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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


Comments () | Archives (43)

The comments to this entry are closed.

Randy B.

I would like to add my comments to this issue.

If you support abortion, then this is what you must support. PLEASE BE WARNED: GRAPHICAL IMAGERY (However, this is what abortion does). During a second trimester abortion: “A long curved Mayo scissors may be necessary to decapitate and dismember the fetus…" (From the medical textbook Abortion Practice – Dr. Warren Hern, p.154, describing legal activity) (priestsforlife.org). This textbook is used by abortionists.

It's a who that is killed, not an it. Science proves it.

Treat an unplanned pregnancy? It's called giving birth. I know some women are horribly sexually abused and a child is conceived. However, what wrong did the child do? It is the equivalent of if a person had their home be destroyed by fire and then someone stole their car, because the affected victim probably would not be able to afford the car insurance anymore. It does not make much sense and neither does abortion: one person is killed and a mother is scarred for life.

Medically necessary? Define that for me please. The only case for a mother's life being in danger is an ectopic pregnancy. The secondary cause of treating this is unfortunately the lose of a human loss that was not the doctor's intention. Plus we have the medical technology available today to treat and save people, the mother and child.

Thank you for your time.


It confuses me how one can compare an unplanned pregnancy to an illness or a broken bone. A disease or illness is a part of the body that is not working correctly. Pregnancy is not a disease or an illness (you're comparing apples to oranges) A pregnancy is proof that that organ system is in fine working order. Why should insurance or federal money be used to support abortion when an abortion is not part of taking care of your health? Abortion is not fixing something that is wrong, it is breaking down something that was working correctly in the first place. The purpose of health care is to help each of us live longer lives. How does abortion accomplish this task?


Is it really so much to ask people to use their OWN funds to kill their unborn children? Why does anyone think they have a right to use money confiscated from the American taxpayers, many of whom find abortion morally abhorrent, for an elective procedure, especially one so controversial?


Would you consider ending insurance for public employees as it may be used for abortion? If affordable insurance is to be denied based on inclusion or exclusion of abortion language or on cost perhaps we should reconsider the coverage and billions of dollars spent on insurance subsidies for public employees. Are health care opponents fighting on moral and finical beliefs or supporting the health insurance industry?

dont buy it

So, if you are a 50 year old woman who is barely making it financially, and who has no plans to get pregnant, but does so....and the baby is likely to be severely deformed or otherwise unable to live if born, and that same woman did not spend EXTRA MONEY to buy a supplemental plan, she is out of luck if she cannot afford to pay out of pocket. And the baby is born and dies in front of her. This is something that many have no discussed. The exclusions do not cover an instance like this.

Folks abortion is LEGAL. And to demand that a woman pay for a rider to cover a LEGAL MEDICAL PROCEDURE is wrong and DISCRIMINATORY.

This had better be stripped from the final bill. I am sick and tired of (mostly) right wing men controlling our bodies. Enough is enough. We pay more as it is for insurance, and a male Republican members of congress says women are like those who smoke so we should pay more?

These same men made sure VIAGRA is covered in insurance while birth control was not and are still trying to stop the latter from coverage.

One of these days the women of this country should go on a sex strike. When men agree to stop dictating and discriminating against us, they get some. Until then, no sex! That might wake them up.


Whatever people feel about abortion, the simple fact is that it is a very hot-button issue. I don't think opponents of health-care reform could have found a better issue to try to kill it than this if they'd actually looked for one. I mean, it's practically tailor-made for causing otherwise rational people to start frothing at the mouth.


This discussion inadvertantly illustrates the hazard embedded in Roe v. Wade: using the Supreme Court rather than the Congress to secure a Federal abortion "right" forever leaves this issue unresolved for a large minority of the American public.
It also illustrates a big flaw in the Pelosi legislation, namely the elimination of choice not just for abortion but for virtually all aspects of our health care. There is enabling language in the legislation to mandate that bureaucrats define and standardize the terms and conditions of our health insurance plans - and to prevent us from shopping for alternate policies.
So when liberals begin to whine about the specific lack of "Choice" as regards abortion perhaps they should contemplate also the broad lack of choice generally in the legislative alternatives that are being provided by Congress.

