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Why the Stupak Amendment Goes Too Far
by Beth Isbell,
November 13, 2009</center>
A friend of mine recently asked "The Stupak amendment only enforces current law banning government money from paying for abortion. Please if I am wrong I would like to know."
He was referring to the current restrictions imposed on Government's ability to fund any abortions under the Hyde Amendment, which as I understand it, currently must still be renewed every year. Stupak would make the changes proposed in its new amendment permanent.
The Stupak amendment mandates that no federal funds can be used to pay for an abortion or "cover any part of any health plan" that includes coverage of an abortion, except in cases where the mother’s life is in danger or the pregnancy was the result of rape or incest.
Source:
http://www.alternet.org/story/143849/ho ... ion_rights
As to the claim that Stupak just ensures that there will be no direct funding by Government for abortion ...
I'd prefer that it be a choice in the public option, as would a lot of women who also see it as a matter of reproductive freedom and in particular the freedom to not have the government tell you what you can and can do with your body and all that is inside of it, ... but I can see how you might not.
I'd prefer that if a citizen buys insurance from a private company that the government not interfere with the choices available under that plan, even if some blind subsidies are given to citizens based on need ... so that this remains just about making health care affordable ... but again, I can see how you might not, ... although in crossing this threshold you would have to admit that your position is now a political one.
I'd prefer that insurance companies with plans that do cover abortion costs be allowed to participate in the exchange, since almost every insurance company will want to participate in the pool for their own profit motives, ... Stupak ensures they can't participate if they do ... and I think both of us might agree that this is going too far.
It seems to me that the President has promised to deliver a plan that will not restrict any citizens current insurance coverage. He and I agree that this amendment does just that.
Further, Stupak is but another example of the choices available to the poor, the young, and the politically powerless being restricted, but never the rich. Never the rich. The fact that Government is providing subsidies to allow every citizen to afford coverage, should not be used as a club to restrict choices to conform to the political beliefs of only those with particular points of view. Such funding should be content neutral. And the fact that a private insurer offers such coverage in any of its plans, including those only offered to private payers, should not automatically disqualify it from participating in the public exchange. Stupak would do just that.
And if we can do that, why don't we just add another amendment that the Government will not provide subsidies to close minded assholes, or maybe just anybody that votes Republican. I mean after all, if we really can restrict funding to enforce political views, what's the limit?
Somehow historically such politically restricted funding rules always seem to only cut against the poor and the powerless, even when their cause is a just one.
Go figure.
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UPDATE: After sending my friend this response, he sent me this reply:
"So you still did not tell me how Stupak is not just plugging a loophole in the Hyde amendment. It even allows people who get government subsidies to get abortion coverage, they just have to do it with their own money, not the taxpayers. Once again all Stupak does is make it where federal money will not fund abortions as has been the law for over a generation. You have to agree that without the Stupak amendment then government dollars would pay for abortions, this fixes that. I agree with the President that this is not an abortion bill and should not be used to change the law, it is Stupak who is ensuring the status quo not changing it."
To which I responded ...
No, you keep missing the point ...
if 100 insurance companies cover abortion now,
after Stupak, if it becomes law, they're might be 10 or even none.
Because they all want to participate in the exchange to have access to all those customers.
As a practical matter, it will greatly restrict access and availability of the procedure nationwide. It will make it far more difficult to find a medical provider who performs them.
In a lot of cases, it will take away the coverage of those whose insurance currently covers it, because their plan will drop that coverage to participate in the exchange.
That's not protecting current rights, that's radically advancing an anti-abortion agenda.
"Do you have any proof to back this claim up? No, because it is a scare tactic used by fear mongers trying to make this law into something it isn’t. If 100 insurance companies cover abortion now, and want to be on the exchange they will just drop abortion coverage in the exchange. Even on the exchange you are allowed to buy a rider that allows abortion coverage as long as you do it all with your own money. Have you even bothered to read the law? Also Supply and demand will dictate that out side of the exchange, where no government dollars are paying for healthcare, if people want abortion coverage there will be abortion coverage. As a practical matter, without the Stupak amendment government money would pay for abortions. You have to admit this, it would. The fact is the removal of the Stupak would be a fundamental change to our current policy on abortion. Stupak is not the radical."
To which I responded ...
The real question, since you're advocating passage of the amendment is where is your proof that it won't have this effect on the insurance market -- Where the fuck is your proof, have you surveyed insurers to find out how they will respond? Conducted any neutral study?
Where the fuck is your proof that it won't have this effect?
Either put up, or shut up.
The President has promised women's insurance coverage and choices won't be diminished. Your view requires the President to violate his promise to the American people.
Due solely to your political/religious views about abortion that you are trying to impose on the rest of us. In my view, the subsidies should be content neutral.
