We've reached a point where health-care reform threatens to leave access to abortion in worse shape than it is right now. The Stupak Amendment, added to the health-care bill in last-minute negotiations this weekend, goes beyond the existent ban on federal funding of abortion. By prohibiting anyone receiving federal health-insurance subsidies from buying plans that cover abortion, it's almost certain to compel many plans to drop abortion coverage for everyone.
Almost all progressives have realized that passing health-insurance reform was going to require some bitter compromises. But it's both maddening and heartbreaking that a pro-choice president and a Democratic Congress are poised to give the anti-abortion movement its biggest legislative victory since 2003's Partial Birth Abortion Ban Act.
Right now, most employer-based health insurance plans cover abortion. The reason for this is depressingly mercenary -- it's cheaper for insurance companies to pay for a termination than for prenatal care and delivery. Motives aside, though, this coverage is crucial, given that abortion is among the country's most common medical procedures. Congressman Bart Stupak's amendment threatens it even for women who buy insurance themselves or get insurance from their employers.
The Congressional Budget Office estimates that if health-care reform passes, by 2019, 21 million people will buy insurance on health-insurance exchanges. About 80 percent of that number will have some sort of subsidy from the federal government, and so any plan that wants its business can't offer abortion. To be sold on the exchanges, a plan offering abortion coverage "would have to explicitly be marketed for people who aren't eligible for subsidies," says Adam Sonfield, senior public policy associate at the Guttmacher Institute. "We're looking into whether that's even legal. We're not sure it is -- it sounds very much like discrimination on the basis of income."
Nor does this just affect individuals purchasing insurance. The exchanges will offer coverage to small businesses as well, and they're intended to expand to larger and larger businesses as time goes on. Thus the Stupak Amendment means that the more successful health insurance reform is, the more women will lose access to abortion coverage.
The amendment's supporters and apologists are downplaying its scope by noting that, according to the Guttmacher Institute, only 13 percent of abortions are currently billed to health insurance. But that's misleading, because it doesn't include women who file for reimbursement after seeking an abortion from an out-of-network provider -- and, as Sonfield points out, most providers are out of network.
Even 13 percent is not a negligible number, given that over a million abortions take place in the United States each year. And it's important to realize that it's not just those with unintended pregnancies who are going to be stripped of coverage. The Stupak Amendment includes exemptions for rape, incest, and threats to the life of the mother but not threats to her health or cases of severe fetal abnormality. Women with wanted pregnancies that go horribly wrong will either have to pay for expensive, late-term terminations out of pocket or carry them to term against their will. Imagine being forced, because of economic circumstances and political callousness, to continue a doomed pregnancy even if the fetus has no chance of survival. Imagine being forced to do it even if it would destroy your ability to ever have a healthy baby in the future.
Health-insurance reform was supposed to end the sort of hideous cruelties our system inflicts on patients, not create them.
Of course, the Stupak Amendment is not yet law. Pro-choice activists and politicians will now fight to strip it out during the reconciliation process. The valiant Colorado Congresswoman Diana DeGette has collected more than 40 signatures from Democrats pledging to oppose a final bill containing the Stupak language, and pro-choice lawmakers have demanded a meeting with President Barack Obama.
The goal is a return to an earlier compromise, the Capps Amendment, which would have essentially maintained the status quo regarding abortion coverage. Under Capps, no federal money could pay for abortion, but insurance plans could fund the service with money from premiums. (Conservatives opposed to Capps say that money is fungible, so sequestering it into different accounts is essentially an accounting trick. Naturally, they reject this argument completely when it comes to faith-based funding flowing to churches for ostensibly secular work.)
At this point, though, with intense pressure coming from the Conference of Catholic Bishops, it seems unlikely that the previous compromise can hold up. "We passed health-care reform on Saturday because of these pro-life Democrats," says Kristen Day, executive director of Democrats for Life of America. "That's the big difference here. We can't go back to people and say we voted for health-care reform with abortion funding in it. We believe abortions kill people. The other side would have a lot harder time explaining why they voted against a bill because it didn't contain abortion funding."
Day isn't wrong about the political dynamics. Anti-abortion Democrats seem willing to see their party's plans destroyed over abortion. Most progressives -- including feminists -- are not, which gives them a lot less leverage. Sometimes nihilism can be a powerful political weapon, especially when it comes disguised as piety.
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