Written by Judy Waxman, Vice President for Health and Reproductive Rights,
National Women’s Law Center
Last week it seemed that a compromise had been reached between abortion rights supporters and opponents. The compromise was based on the idea that health reform is so important that no one would try to use a single controversial issue as an excuse to bring the whole thing down. So, language was drafted that would sustain the status quo on abortion; no federal funding, but people could still use their own money to buy insurance that would cover them. But just hours before the final vote on the House reform bill, anti-abortion Democrats threatened that unless they got new restrictions on abortion rights they would vote against health reform. Here’s the breakdown:
The compromise: Under the language currently in the Senate Finance Committee’s bill and formerly in the House bill, no federal funding would be used for abortions. Under this provision, called the Capps Amendment, all insurance plans in the exchange would have to keep the money from private premiums and the money from government subsidies separate. Only money from private premiums would be allowed to pay for abortions covered under the plans. This is how current law on abortion works; for example, under Medicaid federal funds are not allowed to be used for abortions, but some states provide funding by separating their state funds from the federal funds. Republican Senator Collins said that the compromise provision “did a good job of putting up a firewall that would prevent federal funds from being used to finance abortions.” Under the compromise at least one plan in the exchange would cover abortion services and at least one plan would not cover abortions services, giving every American the option of what type of plan she would like to purchase while ensuring that no federal funding would be used to cover abortions.
The change: The last minute amendment added to the House bill, referred to as the Stupak amendment, goes much further than preventing federal funding from being used for abortions. The House bill that was passed on Saturday “would prevent millions of Americans from buying insurance that covers abortions — even if they use their own money.” Insurance companies are allowed to offer a rider, which is a separate policy that covers only abortion, but this is a hollow promise. We buy insurance because we can be pretty sure that we will need some kind of health services at some point, and there’s a good chance they’ll be out of our financial reach; but if you single out specific services, there’s less chance that we will need that particular service, and buying insurance against the possibility that you will need that single service becomes less logical. For example, if you had to buy a separate insurance policy that covered only broken arms, you probably wouldn’t buy it because you’ll be spending money to cover a specific set of services that you are not likely to need. In the abortion context, an average woman who uses birth control except when she wants to become pregnant will be unlikely to buy an abortion rider; but if she becomes pregnant unexpectedly or suffers complications of an intended pregnancy, she may well end up with an abortion procedure with costs that strain or ruin her financial well being. Even a woman who decides she wants to cover against all risks might not be able to get abortion coverage; because few people would buy it, it is likely that few or no insurance companies will even offer it.
This was not an argument over federal funding; there is agreement from both sides of the aisle that the Capps compromise prohibits federal funding from being used to cover abortions. Instead, the Stupak amendment, now part of the bill that passed the House, deprives women of the ability to choose whether they want to buy insurance that covers abortion with their own premium dollars. This is the only example in the entire health care reform effort of the government trying to force insurance companies to stop covering a service they already cover. As the debate moves into the Senate, we must be clear that we won’t stand for health reform being used as a Trojan horse to sneak in restrictions on women’s ability to choose insurance plans that cover all of our health needs.