This weekend on NPR, insurance company executives confirmed to NPR health reporter Julie Rovner what the pro-choice community has been saying since the Stupak amendment was added to the House Health reform bill.
In short, the amendment will lead to a virtual elimination of insurance coverage for abortion care, in turn leading to what one analyst calls "devastating outcomes" for some women.
As Rovner reports:
Backers of controversial abortion language added to the House health overhaul bill last week say it merely continues longstanding policy that bans federal funding of the procedure. But opponents say it could have much more far-reaching consequences on access to abortion, particularly in the private insurance market. The ultimate impact of the House abortion amendment could be to change abortion from being a procedure routinely covered by most private insurance plans to a procedure routinely excluded -- even in cases of medical emergency.
The Stupak amendment has two parts with numerous ramifications.
The first part would write into permanent law the so-called Hyde Amendment, which for three decades has been renewed annually to forbid direct federal funding for abortions except in certain specific cases — currently rape, incest and to save the life of the pregnant woman.
"Codification of the Hyde language means if there is a government-run public option available in the new health program, it won't be able to provide abortion as a covered benefit," reports Rovner.
But she notes, "the dispute is over the second part of the amendment, [which would] bar health insurance plans in the new health insurance marketplaces the bill would create — known as exchanges — from offering abortion as a benefit to people who are receiving federal subsidies to pay for their coverage."
Stupak and his supporters claim the fix is easy:
"I can go to the exchange as a private individual and purchase a plan in the exchange that has abortion coverage in it because I did not receive any affordability credits," he said in an interview.
And as NPR notes:
The amendment does say that health insurers can offer plans with abortion coverage to people who are paying the full premiums themselves, as long as they offer identical plans without abortion coverage to people who are getting subsidies.
But, Rovner goes on to report that "most insurance experts say that's not likely to happen."
"I really think it would be impractical," says Robert Laszewski, a health insurance industry consultant. Several health insurance companies contacted for this story declined to comment, citing the sensitivity of the subject matter.
Why? Because insurance companies are, as we all know, nothing if not profit maximizers, and asking them to create "boutique policies" for unplanned events at a time when the main objective is to reduce costs will not be tenable. Making the procurement of insurance coverage for abortion care virtually impossible is the unstated goal of the United States Conference of Catholic Bishops and the C-Street fundamentalists trying to impose their view of a Christian world order on Americans.
And Laszewski tells NPR this is precisely what will happen. The problem is that by all estimates, the vast majority of people who will be shopping in the new exchanges will be getting subsidies, so they won't be allowed to get abortion coverage. Thus, if a health insurer did offer a separate plan with abortion coverage, it would only be available to a small universe of buyers, and it simply wouldn't make much business sense.
"It's not an ideological issue, it's not about abortion or not abortion," Laszewski says. "It's about what is administratively simpler, easier to administer. It just adds a level of complexity they will likely avoid."
"If more plans don't have it than have it," says Laszewski, "then that becomes the standard of competition and everything else is the exception."
It's about volume and profit margin, plain and simple.
Rovner also spoke to Sara Rosenbaum, a health lawyer and professor at George Washington University, who agreed with Laszewski that "it is impractical to expect health insurance plans to cover abortion in the exchanges, even for people paying the full premiums without federal help."
"If you speak to insurers in the industry, they will tell you that they simply can't operate under these circumstances," Rosenbaum says. "They need to be able to offer standard products that get administered in a standard way for everybody."
So-called abortion riders also are a figment of the far right spin machinery desperately trying to make its efforts to eviscerate women's fundamental rights seem relatively innocuous and rational.
Stupak, for example, also helpfully suggests that women could use their own money to buy a separate policy that just covers abortion.
But in real life, this also is not feasible. (Hard when you have to live in the real world, isn't it?)
According to Laurie Rubiner, Vice President of Public Policy and Advocacy for Planned Parenthood of America, in the five states that already ban private insurance from covering abortion — Missouri, Idaho, Kentucky, Oklahoma and North Dakota — no such riders exist.
"We haven't been able to find any kind of separate abortion rider, and it doesn't surprise us because there's no market for it. Why is that? Because no woman plans to have a catastrophic pregnancy, or an unintended or unplanned pregnancy. Therefore, she doesn't think about buying coverage separately for abortion. And since there's no market for it, the product doesn't exist."
As a result, according to both insurance consultant Laszewski and health lawyer Rosenbaum, the House abortion amendment could dramatically reduce the availability of insurance coverage.
Rosenbaum says this situation could become what would be a financial catastrophe for women who encounter problems later in pregnancy and do not have insurance coverage.
"The consequence," says Rosenbaum, "...is to exclude from the insurance system a procedure--[and] depending on the circumstances under which it's needed [this could be] an incredibly costly procedure — and even when it's not life threatening, [it may] leave a woman and her family with thousands of dollars in unpaid bills."
