The Wonk Room

The Far Reach Of Stupak’s Amendment, Part II

Rep. Bart Stupak (D-MI)

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.

Casey Hints He Will Oppose The Stupak Amendment

The Pittsburgh Post Gazette is reporting that Sen. Bob Casey (D-PA), a pro-life leader in the Senate, will likely oppose the Stupak abortion amendment. Casey’s office issued a press statement clarifying that the Senator supports preserving the status quo on abortion coverage:

Senator Casey has been a vocal supporter of health care reform and voted for the HELP Committee bill in July. He supports the public option to increase competition and reduce costs. And he is offering amendments to improve health care for children. Senator Casey thinks that health care reform should not be used to change longstanding policies regarding federal financing of abortion which has been in place since 1976.

He continues to work with his colleagues in the Senate and with the White House to ensure that the Senate health care reform bill protects existing federal and state conscience protections, existing state abortion laws and contains strong language to prohibit federal funds from being used to fund abortions. He voted for amendments in the HELP Committee that would maintain neutrality on abortion. Until Senate bill language is released it is premature to discuss next steps.

The existing abortion language in the Senate bill maintains the status quo by ensuring that federal dollars can only be used to pay for abortions when the pregnancy threatens life of mother or results from rape or incest. Only private premiums could be used to pay for so-called ‘elective’ abortions.

Democrats believe that pro-life advocates would not be able to muster the requisite 60 votes to pass a more restrictive amendment that would make it difficult for many private plans to provide abortion coverage. “If someone wants to offer this very radical amendment, which would really tear apart [a decades-long] compromise, then I think at that point they would need to have 60 votes to do it,” Sen. Barbara Boxer (D-CA) said during a recent interview with the Huffington Post. “And I believe in our Senate we can hold it.” On Monday, President Obama also indicated that he wanted to preserve the status quo on abortion coverage.

Casey’s statement, while promising, does not guarantee that the Senator won’t vote for a bill that includes stricter abortion restrictions. During the Health, Labor, Education and Pensions Committee’s (HELP)’s mark-up, Casey provided the only Democratic vote to at least four anti-choice amendments, all of which ultimately failed. One such amendment — offered by Sen. Orrin Hatch (R-UT) — closely resembled the Stupak provision.

If the Senate bill retains its current abortion compromise, it’s likely that the conference report will include similar language. Already, 41 House Democrats have sent a letter to Speaker Nancy Pelosi (D-CA), vowing to vote against the final conference report if it contains the Stupak amendment.

Republicans Don’t Care If Their Insurance Policy Covers Abortions

Politico is reporting that “the Republican National Committee will no longer offer employees an insurance plan that covers abortion after POLITICO reported Thursday that the anti-abortion RNC’s policy has covered the procedure since 1991″:

“Money from our loyal donors should not be used for this purpose,” Chairman Michael Steele said in a statement. “I don’t know why this policy existed in the past, but it will not exist under my administration. Consider this issue settled.” Steele has told the committee’s director of administration to opt out of coverage for elective abortion in the policy it uses from Cigna. Federal Election Commission Records show the RNC purchases its insurance from Cigna, and two sales agents for the company said that the RNC’s policy covers elective abortion.

Of course Steele doesn’t know why “this policy existed in the past” for the same reason why Focus on the Family, one of the nation’s largest religious right organizations, didn’t know that it paid premiums to an insurance company that also offered abortion coverage: they don’t care. They’re using ‘abortion’ to manufacturing outrage, derail health reform and energize the pro-life base.

Even they don’t believe that purchasing insurance coverage that includes abortion is an abomination. Nor do they believe the argument made in the Stupak-Pitts amendment — that paying premiums to an insurance policy that offers abortion coverage is indirectly subsidizing abortion. As Steven Benen points out, while the RNC may have opted-out of the abortion benefit, it is still “taking Republican money and giving it to an insurance company through premiums. That company will then use its pool of money to pay for abortion services, not for RNC employees, but for other customers.”