Blurring the lines

dont buy it - many of your comments are either wrong or absurd. First, support for abortion is empirically higher among men than among women in this country.

Second, 50 year old poor women who have deformed fetuses who will die upon being born are not exactly a prominent number of abortions. In fact, I'd be willing to guess that happens less than once a year. The vast bulk of abortions are done by younger women with perfectly healthy fetuses. If you want to have a debate, debate the reality, not some hypothetical corner case.

Third and finally, you state that "to demand that a woman pay for a rider to cover a LEGAL MEDICAL PROCEDURE is wrong and DISCRIMINATORY." That is absurd. Rhinoplasty is a legal medical procedure and I can't imagine anyone saying that you should not have to pay extra to have that kind of health care.

The fact is, you support abortion, so you think it should be paid for. But it's one thing to allow individuals to exercise a morally controversial right and another thing altogether to demand that those ethically and religiously opposed finance it.


Remember, the issue is who will pay for it, not whether a woman can choose to have one. There are a number of items I don't want my federal tax dollars to pay for. This is one of them. The choice still belongs to the woman, as it should.


Please call the amendment by its proper name: Stupak-Pitts amendment. This was designed by Joe Pitts (PA-16). Stupak is just the Dem. name. This is a GOP/C Street Gang thing. Most of the support for this bill came from the GOP anyway.


I have a huge concern on this topic. The term "abortion" is defined as the loss of a pregnancy...whatever the reason or however the procedure. I have done insurance billing in OB-Gyn for years and I have yet to find a private insurance company willing to cover an "elective abortion" Maybe because insurance policies don't tend to cover any "elective" procedures. Therefore, neither should any gov't. funded plan either.

I have also had to argue with insurance companies to cover the cost of a "spontaneous abortion" (miscarriage) because the term "abortion" is in the diagnosis. So, I'm just not sure what they are talking about when they say private health carriers already cover abortions.

I have also worked in hospitals where, unfortunately they have performed 2nd trimester abortions for MEDICAL REASONS and there is no dismembering or decapitation done! The woman is put through labor with the use of pitocen and the fetus is delivered as any full-term fetus would be.

There are many other reasons why abortions are done other than being used as a form of birth control. I think before any of us can speak out for one side or another on this issue, it needs to be clarified on exactly what we are talking about. A therapeutic abortion is a whole different ballgame than an elective one. That would be comparing apples and oranges.


They are merely interested in restricting safe abortins only to those who can afford a first class plane ticket and a Eurpoean vacation with a side visit to a private clininc where thay can take care of things that never officially happened therby giving them the right to pretend it never did and to sit high upon their moral pedestal and look down on everyone else.


I'm a progressive libertarian, I want single-payer healthcare (i.e. medicare for all), and I support a women's right to have an abortion. I don't see anything wrong with this amendment, and it's certainly not worth weakening health care reform over.

First of all, if we're going to use government funds to provide for people's healthcare, which I believe we should (and I would personally prefer the government paid for all healthcare through a single-payer system), we have to be careful about how we allocate those funds so that it does not just turn into a rampant populism of who can snatch more government cash. For that reason, health care funds should only go to MEDICALLY NECESSARY procedures. Asking someone to give their tax dollars for elective abortions, from a fiscal perspective, doesn't make anymore sense than using tax dollars to pay for face lifts, or breast enlargement.

Secondly, many people in this country have a very understandable moral issue with abortion. If we believe in the right to make our own choice on this difficult moral question of when life begins, we need to respect the opinions of those who make a different decision than us. Pro-lifers have a right to their opinion too, and their opinion is that abortion is murder. Now they shouldn't have the right to force that conclusion on every other woman, but neither should they be required to fund an act they believe to be murder if it is not medically necessary to protect the life of the mother, in the name of health care reform.

And really, in the grand scheme of medical costs, abortions are relatively cheap. Nobody is going bankrupt or losing their home over the cost of an abortion. And this is coming from someone who earns sub-poverty wages and has no health insurance.

Let's focus on things that matter here.

Molly, NYC

"I'm not so sure about [women not buying insurance for unplanned pregnancies] -- 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."