But I think the economists who have looked at this almost unanimously agree that the effect will be to greatly reduce availability. But, I'm also sure, that result may please you.
I'm sure some compromise can be reached with those that support your view that allays your legitimate concerns about federal funding directly going towards abortions which does not result in reduced market availability or dimunition of current choices available. But Stupak goes too far ... for now.
False Hope and the Stupak Amendment
by Matt Yglesias
One reason private health insurance tends to cover abortions is that having an abortion is a lot cheaper than having a baby. Consequently, it kinda sorta seems like the Stupak Amendment might have a limited practical impact. Thus I’ve had thoughts along the lines of this from Mark Kleiman:
But what happens when some of the women you insure get pregnant and wants to terminate? Since perinatal care plus delivery would probably cost you $2500, while a first-trimester abortion costs about $200, you’d be happy to provide the abortion coverage gratis if you thought that otherwise even as many as one in twelve of those women would choose to carry to term. You can’t provide it gratis; that’s what Stupak provides. But you could provide it cheap, even to someone who’s already pregnant. Charge $50 for the abortion-coverage rider, effective immediately.
There seem to me to be logistical questions about this. But I don’t think the profit profit motives quite add up. After all, an abortion is not a hugely expensive medical procedure, and whether or not to carry a pregnancy to term is a major life choice. Consequently, I think we should anticipate the price-elasticity of abortions to be relatively low. In other words, in a Stupaked universe most women who find themselves with an unwanted pregnancy are just going to take the financial hit, not have the baby. Under the circumstances it doesn’t really make sense for insurance companies to provide the coverage at an actuarial loss.
The big losers here, however, will be the set of poor women who really may not be able to get together the few hundred dollars that would be needed. This is, of course, entirely typical of relatively “soft” abortion restrictions. Very few people are sufficiently hardcore to push for legislative measures that would really and truly make abortions generally unavailable. Instead the tendency is to create situations that leave loopholes for the affluent while making poor women bear the burdens of middle America’s somewhat incoherent moral stance on the issue.
To which my friend responded with ...
My proof is that in Oklahoma and North Dakota you can not get abortion coverage and guess what, abortion coverage is still available in other states. The insurance companies are going to do whatever makes them the biggest profit. With the vast amount of people on private or company funded plans if there is a demand the insurance companies will supply abortion coverage outside of the exchange, where no government money would pay for it and thus not changing the current status quo. As far as it meaning President Obama would be wrong, well he is not infallible.
And in response to the Yglesias article, he added ...
The Stupak amendment is not supposed to stop abortion, just make sure government money is not used for them. It does that.
Please answer this question: Without the Stupak amendment would taxpayer dollars be used to pay for abortion?
This was my response ...
Look, while I personally favor making sure abortion services are available to the poor, and that all women, regardless of their economic status have choice ... I, like many, am willing to agree that no federal funds be directly used to pay for abortions as a compromise to make sure that reform passes.
I think that some version of Stupak is appropriate - just a less overbroad version.
One that makes sure that it does not have intended or unintended consequences of making it more difficult to obtain abortions or which causes insurers currently offering such coverage to drop it.
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 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.
Currently, a self-employed graphic designer or writer, buying coverage from Kaiser Permanente in the individual market, likely has 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 exchange.
In other words, two very likely scenarios caused by Stupak are that women who have abortion coverage in their plans now would lose such coverage because either their employer switches to an exchange-plan or their insurance company drops such coverages in order to participate. And, historical data shows that in states currently using the "buy an additional rider" approach, that it's not working, and such riders are not made available.
So the reality of it is that Stupak, as currently drafted, will reduce availability and access nationwide. It will divest many women currently covered of their coverage.
I'm willing to accept some compromise here - are you? And if not, why not?
Of course, perhaps you're right - perhaps Stupak will merely have the unintended consequence of insurance companies offering immediately effective abortion riders for $50 to any women that becomes pregnant while covered by their plan simply to avoid the higher costs of delivery or complications or deformities or premature birth as Yglesias suggests might be a result. Is that the result that you want? Insurance companies soliciting customers to have abortions & making it really, really, really cheap to get one?
Which brings me back to my original position - perhaps the subsidies should be kept content neutral - actually based solely on need - and then you are free to purchase insurance consistent with your beliefs and I would be able to purchase insurance consistent with my beliefs. And Government would not impose religion on either of us. I think I actually read that somewhere - hmmm, where was that? Oh yeah, the First Amendment.
Of course, maybe Scientologists or some other minority sect will one day become the majority and impose their religious beliefs that no federal funding should be used to pay for any medical procedure to extend anybody's life since you're so willing to set the precedent that federal assistance to the poor should be altered to enforce religious views. Now, is that something that you would be ok with - after all, you think it's a good idea.
As a civil rights attorney, I have often observed that the majority is quite willing to sacrifice the minority's rights to suit their moral views, until the majority becomes the minority, and then realize all those same poorly conceived justifications will now be used against them.