The Republican Party does not believe in the Stupak Amendment; it believes in opt-outs…

EJ Dionne To Democrats: ‘Learn To Live’ With Health Reform That Leaves Women Behind

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.

How The Stupak Amendment Changes The Status Quo

Our guest blogger is Jessica Arons, Director of the Women’s Health and Rights Program at the Center for American Progress Action Fund.

On Monday, in an interview with ABC News, President Obama reminded Congress that “this is a health care bill, not an abortion bill.” When asked about the Stupak Amendment, he responded that “there needs to be some more work before we get to the point where we’re not changing the status quo,” implicitly acknowledging that the measure does not preserve the status quo on laws related to abortion funding. “I want to make sure that the provision that emerges meets that test — that we are not in some way sneaking in funding for abortions, but, on the other hand, that we’re not restricting women’s insurance choices,” he said.

Ironically, it was the U.S. Conference of Catholic Bishops that was among the first to call for an “abortion-neutral” health care bill back in July. It defined abortion-neutral as maintaining current policies on funding, mandates, and conscience protections:

Any legislation should reflect longstanding and widely supported current policies on abortion funding, mandates and conscience protections because they represent sound morality, wise policy and political reality. Making the legislation “abortion-neutral” in this sense will be essential for widely accepted reform.

The Capps Amendment, which was in the original House bill and is still in Senate legislation, meets all of these criteria:

- The Hyde Amendment ban on Medicaid funding for abortion would remain unchanged.

- The Hyde Amendment would be applied to all public and private plans in the Exchange by segregating private premiums and government subsidies and ensuring that only private premiums be used to pay for abortion.

- No abortions could be mandated as part of the minimum benefits package, even those allowed by Hyde.

- Evenhanded conscience provisions protect those willing and unwilling to provide abortion care, counseling, and referrals.

But the Bishops lobbied against this compromise and demanded that the far-reaching Stupak Amendment be adopted. This measure:

- Goes beyond the Hyde Amendment by preventing women from using their own money to buy an insurance plan that includes abortion, even though no public funding would be spent on abortion services.

- Gives insurance companies an incentive to discriminate against low- and moderate-income women.

- Limits insurance companies in deciding what benefits to offer their customers

- Provides for the purchase of flimsy abortion-only riders that are unlikely to be offered or purchased.

- Allows for discrimination against health care providers who are willing to offer abortion services

The Capps Amendment involved a number of concessions from abortion rights advocates and ought to satisfy the demands of abortion rights opponents. If the true goal is health reform and not to undermine that reform or advance an ideologically-rigid agenda, then we need both sides to meet in the middle.

The Far Reach Of Stupak’s Amendment

Rep. Bart Stupak (D-MI)

But as Walker explains, while the bulk of the federal money may lie in subsidizing coverage for middle class Americans, the federal dollars appropriated through HR 3962 touch “many insurance plans directly and indirectly.” The Stupak amendment would prohibit insurers from selling abortion coverage in the following ways:

1) Any policy that is sold within the Exchange: A strict interpretation of the Stupak language suggests that since the Exchange is established by the federal government, any plan that operates within the Exchange would not be able to provide abortion coverage. However, since Stupak allows insurers that operate plans within the Exchange to sell abortion riders, one could also assume that a policy in the Exchange could still offer abortion coverage.

2) Policies in the Exchange that receive risk-adjustment dollars: Even though the risk adjustment mechanism is distributed from a pool that is seeded with insurer dollars, the government distributes the dollars, which adjust for individuals who receive government-subsidized coverage. Moreover, one could also argue — like the Bishops did — that once insurer money enters a risk adjustment mechanism that is administered by the government, it automatically becomes government money. Under this explanation, insurers that sell abortion riders may not qualify for risk adjustment payments.

