Rep. Bart Stupak (D-MI)
A new study
from George Washington University casts doubt on the argument that “restrictions on abortion coverage approved in the House version of the health-care bill likely will affect the affordability of the procedure for only a small minority of women
.” The study finds that “the treatment exclusions required under the Stupak/Pitts Amendment will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women, not only those whose coverage is derived through a health insurance exchange”:
In effect, the size of the new market is large enough so that Stupak/Pitts can be expected to alter the “default” customs and practices that guide the health benefits industry as a whole, leading it to drop coverage in all markets in order to meet the lowest common denominator in both the exchange and expanded Medicaid markets. Furthermore, for the reasons outlined above, because the Stupak Amendment bars the subsidization of plan administration activities in connection with prohibited procedures, it can be expected to chill the development of abortion coverage supplements as well as entirely separate plans to non-subsidized women. .
The Stupak amendment “is intended to reach only a specific part of the market,” but in effect, the provision — which prohibits the government from funding any plan that offers abortion coverage — could “move the entire health benefits industry away from its current inclusive coverage norms and toward a new norm of exclusion,” the report concludes.
Given the size of the market in the Exchange (30 million and growing), the scope of the amendment, and the technical challenges and difficulties that arise from administrating supplemental abortion coverage, insurers will “shift away from current abortion coverage norms“; excluding abortion from coverage will become the new norm.
Ultimately, “companies offering coverage products in the employer-sponsored market” “may elect to simply remove the [abortion] procedures from their products so that they can be sold in all markets.” The Stupak amendment will discourage insurance companies from providing abortion coverage and increase the costs of the procedure:
- Amendment could chill the development of abortion coverage supplements: Since Stupak effectively requires that supplemental abortion coverage “be administered separately from other plans,” the cost of supplemental abortion coverage “could be expected to be far higher than simply the cost” of any other supplemental policies.
- Companies would have to absorb the extra administrative costs of providing supplemental abortion coverage: “Not only would companies have to absorb all costs of administration into the supplemental or separate plan fee, but companies would confront having to expand provider networks to assure access to the full range of medically indicated abortions in the case of women who purchase expanded coverage.”
- Cost of later-term abortions would be particularly expensive: The cost of abortions performed later in pregnancy can already “carry a price tag in the thousands of dollars.” However, since this coverage will now be sold as supplement — excluded from the larger risk pool — “the cost of a supplement or a plan that carries additional coverage could be considerable.”
- No incentive for companies to offer additional coverage for women who move into Exchange: While a migration over time of thousands of smaller employers (who offer abortion coverage) into the Exchange “might encourage health benefit services companies to create supplemental abortion coverage products,” the Stupak amendment discourages their development. Currently, almost no insurers offer supplemental abortion coverage in states that already bar the sale of products that offer abortion coverage. The Stupak amendment is designed “to push the price of supplemental coverage higher by prohibiting the integration of administration costs into a single administrative scheme.”
- What if the abortion procedure is part a broader treatment? Under Stupak, plan administrators can only pay for abortions that threaten the life of the mother. But what if the abortion procedure “is part of broader treatment for a serious health condition?” What if the procedure must be performed to in the course of treating a significant health problem? “In these circumstances, how are plan administrators to distinguish between the abortion procedure and the rest of the treatment? Will the entire cost of a course of treatment (e.g., surgery to repair a damaged pelvis following an automobile accident) be denied if abortion is part of the procedure? Health plan administrators, confronted with the prospect of a legal violation for paying for the excluded abortions, may elect to deny the treatment altogether, claiming that it is all related to the excluded treatment.”
The unintended consequences of Stupak are alarming. Legislators have designed a policy that changes the way abortion is treated by insurers and providers in the broader health care market. The amendment devastates the status quo and could prove a serious obstacle to women.