|On the Saturday of the healthcare vote, the pro-choice members of the House revolted when told about the Stupak enrollment bill which was being considered, considered under pressure from the administration. The Speaker announced that she would not negotiate with Stupak. They seem to have defeated Bart Stupak at that point. But Bart Stupak won anyway - as least in terms of his desired outcome...which is to make abortion much more difficult for women. Millions of women is America will have effectively lost the ability to buy abortion coverage with their own money - not federal money, but their own.
THE MECHANISMS BY WHICH NELSON DECIMATES ABORTION COVERAGE IN INSURANCE
First, the bill is designed to destroy abortion coverage in the insurance market. And it will succeed pretty quickly. Many components work together to do that.
- There is a state opt out provision.
- A provision which mandates at least one plan with NO abortion coverge, but no provision mandating a plan with abortion coverage. It tilts the playing field so much that it will wipe out insurance coverage for the procedure.
- The Nelson amendment has a conscience clause provision, however it only protects those who refuse to provide women abortion services, it's not reciprocal. It does not protect abortion providers from harassment. Who actually gets harassed more? Anyone remember Dr. George Tiller who was constantly harassed legally and personaly before he was murdered.
The newly issued Executive Order gives HHS enormous leeway in how it enforces the Nelson amendment's conscience provisions. We have a prochoice administration now, but later? Though frankly by then it won't matter, there will be no abortion coverage in insurance at all.
However, the biggest tool for destroying coverage is the 2 CHECK PROVISION.
The 2 check provision is meant to highlight and stigmatize. It is designed to be difficult to execute and to actively discourage insurers from providing coverage.
this is how it works. You write a check for the premium, then you write an additional check for about $1.00 which goes into a different pool of money for abortion. That is supposed to segregate federal from private money. If that was the sole purpose, that could have been achieved by just having the insurance company set up different accounts. But that was not the purpose. The 2 check provision actually winds up making sure that women can't use private money for abortion rather than the other way around.
In January, there were insurance companies in NY that had already notified community health care clinics specializing in low to middle income women, that if the amendment passed, the 2 check provision was so onerous, that they would no longer provide any plans at all with abortion coverage.
The George Washington University study on Stupak said in a few years there would be no plans in the exchange that provide insurance coverage for abortion. NONE. The professor who did that study put out another study after the Christmas passage of Nelson making it clear that the actual impact of Nelson would be the equal to Stupak. No coverage in a few years.
The 2 check payment is made, not just by women in their childbearing years to a plan that covers abortion, but also by those who are male head of households or single men. It's designed to make you NOTICE that the plan covers abortion. Plans now cover abortion and most people don't even know until or unless they need to use it. Just like they don't know what other procedures the plan covers until they go to use it. (One of those things the new HCR bill doesn't really fix)
Can you imagine telling your employer in some anti-choice workplace or state that you want the plan with abortion coverage? How many would and how long would they keep their job?
Highlighting it will result in male heads of household and others dropping coverage, going to another plan. They may be well intended or they may be abusive. Who plans ahead and says they need an abortion to cover an unplanned pregnancy?
The political point of highlighting abortion coverage is meant to create an arena for anti-choice forces in the state to happily conduct campaigns to opt out of coverage. That was one of the main purposes of the Nelson Amendment. It provides more fodder for organizing by anti-choice forces. Those folks should thank Sen. Nelson.
Increasing access to health care for women through this bill will not increase access to abortion for women. It does make it nearly a certainty that it will eliminate abortion coverage. The Nelson amendment is designed to decrease it and without changes it will succeed. In many states there are stretches of hundreds of miles where there is no abortion provider at all. The fewer there are, the more noticeable they are and the more pressure there is, especially in rural areas, where there's also more social pressure to be anti-choice.