3) Policies in the Exchange that are directly subsidized by the government: Anyone who receives government affordability credits (Americans between 150-400% FPL) would not be able to purchase an insurance policy that includes abortion coverage. Insurers are also required to accept all applicants and would have to stop offering abortion coverage once it accepts its first federal-dollar beneficiary.

4) Employer-sponsored policies that receive reinsurance funds: The bill requires the Secretary of Health and Human Services to “establish a temporary reinsurance program to provide reimbursement to assist participating employment-based plans with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses dependents of such retirees.” Employer-sponsored plans that offer abortion would not be eligible for this funding or would have to forego the benefit.

5) Employer-sponsored policies that receive “wellness program grants”: The bill allows the Secretary of Health and Human Services to award Wellness program grants to small employers. Employers would have to segregate their wellness programs from their health benefits in order to receive the credit and provide abortion coverage.

6) Employer-sponsored policies that receive small business credits: For small businesses that want to offer health insurance coverage, the bill provides a tax credit over a two-year period will help them transition to or continue providing health benefits to their employees. In order to receive the tax credit, small businesses would have to stop offering abortion coverage.

In 2015 and beyond, the Commissioner can allow larger employers to enter the Exchange, permitting the Stupak amendment to further restrict their ability to offer abortion coverage.

Pro-life proponents may claim that Stupak simply preserves current policy but if they bother to examine the implications of their amendment they would discover that it actually accomplishes their goal of significantly restricting access to abortion.

The United States Conference of Catholic Bishops Advocates Double Standard In Health Care Debate

Hours before the House passed health care reform, the United States Conference of Catholic Bishops lobbied lawmakers against a provision that would have allowed an insurance policy to segregate public funds from private premiums that could be used to pay for abortion services. The group maintained that “premiums paid to that plan in the form of taxpayer-funded subsidies help support that abortion coverage even if individual abortion procedures are paid for out of a separate pool of privately-paid premium dollars.” Or, alternatively, if a woman uses federal subsidies to pay for a basic benefit, she would have more private money available to fund her abortion:

While all funds in the public plan begin as private funds, in the pockets of taxpayers and purchasers, they all become federal funds once they are paid to the government (whether paid as taxes or as premiums) – and all abortions in the plan are paid for by the federal government. … So this money-laundering system, aside from making the operation of the public plan more unwieldy, does nothing to address pro-life concerns.”

The organization also rejected a compromise offered by Brad Ellsworth (D-IN), which would have established “clear, strict rules for separating public funds from the premiums of private individuals” and allowed the public option to provide abortion coverage if it hired “a private contractor to pay abortion providers, thus avoiding direct federal payments.” The Bishops maintained that once funds enter the federal treasury, they cannot be properly segregated. If that’s the case, then the organization is, by its very own definition, condemning its very own accounting practices.

The Conference works to “unify, coordinate, encourage, promote and carry on Catholic activities in the United States; to organize and conduct religious, charitable and social welfare work at home and abroad; to aid in education; to care for immigrants; and generally to enter into and promote by education, publication and direction the objects of its being.” The Bishops receive federal grants to finance their “charitable and social work at home and abroad,” but, by law, they must segregate those funds from efforts “to organize and conduct religious” work. In fact, the Bishops provide subgrants to organizations that directly serve disadvantaged individuals and ensure that public funds are not spent on religious purposes. This is a practice that’s strikingly similar to what the public option could have done under the Ellsworth amendment.

If agencies are incapable of properly segregating funds, then perhaps they should stop receiving them.

Why The Stupak Amendment Is A Monumental Setback For Abortion Access

Our guest blogger is Jessica Arons, Director of the Women’s Health and Rights Program at the Center for American Progress Action Fund.

