Thursday, November 12, 2009

Anti-abortion amendment threatens all women, all health plans

Media coverage of the Stupak amendment underestimates its impact on privately-funded abortion. The impact is also being downplayed by the right.

This looks specifically at the language of the amendment to show how it:

1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for any enrollee, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. This would include the public option, but also any other plans that participate in the exchange.

It also prohibits any plan that would offer “affordability credits” from covering abortions.

2. Could eliminate current practices by 17 states to cover abortion under Medicaid, and prevent other states from doing so.

In addition, it has the following potential effects:

3. Can eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, depending on the menaning of "any costs."

This could mean any health insurance plan offered through the new health insurance exchanges. The Exchanges, in turn, include both private insurance plans, and a public option.

4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."

1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for all enrollees, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. In this way it restricts abortion coverage both to low-income and middle-income women who receive federal funds for subsidies. It also restricts coverage for women who pay entirely with their own funds. This would include the public option, but also any other plans that participate in the exchange.

There is general agreement that the amendment prevents health plans in the new health insurance exchanges from covering abortions, if they will accept women who use federal subsidies to pay part of their premiums.

This prohibition applies to all plans in the exchange. These include the public option, as well as all other private insurance plans in the exchange.

Some people (those earning up to 400% of the federal poverty limit, or about $88,000 for a family of 4) will use federal subsidies (or “affordability credits”) to pay for their premiums. Those people could not buy a health plan that covers abortion through the exchange.

It will apply even though the federal subsidies constitute only a part of the premium, and the rest is paid through private funds.

In addition, any plan that intends to enroll people who accept federal subsidies to help pay part of their premiums will not be able to cover abortion, for anyone who enrolls in the plan. This means women who do not accept federal subsidies, who pay the entire cost of insurance privately, cannot buy an insurance plan that covers abortion through the exchange, if the same health insurance plan covers women who do use the subsidies.

The bill offers women the ludicrous option of buying supplemental abortion plans, as long as they do so outside of the exchange and using their own money. Supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This extra punch assures that in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance when they find out their birth control has failed.

All of this is worse than current law. Current law, through the Hyde amendment of 1976, says no federal funds can be used for abortion except if the mother’s life is in danger or in the case of rape or incest. Where the language is ambiguous, the Supreme Court will decide.

"Sec. 265. LIMITATION ON ABORTION FUNDING.
(a) IN GENERAL.- No funds authorized or appropriated by this Act (or an 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 [life-threatening illness related to the pregnancy, or pregnancy is a result of rape or incest]."

2. Could eliminate current practices by 17 states to cover abortion under Medicaid.

17 states now find ways to use state funds to pay for abortion through Medicaid. Medicaid is a program for low-income women which is funded jointly by state and federal dollars. The amendment appears to explicitly prohibit this:

"(b) OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. – Nothing in this section shall be construed as prohibiting any nonfederal entity (including an individual or State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as –
(2) such coverage or plan is not purchased using –
(B) other nonfederal funds required to receive a federal payment, including a State’s or locality’s contribution of Medicaid matching funds."

3. Could eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, whether or not it includes people who use federal subsidies to pay for their premiums, depending on the menaning of "any costs."
This explicitly could mean any health insurance plan offered through the new health insurance exchanges, both private insurance plans, and the public option.

The amendment says “No funds authorized or appropriated by this act…may be used to …cover any part of the costs of any health plan that includes coverage of abortion.”

It also does not restrict the use of federal funds to premiums. “Any part of the costs of any health plan” could refer to the administrative costs of setting up a health insurance exchange.

There will be people covered in the Exchanges who do not receive any federal subsidies for their premiums. They will pay every penny of the premium out of their own pockets. Some others will pay the premium by a combination of funds from their employers and from themselves.

These people may not be able to buy a plan through the Exchange that covers abortion

4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."

It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion. It does not limit the application of this prohibition to funds authorized by any section of the bill, to health insurance exchanges, or to the public option. It applies to every word in HR 3962.

It also doesn’t necessarily restrict its application to funds “authorized” by Congress to be paid through federal sources.

Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.

The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. The funds can be used to buy health insurance entirely privately. Or they could be used to buy insurance within the new health insurance exchanges. It could mean that no health insurance plan purchased as a result of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill.

In the case of ambiguity, the Supreme Court could make the final decision.

1 comment:

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