Didn't actually run this piece of brilliance by any women, did you?


This is what I think it's about: There will be less abortions in this country if people (women, spouses/boyfriends, or both) have to pay for them. This is what I think the anti-abortionists are trying to accomplish - less abortions through responsible use of birth control.

One of my friends had six abortions between the ages of 18 and 35. Because of her wealth and views, she was not as concerned about terminating pregnancies, or the costs, and was not as responsible with birth control.

Another friend, after having three children, chose to abort her fourth pregnancy, and because she had to borrow the money for her abortion, she made sure it never happened again by using birth control responsibly.

I think anti-abortionists are concerned that my wealthy friend's attitude may become more common with more "covered" abortions, resulting in more slip-ups in birth control, and an increase in abortions. They are probably right.

Tom Bates

What happened to the birth control pill, vasectomy's or personal responsibility?

Did the Catholic Speaker of the House forget?

Rick Gibson

It appears likely that this amendment has effectively killed Obamacare. The overall bill passed the House of Representatives by 5 votes. There are 40 Democrats who say they will not vote for the bill, unless it has this amendment. There are also 40 Democrats who say that they will not vote for the final bill, unless this amendment is stripped out of it. Either way, the final bill cannot pass, unless either the pro-life or the pro-choice people fold. We already know that the pro-life people are not folding; they forced Pelosi to permit this amendment. How strong are the pro-choice going to be? We do not know, but my guess is, when you force liberal Democrats in Congress to decide, which do you value more, Obamacare or abortion, you are going to get at least five, and probably many more, who say no to Obamacare.


C Streeters - The press needs to track how they vote on everything so we can learn the details of their agenda, particularly in foreign affairs.

joel palmer

It comes as no surprise that there are stupid and destructive demmocrats too.

Stupak (that name should tell you somthing) is as misguided as anti choice gop hardliners; lest get rid of him in the next go round; mpore progressives needed across the board.

Time to defeat all republicans and about 40 democrats in the House


Very well put. If something is medically necessary it should be covered, if it is elective then I should not be covered. If we choose to cover elective procedures, then I'll put my order in now: my husband would love me to get breast implants just because it would put a smile on his face and I would love to throw my glasses in the garbage so sign me up for eye surgery.


If democrats are seriously concerned about any woman getting access to elective abortions, they are quite free to set up a charity to pay for as many as they want.

Why are they so determined to fight so hard to take my money to help?


It seems to reason, that abortions are still covered under this plan. This part of the bill will leave many gyno's faced with a choice. To claim their patient was raped, her father did it, or it could risk her life and collect on an abortion, which is insurance fraud; or to actually follow the rules. More than likely, many doctors may look the other way, its not women who want abortions that are the most likely candidate to sue a doctor.

Bill Becker

How many people who oppose a woman's right to a safe abortion were enthusiastic supporters of all U.S. violence--direct or by proxy--against innocent foreigners? (Iraqis, Nicaraguans, Indonesians, Salvadorans, ...) Virtually 100%, as long as Washington (read "Reagan/Bush I & II:) said the violence was necessary.

So, please don't try to con me with crocodile tears over an aborted fetus.

Gordon Potik

Compromise is a wonderful attribute to our Social, and Political proces. It allows us to attain social progress from chaos.


First, an "elective" abortion is not the same as breast implants or elective eye surgery. It is about a difficult, life-changing decision. It is about getting an education so you can support yourself. It is about getting out of an unhealthy relationship. It is about realizing you made a HUGE mistake, that you'll never make again. It's really a very serious decision. "Elective" doesn't do it justice.

Second, for those who don't want their tax dollars spent on abortion -- consider how much 20 years of AFDC payments will cost. Not to mention, unwanted children are much more likely to turn out badly, at an even bigger cost to society.

It is in everyone's best interest to make sure that every child is wanted, cared for, and can be properly provided for.


I am appalled that people in this comment thread are equating breast enhancement surgery and eye-corrective surgery with abortion. Do we really need to remind people that choosing to have an abortion is not like getting up in the morning and, after finishing one's coffee, proudly chirping "you know what would really complete my already wonderful day? getting an abortion!" and then frolicking off to the abortion clinic.