Rep. Bart Stupak (D-MI)

The claim that it only bars federal funding for abortions is simply false. Here’s what the Stupak Amendment does:

1. It effectively bans coverage for most abortions from all public and private health plans in the Exchange: In addition to prohibiting direct government funding for abortion, it also prohibits public money from being spent on any plan that covers abortion even if paid for entirely with private premiums. Therefore, no plan that covers abortion services can operate in the Exchange unless its subscribers can afford to pay 100% of their premiums with no assistance from government “affordability credits.” As the vast majority of Americans in the Exchange will need to use some of these credits, it is highly unlikely any plan will want to offer abortion coverage (unless they decide to use it as a convenient proxy to discriminate against low- and moderate-income Americans who tend to have more health care needs and incur higher costs).

2. It includes only extremely narrow exceptions: Plans in the Exchange can only cover abortions in the case of rape or incest or “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.” Given insurance companies’ dexterity in denying claims, we can predict what they’ll do with that language. Cases that are excluded: where the health but not the life of the woman is threatened by the pregnancy, severe fetal abnormalities, mental illness or anguish that will lead to suicide or self-harm, and the numerous other reasons women need to have an abortion.

3. It allows for a useless abortion “rider”: Stupak and his allies claim his Amendment doesn’t ban abortion from the Exchange because it allows plans to offer and women to purchase extra, stand-alone insurance known as a rider to cover abortion services. Hopefully the irony of this is immediately apparent: Stupak wants women to plan for a completely unexpected event.

4. It allows for discrimination against abortion providers: Previously, the health care bill included an evenhanded provision that prohibited discrimination against any health care provider or facility “because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions.” Now, it only protects those who are unwilling to provide such services.

One in three women will have an abortion in their lifetime. Eighty-seven percent of employer plans offer abortion coverage. None of that will matter if the Senate takes its cues from the House. In every other way, this bill will expand access to health care. But for millions of women, they are about to lose coverage they currently have and often need.

How Did Stupak’s Gang-Of-40 Win On Abortion

Sources tell the Wonk Room that Rep. Bart Stupak (D-MI) and his 40 pro-life Democratic colleagues successfully won debate for a restrictive abortion amendment on the House floor by moving the goal posts on an earlier agreement.

Stupak had agreed to keep the amendment from the floor if it received a hearing in the rules committee. But, once the Conference of Catholic Bishops refused to endorse the bill unless the amendment was accepted, Stupak and his colleagues demanded a vote on the floor and threatened to derail the bill. Unable to muster enough opposition to Stupak’s ‘gang of 40,’ the Democratic majority agreed to move the the amendment to the floor and vote for the full bill if the amendment passed.The Conference of Catholic Bishops has since endorsed the bill and House Republican Leader John Boehner (R-OH) and Reps. Eric Cantor (R-VA) and Mike Pence (R-IN) will all vote “yes” on the Stupak amendment.

Today, during the Democratic press conference that followed the caucus’ meeting with the President, House Speaker Nancy Pelosi (D-CA) said she recommended that the Stupak amendment be voted on the floor. The amendment is expected to pass.

House Democrats Will Consider Stupak’s Abortion Amendment On The Floor »

During yesterday’s all-night marathon hearing before the House Rules Committee to consider which amendments would be introduced during floor debate of the House health care bill, the Committee agreed to allow the full House to vote on Rep. Bart Stupak’s (D-MI) amendment to effectively ban plans in the exchange from covering abortion services. The floor will debate the amendment on the House floor for 20 minutes.

Democrats have been trying to broker a compromise on abortion coverage by offering up Rep. Brad Ellsworth (D-IN) less restrictive amendment to segregate public funds from abortion funding and hire “a private contractor to pay abortion providers, thus avoiding direct federal payments.” But that agreement “fell apart,” Stupak reported.