Further, the Capps Amendment proposed by the Energy & Commerce Committee prohibits federal funding of abortion, but is not nearly as overbroad as the Stupak Amendment. So why is that not a reasonable compromise?
Why should any plan offering abortion coverage not be allowed to participate in the exchange - which would still allow you to say if you get subsidies you can't buy it (not that I agree with your approach), ... but folks who paid for it with private funds could still get it. The idea behind the exchange is to provide large economies of scale and negotiating leverage to reduce costs ... for both those receiving subsidies and those who don't. So why limit this lower cost insurance to make sure that no participating plan can offer such coverage - why not just limit Stupak to your main problem: if you get federally money you can't buy it (not that I agree with this approach), but not also provide that no such plan can participate. In other words, it seems to me you can still restrict the ability of those receiving federal funds from buying such insurance by monitoring the recipient's purchases, rather than just bluntly prohibiting the insurer/seller itself from offering such a choice, even for private payers.
And the reason Stupak goes farther is because it's real purpose is not merely to make it more difficult for poor women receiving subsidies to actually exercise their Constitutional right to have an abortion if they so choose, but to try to severely diminish and disrupt the actual availability of such services.
I'm willing to accept some compromise here - are you? And if not, why not?
Representative Capps discussing the Capps Amendment compromise ...
http://www.huffingtonpost.com/rep-lois- ... 88284.html
The "best approach" to the issues of abortion and health care reform "would seem to be neutralizing them," which is what Rep. Lois Capps (D-Calif.) "tried to do when similar anti-choice measures came up in the House over the summer," Lerner continues, adding that Capps' amendment "clarified that health reform wouldn't affect the status quo," which "already prohibits using federal funds to pay for abortion in almost all cases." The amendment's language has been "integrated into bills in both the House and the Senate," Lerner says. She adds that the language "promises not to loosen the existing ban on federal funding for abortions, proposing that insurance plans offering abortion coverage keep public and private funds separate and use only the private funds to pay for abortions." (Lerner, The Nation, 9/24).
So why is that not an acceptable compromise? Since it fulfills the guarantee that no public funds are used to pay for abortions, but preserves the status quo that abortions are legal and should be available. This was the compromise in most of the House and Senate bills before Stupak entered the arena and tried to ram a broader ban down everybody's throat.
Buy whatever coverage you like, but I have the right to not pay for it with my tax dollars.
Wow you just described the Stupak amendment
Here is the text, please show me the part that is wrong:
Stupak-Pitts Amendment to H.R. 3962
(a) IN GENERAL -
No funds authorized or appropriated by the Act (or amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of rape or incest.
(b) OPTION TO PURCHASE SUPPLEMENTAL COVERAGE OR PLAN -
Nothing in this section shall be construed as prohibiting any nonfederal entity (including an individual or a State or local government) from purchasing separate or supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as-
(1) Such coverage or plan is paid for entirely using funds not authorized or appropriated by this Act; and
(2) Such coverage or plan is not purchased using-
(a) individual premium payments required for an Exchange-participating health benefits pan towards which an affordability credit is applied; or
(b) other nonfederal funds required to receive a federal payment, including State's or locality's contribution of Medicaid matching funds.
(c) OPTION TO OFFER SUPPLEMENTAL COVERAGE OR PLAN -
Notwithstanding section 303(b), nothing in this section shall restrict any nonfederal QHBP offering entity from offering separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as-
(1) premiums for such separate supplemental coverage or plan are paid for entirely with funds not authorized or appropriated by this Act;
(2) administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and
(3) any nonfederal QHBP offering entity that offers an Exchange-participating health benefits plan that includes coverage for abortions for which funding is prohibited under this section also offers an Exchange-participating health benefits plan that is identical in every respect except that it does not cover abortions for which funding is prohibited under this section.
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Capps is not acceptable because it does not fulfill the guarantee that no public funds are used to pay for abortions, as the nonpartisan fact check.org put it:
http://www.factcheck.org/2009/08/aborti ... bricating/
The Capps amendment does contain a statement – as we noted in an earlier article – that prohibits the use of public money to pay for abortions, except in cases of rape, incest and to save the life of the mother. That would still allow the public plan to cover all abortions, so long as the plans took in enough private money in the form of premiums paid by individuals or their employers. The Capps language also would allow private plans purchased with federal subsidies ("affordability credits" for low-income families and workers) to cover abortion.
As for the House bill as it stands now, it’s a matter of fact that it would allow both a "public plan" and newly subsidized private plans to cover all abortions.
Newly subsidized private plans means private plans paid for with help from the government in the form of capital (tax credits, money, etc...) That is why Stupak was needed to fill this loophole. As well as the public plan covering abortions.