Of course women should not be forced to pay extra for an abortion. If getting a tumour (even if it is benign) removed is covered by federal health insurance, then so should abortions. Just because a relatively small number of people will be covered for a certain condition does not mean that it shouldn't be covered at all. You know what else is rare? Prostate cancer. And no one has an issue with getting that covered.

I'd like to know if vasectomies (also an 'elective' procedure),condoms, birth control pills and the morning after pill will be covered by the federal health care plan as well. If not, then excluding abortion isn't just wrong, it should be considered criminal.

RE: Nate's final quip: "Let's focus on things that matter here." Health coverage does matter to a very many people. Just because you are not directly affected by one particular aspect of it does not make the question valueless. If it were men who were at risk of gestating unwanted infants, I'm fairly positive that the abortion debate would have been effectively silenced a long time ago, and it would have been concluded by a resounding "yes" to CHOICE.


I'm with speakeasy on this. The entire way that women's rights as citizens are expendible to pass health care reform is disgusting. As the author notes, it doesn't matter if all women won't be immediately effected. As long as a group of women based on class and income level will even potentially be effected, there is an assault on women's rights to reproductive freedom.


Adoption ...
The mother is not saddled with a child for life.
She has a choice other than abortionor raising a child.
If she doesn't want the child, can't afford an abortion, then give the baby up for adoption.
Prenancy is covered.


Contrary to what you state in your article, I understand that this amendment includes language causing a woman to be dropped from the subsidized insurance coverage if she buys an additional policy that covers elective abortions, even if she buys that additional policy with her own funds.

In effect, this means that a woman who cannot afford private health insurance and must go with the subsidized option to obtain any coverage, must first give up her legal right of choice. Whoa.

Jon Healey

@Al -- No, that's backwards. I included a link to the Stupak language, so you can check for yourself. It specifically says nothing in the amendment shall be construed to bar an individual from purchasing "supplemental" coverage for abortions, as long as it's truly supplemental. In other words, abortion coverage can't be included in the same policy that's eligible for subsidies.


This amendment doesn't call for the end of abortion, but if it isn't passed, then there will be no room for discussion over whether abortion should be legal or not.


People need to take responsibility for their actions, even if the outcome is pregnancy. What are we teaching our children? (Those who aren't aborted.) Running from the consequences is what is at the heart of America's troubles, whether in the financial, social, or moral arena. Mistakes happen, but people shouldn't take the easy way out. If you make a big purchase and decide you don't want to pay for it, do you just throw away the bill and pretend nothing happened?


@chartreuse: I'm seriously concerned that, in your analogy, a child is being comapred to an AmEx bill. An unwanted pregnancy is not something that goes away after 9 months of tightening your belt and shouldering responsibility. It's a person. A child, who deserves to be loved if it's going to be brought into the world. And if it's going to spend its entire life resented, or ignored, or underfed, or bounced around an abusive foster system, perhaps a better choice can be made.

I am firmly pro-choice, in large part because I believe that the importance of a child's life doesn't end the moment it's allowed to be born. It's an entire lifetime of need, and many women who choose abortion do so because they know they can't provide it. Yes, there is adoption, but there are 800,000 miserable, adoptable children in the foster system who have never received the set of loving parents that is always cited as an easy fix. And pregnancy has a huge impact on a woman's life: she faces serious possible health risks, she'll have to leave a job that might not be waiting when she comes back, her family may disown her; in short, it doesn't always end after 9 months. It's a complex issue, which I don't pretend to be arrogant enough to understand in one blanket statement. Which is why I believe in leaving the choice to the people involved.

Sometimes responsibility is accepting that you are not mature enough to step up, and then doing the hard thing. Choosing abortion is a hard thing.


@chartreuse: "If you make a big purchase and decide you don't want to pay for it, do you just throw away the bill and pretend nothing happened?"

Most people return the things they can't pay for.


@meredith: I do understand that raising a child is something that should be taken seriously. I apologize if my comment came across as belittling or over-simplifying. You wrote, "in your analogy, a child is being comapred to an AmEx bill." I don't really understand how someone can be pro-choice and acknowledge that it is a child's life that is being ended. I agree that is is horrible for a child to feel neglected or unloved, but what is the "better choice" that you refer to?