“We came to the point where we actually an agreement tonight, but unfortunately it fell apart. So that’s why we had to scramble to be here. I regret that the agreement fell apart, I think everyone meant well and I’m not trying to place blame,” he said at midnight:

First, our amendment does not prevent any private insurer from selling a policy which covers abortion. This ensures that those who want abortion coverage have access to it without forcing anyone or anyone else to pay for another one’s abortion with their tax dollars of with their private funds. Second, our amendment does not prevent any individual from purchasing a plan that covers abortion as long as their coverage is not subsidized with affordability credits….Our amendment does not prevent an insurer participating in the Exchange from selling health plans in the Exchange…Our amendment simply applies the current law, Hyde Amendment to the public health insurance option and the private policies purchased using affordability credits.

Watch it:

But Stupak is misrepresenting the House legislation and the existing federal restrictions on abortion funding. Currently, the House bill contains what’s called the Capps Amendment — a compromise that maintains Hyde Amendment restrictions. The arrangement protects Hyde by specifying that subsidy dollars could only be used to abort pregnancies that threaten the life of mother or result from rape or incest (Hyde allows for this). Other kinds of abortions would have to be funded with private premiums. The provision also requires that at least one plan in each market area offer abortion services and one plan not. No abortion services—even those allowed by the Hyde Amendment — can be mandated as part of a minimum benefits package.

Stupak and his allies want to go beyond Hyde. Under their amendment, women who purchase comprehensive private insurance packages — that include abortion services — would have to pay for the entire cost of the package (even if they qualify for subsidies).

They’re arguing that the current firewall between public and private money is inadequate. If a woman uses federal subsidies to pay for a basic benefit, she would have more private money available to fund her abortion, they claim. Or, alternatively, “premiums paid to that plan in the form of taxpayer-funded subsidies help support that abortion coverage even if individual abortion procedures are paid for out of a separate pool of privately-paid premium dollars.” It’s the equivalent of arguing that women who receive abortions should not use public buses or highways to travel to the abortion clinic.

The amendment won the endorsement of the Conference of Catholic Bishops but sparked criticism from several pro-choice groups. “This amendment would violate the spirit of health care reform, which is meant to guarantee quality, affordable health care coverage for all, by creating a two-tiered system that would punish women, particularly those with low and modest incomes,” said Cecile Richards, the president of Planned Parenthood Federation of America in a late-night release. “Women won’t stand for legislation that takes away their current benefits and leaves them worse off after health care reform than they are today.

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What’s Holding Up The House Health Care Vote?

This morning, on a conference call with reporters, House Majority Leader Steny Hoyer (D-MD) warned that “action on a health care overhaul could slip past a planned Saturday evening vote into Sunday — or even Monday or Tuesday — if House Republicans employ delaying tactics.” House Speaker Nancy Pelosi (D-CA) assured reporters yesterday that “we will” have enough votes to pass the House, but press reports indicate Democrats have yet to reach agreement over coverage for undocumented immigrants and abortion.

Yesterday, 20 members of the Hispanic Caucus threatened to vote against a bill that prevented undocumented immigrants from purchasing coverage in the exchange with their own money and it’s unclear if ongoing negotiations have satisfied enough of the 40 pro-life Democrats unhappy with the bill’s restrictions on abortion funding. Reps. Bart Stupak (D-MI) and Brad Ellsworth (D-IN) have offered stronger abortion language that the caucus is currently considering.

Assuming that every Republican votes against the measure, Democrats have to peel away approximately 22 unsatisfied caucus members to pass the bill in the House. President Obama is expected to officially endorse the legislation later today and personally rally support for the measure during a visit to the Capitol on Saturday. Still, major policy disagreements could delay a House vote. Below is a table laying out the areas of disagreement:

Abortion:

Immigration:

Democrats would also have to defray likely Republican efforts to use the the motion to recommit “as an opportunity to insert a social issue poison pill, likely on abortion or immigration, that would peel off enough moderate Democrats to pass.” Republicans “could craft an abortion measure that gives pro-life Democrats little choice but to vote with the minority to change the bill. That change could make the final bill unpalatable enough for most Dems that its passage would be put in jeopardy,” Politico speculates.

