In this morning’s Washington Post, EJ Dionne characterizes the debate over the Stupak Amendment as a minor “skirmish” that is “unlikely to have a significant effect on the availability of abortion.” “Democratic supporters of abortion rights need to accept that their House majority depends on a large cadre of antiabortion colleagues. They can denounce that reality or they can learn to live with it”:
The Michigan Democrat’s measure — passed 240 to 194, with 64 Democrats voting yes — would prohibit abortion coverage in the public option and bar any federal subsidies for plans that included abortion purchased on the new insurance exchanges….Whatever else is true, Stupak’s amendment is unlikely to have a significant effect on the availability of abortion. And most abortions are not paid for through health insurance. The Guttmacher Institute, for example, reported that only 13 percent of abortions in 2001 were directly billed by providers to insurance companies — although the institute has cautioned that the proportion of women whose abortions were covered by insurance could be higher because the figure did not include those “who obtain reimbursement from their insurance company themselves.”
“Learn to live with it,” Dionne writes, because Stupak would only affect plans in the Exchange, where very few women would pay for abortion services with private coverage.
But the actual language of the amendment may impact coverage outside of the Exchange. It specifies that “no funds” authorized under the health care reform bill “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…[of a risk of death of the mother, rape, or incest].” The bill directs bulk of the federal money into subsidizing coverage for middle class Americans in the Exchange, but federal dollars also flow to small and large businesses. A strict interpretation of the amendment could also restrict abortion coverage in the employer market.
Secondly, as Dionne himself notes, the 13% Guttmacher Institute statistic does not prove that that few women would be impacted by the restriction against using private coverage to pay for abortion (since most pay for it out-of-pocket). The Institute itself argues that “most Americans with employer-based insurance currently have coverage for abortion” and many rely on private insurance to finance the procedure. Women who move from employer-sponsored coverage into the Exchange would lose their existing abortion coverage and the government could ration access to reproductive care.
The problem is, Dionne understates Stupak’s reach. Restricting women’s ability to purchase abortion coverage with private premium dollars is not a mere “skirmish” that Democrats “can learn to live with.” To the contrary. It’s the worst restriction to access since the passage of Hyde in 1976 and it disproportionately disadvantages low income women who can’t afford to buy their own health insurance coverage. Stupak is an attempt by the pro-life movement to use health reform as a vessel to ration access to reproductive health services. Dionne is dismissing these concerns by arguing that women (especially poor women) should “learn to live with” health reform reform that leaves them behind.