What are the real-life effects of the Stupak-Pitts amendment to the House health care bill?
An analysis by experts on health law, and reproductive and sexual health issues at Planned Parenthood shows the following:
The New Health Insurance Exchange
The new health insurance exchange is intended to provide a
new source of affordable, quality coverage for the roughly 46 million uninsured
Americans and the millions more whose current coverage is unaffordable or
inadequate. The House bill is
expected to cover 96 percent of all uninsured Americans by offering subsidies
for private coverage or the choice of a public plan. Depending on their income level and the final package
approved by the Congress, individuals would receive subsidies on a sliding
scale to purchase private insurance through the exchange.
In the House-passed bill, all
individuals with incomes up to 400 percent of poverty ($88,000 for a family of
four) would receive subsidies to help purchase health insurance. However, not everyone in the exchange would
have subsidized coverage — a significant portion of people (for instance, those
currently purchasing in the individual market and those working for small
businesses) who would buy insurance in the exchange would not receive any subsidies,
also known as affordability credits.
The Stupak-Pitts Amendment
The Stupak-Pitts amendment prohibits any coverage of
abortion in the public option and prohibits anyone receiving a federal subsidy
from purchasing a health insurance plan that includes abortion. It also prohibits private health
insurance plans from offering through the exchange a plan that includes
abortion coverage to both subsidized and unsubsidized individuals.
Thus, if a plan wants to offer coverage
in the exchange to both groups of individuals, it would have to offer two
different plans: one with abortion coverage for women without subsidies and one
without abortion coverage for women with subsidies. These private insurance plans would need to be identified as
either providing or not providing coverage for abortion.
Health insurance plans are highly unlikely to operate in this
manner, and it is not even clear that this is feasible under the administration
of the exchange and affordability credits. As one alternative, the Stupak amendment purports to
allow women to purchase a separate, single-service “abortion rider,” but
abortion riders don’t exist. In
the five states that only allow abortion coverage through a separate rider,
there is no evidence that they are available.
Furthermore, women are unlikely to think ahead to choose a
plan that includes abortion coverage, since they do not plan for unplanned
pregnancy. In addition, it is not clear
that health plans would even be allowed to offer two separate plans under other
provisions of the act, such as the anti-discrimination and guaranteed-issue provisions. Those elements of the bill, which
are very important to consumers, may make it impossible for plans to provide
two separate plans, one that includes abortion and another that does not.
Realistically, the actual effect of the Stupak-Pitts amendment is to ban
abortion coverage across the entire exchange, for women with both subsidized
and unsubsidized coverage.
Who Would Be Covered in the Exchange
Most immediately, the exchange would offer coverage to many
of the 17 million women ages 18–64 who are uninsured. It would also be a source of coverage
for the 5.7 million women who are now purchasing coverage in the individual
market. Typically, these are women
who are not receiving health coverage through an employer — they may be
self-employed, underemployed, or unemployed. Small employers (with fewer than 100 employees) are also
likely to transition their health insurance to the exchange where they may be
able to find more affordable options.
In most of these cases, women will lose abortion coverage
that they currently have — in the current private insurance market, the
majority of health insurance plans include abortion. A self-employed graphic designer or writer, buying coverage
from Kaiser Permanente in the individual market, will likely have abortion
coverage. Under the health reform
plan amended by Stupak, she would purchase that same plan from Kaiser Permanente
in the exchange, but it would not include abortion coverage because it would be
barred. This ban would be in
effect even if she were paying the full premium.
Similarly, a woman working for a small graphic design firm,
who currently has abortion coverage through her company’s plan, would lose it
under reform if the company decides to seek more affordable coverage in the
Roughly 60 million women aged 18–64 get their coverage
through their employer or through their spouse’s employer. For some of these women, nothing will
change immediately. But if current
trends continue in the erosion of employer-sponsored health care, more and more
women will be getting their health care through the exchange. Women are much more likely to be covered
as dependents on their husbands’ health insurance plans, and more and more
employers are eliminating dependent coverage as a way to cut costs. Where will these women get covered? They will get health insurance from the
exchange where abortion coverage is prohibited.
Moreover, women are much more likely to lose
employer-sponsored insurance coverage as a result of a husband’s death or
divorce. While they will be able to
purchase coverage in the exchange, their coverage will not include abortion
coverage. Moreover, the House bill
opens the door to large employers joining the exchange by giving the commissioner
the authority to allow large employers into the exchange beginning in the third
year of the enactment of health reform.
If this proves to be true, over time, women who get coverage through
large companies would lose access to abortion coverage entirely.
The Two-Tiered Health Care System
The House-passed health care system adds a huge swath of the
female population to the “have nots” column of an already two-tiered health
care system when it comes to abortion coverage in the United States. Prior to the passage of the House bill,
our health care system was a system in which only women who could afford to pay
for abortions with their own money or through their insurance plans would have
access to abortion. Consider the
current restrictions already in place:
- low-income women on Medicaid
- federal employees, their spouses, and female dependents
- women serving in the military overseas
- women in federal prisons
- women in the District of Columbia
The House-passed bill would add to this list of women who do
not have coverage millions of women who are getting their health insurance
through the exchange. Consider
just a few examples:
- working mothers
in families that earn up to $88,000
- women who are
self-employed and paying the entire cost of their coverage and don’t have
access to employer-sponsored coverage
- young women
entering the job market for the first time who are the least likely to have
- women who were
insured through their husbands’ employers, but now are divorced and have to
purchase coverage on their own through the exchange
- women who work
in small businesses whose owners decide to seek more affordable, quality
coverage through the exchange
The experts conclude:
Over the last six months, we have heard much about how important
it is to reform the health care system to meet the needs of women. Women are much more likely to be left
out of the current employer-based system because this system wasn’t designed
for them — it was designed for higher-wage, full-time earners who have
dependents at home — namely, men.
tend to be in lower-wage or part-time jobs that don’t offer insurance, move in
and out of the workforce because of childbearing and childrearing
responsibilities, and become uninsured because of divorce or death of a spouse.
But these are the very same women
who are targeted by the Stupak-Pitts amendment. And they will join the growing ranks of women who are denied
coverage of a legal medical procedure.
It’s turning out to be a strange sisterhood: the poor, the incarcerated, the
federally employed, the stateless, the soldier, and now the middle-class in the
Essentially, the amendment violates the underlying principle
of health care reform, as articulated by President Obama, that “no one will
lose the benefits they currently have.”
The truth is that under the Stupak-Pitts amendment, millions of women would
lose benefits that they currently have and millions more would be prohibited
from getting the kind of private sector health care coverage that most women
have today. To put a fine point on
it, millions of women would lose private coverage for abortion services and
millions more would be prohibited from buying it even with their own money. Simply put, women’s access to private
coverage for abortion would be restricted by health care reform.