"Buy whatever coverage you like, but I have the right to not pay for it with my tax dollars."
Actually, you don't. No single taxpayer has the right to only pay part of their taxes and withhold any amount to protest a policy they don't like, nor have the power to direct how the government spends the tax money paid except through the actions of their representative. Which is the same point Jon Stewart made on Thursday's Daily Show. (But Cole, since Mary Fallin happens to agree with you, you have nothing to worry about).
There are a lot of governmental policies that each of us disagree with, but none of us have the right to withhold payment in protest or to personally direct how that money is spent. I didn't agree with the Iraq War, but I don't think Government is going to lower my tax bill. After all, we killed several hundred thousand Iraqis, that were actually born & living.
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"Wow you just described the Stupak amendment. Here is the text, please show me the part that is wrong"
Nope. Here are few examples.
Section (C)(2) ... "(2) administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan;"
In other words, if the insurer receives any federal money, including any federal subsidies from customer credits from any customer, that is ever used toward administrative costs, they don't qualify and can't provide abortion coverage. How is an insurer who ever receives any subsidy on any of its plans expected to make sure that does not go to pay any administrative costs on its abortion plan, since there are certainly going to be administrative costs common to administration of all its plans? How do we consider the CEO's salary, he is responsible to "administer" all the company's plans, those which include abortion coverage and those which do not? And that is but one of 1000s of practical examples of the impossibility of trying to segregate administrative costs as attributable solely to one plan. And perhaps through a separate entity or trust with an army of lawyers and accountants it might somehow be possible to segregate all the administrative costs, but that imposes tremendous new expenses on insurance companies to be passed on to consumers through increased rates or more likely to just make them decide its not worth it and simply not offer any plans covering abortion at all. Which, I believe, is Rep. Stupak's real purpose. And we can see that by their insistence that the Capps Amendment, which already applied Hyde to the health reform bill, and was included in most of the other House & Senate committee's versions of the bill before Stupak's amendment was ever introduced, did not go far enough, ergo his attempt to not only restrict the subsidies, but the actual insurance companies and plans themselves, making it exceedingly difficult, if not practically impossible, for them to comply with the terms of his Amendment.
The language in section (C)(2) providing "all services offered through such supplemental coverage or plan" ... so in other words, if the plan offers any service which receives subsidies, it doesn't qualify. Thus, if the company offers a comprehensive plan which covers abortion and another which doesn't, and both plans refer all testing to the same laboratory - oops, you just violated the amendment. Can't use the services of any hospital which ever receives subsidies. So basically, this would only allow a separate abortion rider limited exclusively to abortion clinics that never received any subsidy for not only abortion, but also any other health service they might ever provide.
I can continue to go line by line through Stupak and point out other problems, but seems that the ones I've already pointed out are sufficiently significant to make the point.
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"The Capps amendment does contain a statement – as we noted in an earlier article – that prohibits the use of public money to pay for abortions, except in cases of rape, incest and to save the life of the mother. That would still allow the public plan to cover all abortions, so long as the plans took in enough private money in the form of premiums paid by individuals or their employers. The Capps language also would allow private plans purchased with federal subsidies ("affordability credits" for low-income families and workers) to cover abortion."
So what's going on here is practicality. If a plan takes in enough private funds to cover 100% of the costs of all abortion related services, then we are going to deem the first block of private dollars flowing into the plan sufficient to pay for 100% of those services are paying for those services. (Remember, the concept of FIFO in accounting?). If the company receives more than enough private payments to pay 100% of any and all abortion service related expenses then we are going to allow it to claim that all those private monies paid for all abortion services, rather than imposing the burden of hiring armies of lawyers, accountants, and support personnel to actually monitor every single transaction - which possibly could be done, but as discussed above would be tremendously expensive to the point of being cost prohibitive. Since the bottom line practical result is the same. Just far less costly and burdensome under Capps' approach.
And, after all, I thought maybe the biggest goal of health reform was to reduce unnecessary administrative overhead costs, and wasteful spending, that would make everybody's insurance far more expensive. Or maybe you missed that memo.
The difference between Capps practical approach and Stupak's need to account for every dollar and track it through the system approach is literally billions in savings to American taxpayers, and more fundamentally, the right of every female American to have the practical ability to exercise their legal right to have an abortion if they so choose. Which, last time I checked, the United States Supreme Court ruled was protected by the U.S. Constitution.
Health reform should not be used by you or others to try to take away or diminish this Constitutionally protected right, or to make it more difficult to actually exercise.
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A final thought: It's always interesting to me how the very same people who are so adamantly anti-abortion are often the most vigorous in supporting the Iraq War or the Afghanistan War, or in killing terrorists, or in justifying the death penalty. If you're going to be anti-killing, shouldn't that view apply to every human and not just to the unborn?
Peace,
Beth