Will Abortion Derail Health Care Reform? »

Speaker Nancy Pelosi (D-CA) has scheduled a press conference tomorrow morning at 10am to release the final House health care bill with hopes of voting on the legislation sometime next week. According to early reports, the bill will cost approximately $900 billion/10 years, include a national public option that will reimburse providers at negotiated rates, cover 36 million Americans (6-7 million more than the Senate Finance version) and “be paid for, in part, with a 5.4 percent surtax imposed on those with incomes over $500,000 for individuals, $1 million for families.”

But while media attention has focused on these top line compromises, behind the scenes, some observers are concerned that an impasse over abortion funding could derail the entire reform effort. Yesterday, during an appearance on Washington Journal, Rep. Bart Stupak (D-MI) said said he is “considering teaming up with Republicans to block House health reform legislation (HR 3200) unless Democratic leaders allow a floor vote on an amendment that would add new restrictions on the use of federal funding for health plans that cover abortion with private dollars”:

STUPAK: I still gets down to, under HR 3200 — the house bill, the one I am most familiar with — there is these affordability credits. In other words you’ll get a refund if you will from the federal government to help pay for this tax, to help pay for this health care. So, what we’re saying is, if you are receiving an affordability credit, tax payer subsidies, you cannot buy a plan that has abortion coverage in it and we just can’t get by that. They once said, “no no,” if you get a subsidy from the federal government you should be allowed to buy abortion coverage with that subsidy. And that’s where we can’t go. It’s called the Hyde Amendment — no public funding for abortion. It’s been the law since 1976. If you wanna do health care that’s one thing but let’s not be changing the law on abortion coverage.” [...]

Somewhere in this process we have to have an opportunity to vote our conscious, in other words we have to have a vote or we’re gonna try and take down the rule. If we do not have the vote most members of the forty will not vote for the bill.

Watch it:

But Stupak is misrepresenting the House legislation and the existing federal restrictions on abortion funding. Currently, the House bill contains what’s called the Capps Amendment — a compromise that maintains Hyde Amendment restrictions. The arrangement protects Hyde by specifying that subsidy dollars could only be used to abort pregnancies that threaten the life of mother or result from rape or incest (Hyde allows for this). Other kinds of abortions would have to be funded with private premiums. The provision also requires that at least one plan in each market area offer abortion services and one plan not. No abortion services—even those allowed by the Hyde Amendment — can be mandated as part of a minimum benefits package.

Stupak and his allies want to go beyond Hyde. They’re arguing that the current firewall between public and private money is inadequate. If a woman uses federal subsidies to pay for a basic benefit, she would have more private money available to fund her abortion, they claim. Or, alternatively, “premiums paid to that plan in the form of taxpayer-funded subsidies help support that abortion coverage even if individual abortion procedures are paid for out of a separate pool of privately-paid premium dollars.” Sen. Orrin Hatch (R-UT) proposed a similar amendment, during the Senate Finance Committee’s mark-up, leading Sen. Debbie Stabenow (D-MI) to say, “with all respect to my friend, as a woman, I find it offensive.” Stabenow stressed that further restrictions on abortion funding would drastically change existing law and levy an undue burden on women who seek access to abortion services. Under Hatch’s amendment, women who purchase comprehensive private insurance packages — that include abortion services — would have to pay for the entire cost of the package (even if they qualify for subsidies).

As Pelosi prepares to unveil the bill, “leadership aides admit that they still need to find compromise wording on abortion but are confident the issue will be resolved by the time the bill gets to the floor.” Reps. Tim Ryan (D-OH), Mike Doyle (D-PA), Rosa DeLauro (D-CT) and Lois Capps (D-CA) are hoping to find a compromise before the measure comes to a vote, but conservatives are already organizing around the Stupak provisions.

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Does The Abortion Compromise Preserve The Status Quo?