Social stigma has a very significant role to play here in the entire political process and medical process. According to the Guttmacher Institute, states that have Medicaid funding for abortion are the states with the highest utilization of abortion insurance. In states, like Texas, with no Medicaid funding for abortion, there is next to no utilization of insurance.
There are spillover effects of the lack of abortion coverage that are especially tragic. There are major health threatening and life threatening illnesses that women who are pregnant may suffer from. Treating those dangerous illnesses often require an abortion - late term, very costly abortions; they will not be available.
Lastly it is insurance industry practice to limit their plan template for efficiency purposes, to maximize profits by cutting administrative costs. And this will act to limit their offerings down to plans that do not have abortion.
So I'd ask that before you look more closely at the George Washington University Study ...
Please donate to pro-choice candidate, Connie Saltonstall, who's challenging Bart Stupak in the Michigan primary that takes place on August 3rd.
FR: Sara Rosenbaum, Hirsh Professor and Chair, George Washington University School of Public Health & Health Services
In combination with the Hyde Amendment, Stupak/Pitts will impose a coverage exclusion for medically indicated abortions on such a widespread basis that the health benefit services industry can be expected to recalibrate product design downward across the board in order to accommodate the exclusion in selected markets.
Supplemental insurance coverage for medically indicated abortions: In our view, the terms and
RE: Abortion provisions in the Senate Managers Amendment
December 21, 2009
Our earlier analysis of the Stupak/Pitts Amendment can be found here: (pdf)
Taken together, the provisions of the amendment can be expected to have a significant impact on the ability or willingness of insurance issuers to offer Exchange products that cover a full range of medically indicated abortions. Furthermore, as with insurance laws generally, and for the reasons stated in our earlier analysis, the amendment could be anticipated to have considerable spillover effects. This is because companies that issue insurance products (or administered products in the case of sales to self-insured plans) obviously desire to sell these products in as many markets as possible. If one purchaser market places significant restrictions on one or more aspects of product design, it is likely that sellers will attempt to design their products to a common denominator, so that the product can be sold across all markets in which the company desires to do business. This is particularly true with modern health insurance coverage products, where the concern is not only the coverage but the provider network through which coverage will be obtained. Negotiating the elements of such a product is extremely difficult, and it is just as difficult to have to explain to providers that some of their patients will be insured for certain medical procedures while others will not.
The Senate amendment (§1303) provides as follows:
- Section 1303(a) provides that states may "elect to prohibit abortion coverage in qualified health plans offered through an Exchange in such state if such state enacts a law to provide for such prohibition." A state making this election could reach all of the markets to which state insurance law applies, both for products sold in the Exchange and those sold outside the Exchange. Together these markets could represent a considerable proportion of all insured persons in a state, particularly states without large self-insured employer markets. Furthermore, because the amendment reaches the design of the product itself, it extends beyond the Hyde Amendment. The Hyde Amendment deals with the use of federal funding to directly pay for abortions, not with the nature of products sold by private insurers. Issuers doing business in such states presumably may determine that it is not sensible to sell a product covering medically indicated abortions in any of the state's geographic markets, regardless of whether the purchaser is an individual in the exchange or a self-insuring employer.
- Section 1303(b) also allows issuers to offer products (unless prohibited under state law) that include many types of medically indicated abortions whose funding is prohibited under the Hyde Amendment. At the same time however, the amendment appears to require that the issuer collect -- "from each enrollee in the plan without regard to the enrollee's age, sex, or family status" -- a separate payment for the prohibited abortions. Payments would have to be strictly segregated, subject to state insurance commissioner oversight and adherence to federal segregation requirements. For several reasons this provision could be expected to chill issuers' willingness to sell products that cover a range of medically indicated abortions. They would have to comply with complex audit standards and more importantly, they would have to collect an additional fee from each member of their plan, a step that could be expected to encounter broad resistance. (It is also not clear what the consequences would be for plan members who do not make the payment or whether non-payment would place them in arrears). The more logical response would be not to sell products that cover abortion services.