@Carla 123: I can't help but notice there's an awful lot of she- blaming in your comment below. In it, you suggested adoption as the choice for mothers who don't want to be saddled with the burden of a child. What about when a father doesn't want to be saddled with a child? What are his options? Oh, that's right. Walk away. Claim it isn't his. The most he will be required to do is dole out a percentage of his paycheck for child support. He certainly won't have to deal with day care arrangements, midnight feedings, or any of that other pesky business involved with raising the child. None of that means he should have kept it in his pants, though.

Also of interest is that you didn't mention giving the child to it's father if the mother doesn't want to be saddled with the child.

In fact I don't think there was a mention of a he or a man in whole thing. Now why would that be? Doesn't it take two to tango or whatever saying is? Blame blame blame. It's always the woman's fault in these situations.

End patriarchy.


Trying to be respectful, but it is difficult when I hear rediculous reasons for aborting a human life. (This, barring of course, incest, rape, severe deformities, and endangerment of the mothers life). But to talk about aborting a life because the mother just doesn't have it in her to give it her best? That just is disgusting and repulsive. Ever heard of ABSTINENCE? Seriously, people. If you can't take on the responsibility, then keep your underwear on.


Dear Mr. Krugman:

Certainly, no sane human being can believe for a nanosecond that Republicans have become true protectors of Medicare beneficiaries? Nobody is THAT STUPID! McCain & Co. have merely dressed up in their sheep’s clothing to protect the Insurance Companies. These wolves are merely schlepping for their Insurance-mogul masters, to prevent Congress from cutting billions of dollars in Federal subsidy payments to Insurance Companies, for offering lucrative Medicare Advantage “Cadillac” coverage (and to selfishly keep huge portions of those subsidy dollars flowing back into their campaign coffers)!

We all know how “fungible” money is! We all know how difficult it must be in order to be ABSOLUTELY CERTAIN that ALL Federal Medicare subsidy dollars go directly to Medicare patient beneficiaries—and ARE NOT used to pay Fat-Cat Executive Salaries and bonuses, or siphoned off into PAC Funds, or used to buy lobbyists to fight against cuts to their federal subsidies.

There ought to be a Stupak-like law (Perhaps an AMMENDMENT) against this type of “criminal” activity! The Republicans MUST be prohibited from stealing from the poor, the sick and the dying to give to the rich private-sector moguls—to surreptitiously share with their congressional cronies!


I think this is an interesting discussion. As the author noted, most abortions are paid out of pocket and not covered my most insurance plans, so this bill doesn't change much in my mind.

That said, I still am so fascinated by the ethically charged comments. There is this strange catch 22 in these seemingly republican areguments - we want small governement, except when we disagree with that tax monday goes towards...

I understand that the people who support this amendment are ethically opposed to their money going towards abortion. I am economically opposed to spending millions on end-of-life care, but I still want the healthcare bill to pass without such measures.

My question: Are you Stupak supporters, as Jesus might be, interested in ensuring the populace has the right to receive care? You stuck your necks out to ensure there was this controversy so it appears to me you don't.

Can someone please give me a less emotionally charged answer?


Who's going to buy a "supplemental policy" for abortion? They're for unplanned pregnancies--I don't think anyone predicts they might have an abortion that year. And anyone that does predict that already has a supplemental policy; it's called the pill.

Abortion coverage is necessary precisely because most people never think they'll need it. And so those who do end up needing it need it that much more.

Besides, controversial or not, abortion is a completely legal medical procedure. There's no legal basis for it to not be included (and don't cite the Hyde Amendment, because there was no legal basis for it then, either).


Women Deserve Better Than Abortion. Women need all options openly available to them when there is an unplanned pregnancy. Adoption is a real alternative that should be talked about much more.


A very useful article indeed. http://rd3.ca

breast augmentation las vegas

Hey Randy B., I do not support abortion. Babies are very pitiful. They are innocent. They should not suffer. They should enjoy the beauty of life. Damn are those women who had aborted, are aborting, and about to abort. I just hope they would realize that it is a very big sin to kill.



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