Like most anti-choice efforts we've seen come out of Congress and state legislatures in the past 30+ years since abortion was legalized, Stupak's Coathanger amendment is another attack on the practical side of the issue: on access. Rather than going for Roe and actually proposing something that could result in it's being overturned, he's going the practical route of making it more difficult to obtain by stretching the limits of the Hyde amendment beyond the breaking point.

The Stupak amendment does not literally say that plans on the exchange can’t include abortion coverage, it just makes it completely impossible that a plan could for several reasons. To pretend that a reading of the Stupak amendment could not easily be used to stop the sale of plans covering abortion on the exchange is absurd. That is like claiming a law making it illegal to sell tubes capable of having a bullet pass through at high speeds would not be a ban on firearms. Nita Lowey is correct that this amendment could easily put new restrictions on a woman’s ability to buy an insurance plan that does include abortion coverage from a private insurance company, even with her own money.

Once the dust settles on the legal issues of what this bill does, you have to look at the practical results. Even if insurers participating in the exchange can find the needle to thread to offer abortion coverage, would they? No, says one industry expert.

"I really think it would be impractical," says Robert Laszewski, a health insurance industry consultant....

Laszewski says the problem is that by all estimates, the vast majority of people who will be shopping in the new exchanges will be getting subsidies, so they won't be allowed to get abortion coverage. Thus, if a health insurer did offer a separate plan with abortion coverage, it would only be available to a small universe of buyers, and it simply wouldn't make much business sense.

"It's not an ideological issue, it's not about abortion or not abortion," Laszewski says. "It's about what is administratively simpler, easier to administer. It just adds a level of complexity they will likely avoid."

Sara Rosenbaum, a health lawyer and professor at George Washington University, agrees that it's impractical to expect health insurance plans to cover abortion in the exchanges, even for people paying the full premiums without federal help.

"If you speak to insurers in the industry, they will tell you that they simply can't operate under these circumstances," Rosenbaum says. "They need to be able to offer standard products that get administered in a standard way for everybody."

For insurers, it's about the bottom line, and the bottom line is easier to maintain through standardized, streamlined processes. That means offering a standard product, in this case one that excludes abortion. Ah, but what about those riders? you ask. Wouldn't that be a standard product?

Women could use their own money to buy a separate policy that just covers abortion. But that's not likely to happen, either, says Laurie Rubiner, vice president of public policy and advocacy for Planned Parenthood of America.

Rubiner bases her conclusion on real-world experience. Five states — Missouri, Idaho, Kentucky, Oklahoma and North Dakota — already ban private insurance from covering abortion.

Yet, she says, "we haven't been able to find any kind of separate abortion rider, and it doesn't surprise us because there's no market for it. Why is that? Because no woman plans to have a catastrophic pregnancy, or an unintended or unplanned pregnancy. Therefore, she doesn't think about buying coverage separately for abortion. And since there's no market for it, the product doesn't exist."

Would the product exist if this legislation went into effect and millions more women were without abortion coverage? Possibly, but in the five states where this is a reality, it hasn't happened. Because women don't plan for unplanned pregnancies, or dangerous pregnancies, any more than they don't plan to have another car smash into theirs or to slip on an icy sidewalk or to have appendicitis. And in this case, many women would have to negotiate with partners or with parents to get that extra coverage--negotiations that in many cases just aren't going to happen.

This analysis just discusses what would happen within the exchange, but has to be considered outside of it, as well. While the status quo is likely to be maintained in existing employer-provided plans--those the majority of people with insurance have now--the exchanges in both the House and the Senate bills are going to expand, as David Dayen discussed earlier in the week. "In theory, by 2015 all employers, and therefore all Americans not on Medicare or Medicaid, could start using the new health insurance exchange for health care."

That'd be quite the coup for Stupak, his C-Street pals, and the bishops.

Originally posted to Daily Kos on Sat Nov 14, 2009 at 01:30 PM PST.

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