Rep. Lois Capps (D-CA)

Democrats have argued that health care reform would preserve the status quo. In July, Rep. Lois Capps (D-CA) introduced an amendment in the House Energy and Commerce Committee “that attempted to strike a balance and preserve the status quo on abortion funding”; Sen. Max Baucus (D-MT) has unveiled a bill that closely mirrors Capps’ amendment.

But as Arons points out, reform changes current law by mandating that at least one plan in each market area not offer any abortion services and jeopardizes the abortion coverage of women who transition form employer insurance to plans within the exchange:

Read Arons’ full memo here.

Stabenow On Hatch’s Abortion Amendment: ‘As A Woman, I Find It Offensive’

The Baucus health bill maintains federal restrictions on abortion funding by preventing federal money from funding any abortions beyond reasons of life-endangerment, rape or incest. Under the mark, women wouldn’t be able to use subsidy dollars for the procedure and would finance the operation only with private premiums.

This morning, Sen. Orrin Hatch (R-UT) introduced amendment Hatch C14, requiring that “no funds authorized or appropriated under this Mark 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.” Under Hatch’s amendment, women who purchase comprehensive private insurance packages — that include abortion services — would have to pay for the entire cost of the package (even if they qualify for subsidies) and obtain a separate rider for abortion coverage.

Responding to Hatch’s amendment, which ultimately failed in a vote of 10-13, Sen. Debbie Stabenow (D-MI) said, “with all respect to my friend, as a woman, I find it offensive”:

In fact, with all respect to my friend, as a woman, I find it offensive that in here– any woman, any family purchasing through the exchange, if they did not receive any tax credit, would be prohibited from having the full range of health care options that they may need covered….This is an unprecedented restriction on people who paid for their own health care insurance…the assumption that somehow a woman or family would say, ‘you know some did we may have an unintended pregnancy, so we’ll get a separate rider or maybe my pregnancy is going to have a crisis, many, many crises, and so we’re going to find some other rider.’ In my judgment, I don’t even know how that would work.

Stabenow explained that Hatch’s ‘extreme’ amendment would drastically change existing law and levy an undue burden on women who want access to abortion services. Watch it:

While the Baucus amendment establishes a firewall between public dollars and private dollars for abortion services, some advocates believe that the existing language would jeopardize the abortion coverage for women moving from employer sponsored plans (the majority of which cover abortion services) to insurance within the Exchange. They point to present federal policy which subsidizes employer-sponsored plans without restricting abortion coverage.

The mark requires each state-based exchange to contain at least one plan that does not cover abortion and a separate policy that does.

Coburn: I’m Willing To Go To Jail To Save Conscience Clause

The Obama administration has suggested that it will move to “rescind a controversial rule that allows health-care workers to deny abortion counseling or other family-planning services if doing so would violate their moral beliefs.”

The Bush administration argued that the rule was necessary to protect the “freedom of expression and action” of medical professionals who personally object to providing certain procedures. Health care professionals maintained that the new regulation was highly redundant; activists saw the provision as a backdoor effort to restrict access to contraceptives.

But conservatives are now up-in arms about Obama’s decision to review the regulation. In an interview with CNSNews, Sen. Tom Coburn (R-OK), an OBG-YN, suggested that he might engage in civil disobedience if Obama repealed the conscience clause:

“I think a lot of us will go to jail,” Coburn told CNSNews.com when asked what would happen if the administration reverses the policy. “Let’s see them prosecute the first one of us for not doing that.” By that comment, Coburn meant that doctors, himself included, are willing to defy the law before agreeing to perform medical procedures that violate their conscience, a Coburn spokesman clarified.

Coburn’s sacrifice for principle is impressive, but refusing to provide abortions won’t land him in jail or bring him the publicity that often comes with incarceration. Even without the rule, Coburn’s “conscience” will be protected by The Church Amendment of 1976, The Coats Amendment of 1996, and the Hyde/Weldon Conscience Protection Amendment of 2004.

Coburn might have to keep an eye out for other opportunities for incarceration.