortions. But abortion opponents argued that this arrangement didn't go far enough. Money is fungible, after all, and making the mandatory coverage more affordable with subsidies would also make any additional coverage more affordable.
The same argument applies to the Stupak amendment. The Stupak language would require women seeking coverage of elective abortions through the exchange to sign up for a separate policy, potentially (but not necessarily) forcing them to spend more for the two than they would have spent on a single plan that included the coverage. Of course, their ability to afford the supplemental coverage would be greatly enhanced by the federal subsidies that shrink the cost of the main plan.
So why is the pro-life camp so enthusiastic about the amendment? Maybe they expect it to lead insurers to stop offering any kind of coverage for elective abortions through the exchange. That's what Planned Parenthood and its allies fear. These advocates complain that insurers wouldn't offer the supplemental coverage because there wouldn't be enough demand, given that abortions result from unplanned pregnancies. I'm not so sure about that -- no one plans to get sick or break a bone either, and yet everyone who buys health insurance wants to be covered for such things.
It's also worth noting that although many insurance policies cover elective abortions today, a high percentage of them aren't paid for by insurers. In addition, 17 states use their own Medicaid budgets to pay for "medically necessary" abortions for poor women.
So the Stupak amendment may not have much effect on the poorest women in states such as California, women covered by group insurance policies, or women of means. But it's undeniable that the amendment threatens the availability of insurance coverage for elective abortions for the working poor and lower middle class -- the ones who would receive subsidies under the House bill to buy insurance through the exchange. That category includes those making 150% to 400% of the federal poverty line -- up to $43,000 for a single woman.
Updated, Wednesday at 3:27 p.m.: I see from the comments left by Karen, Nate and a few others that I shouldn't have referred to abortions not covered by the so-called Hyde amendment restrictions (i.e., to terminate pregnancies not caused by rape or incest and not needed to save the mother's life) as "elective." My bad. The non-Hyde category includes abortions that would be deemed "medically necessary," which is a very broad classification. In fact, some abortion opponents view "medically necessary" as a loophole so wide, it opens the door to abortions for practically any reason.
-- Jon Healey