The Stupak amendment has touched off a furious argument among Democratic politicians and elites–one that could tank the entire health care reform project if it’s not resolved by the time legislation comes up for a final vote in the House.
For the most part, the argument has been about justice. The Stupak amendment would forbid anybody who receives new government health insurance subsidies from buying policies that cover abortion. So why should women’s health care be treated differently than other kinds of health care? Is it fair to prevent women, forced into the health care market, from buying any insurance policy she wants, even if they have some government assistance?
But somewhat less prominently, these same combatants have been at odds about what the practical effect of the Stupak amendment would actually be. There’s substantial lack of clarity on that score–many say it’s likely that there will be no abortion coverage in the exchange at all, and others hypothesize that, over time, the norms in the exchange will come to dominate the norms across the insurance market. At this point, that’s all theoretical. But there is at least some data on the immediate practical implications of the Stupak amendment: It will, at least, directly and immediately impact a small, but growing number of poor and middle-class women.The least-impacted women will be those whose employers (or whose spouses’ employers) provide them insurance. In 2013, that will be 88.5 percent of privately insured people (162 million) who will, for the most part, keep the plans they have. The data regarding women with employer-provided health care is very mixed. According to the Guttmacher Institute, in 2002, 87 percent of employer policies covered abortion. But according to the Kaiser Family Foundation, that same number in 2003 was 46 percent. A substantial difference.
Acknowledging the wide chasm, Guttmacher concluded that “The actual answer is probably somewhere in between, meaning that most Americans [tens of millions] with employer-based insurance currently have coverage for abortion.” Guttmacher also said that the overwhelming majority of plans that do cover abortion, will pay for them in almost all cases (i.e. not just in cases of rape, incest, and threat to the life of the mother).
Despite this, the Institute found that most women nonetheless pay for abortions out of pocket. Only 13 percent of abortions in 2001 were paid for by insurance companies. But, they note, this number is skewed downward for a number of reasons. For instance, many women who have abortions don’t have any insurance to begin with, and many of those who do have insurance aren’t aware that their policies cover abortion. These distortions are supposed to be rectified by comprehensive health care reform.
Stupak won’t effect these women at all, at least not immediately, and the greater reform package could actually make abortion a less complicated medical issue for them.
Overwhelmingly, the women effected by the law will be in the insurance exchange.
“Obviously the direct impact of Stupak only applies to the exchange…so it depends how big that gets,” says Adam Sonfield, Senior Public Policy Associate at Guttmacher.
The exchange will be much smaller than will the employer market. In fact, the number of women in the exchange will likely be lower than the number of women with abortion coverage in their employer-provided insurance. But under the terms of the Stupak amendment, the percentage of women in the exchange who will have abortion coverage as part of their policies will be tiny, or perhaps non-existent. “I think it’s pretty safe to say..that it will effect all 21 million in the exchange,” Sonfield says.
Of the 21 million people in the exchanges, 86 percent are expected to be receiving direct federal subsidies. It would be an oversimplification to say that this means 86 percent of women in the exchanges would be blocked from insurance coverage that includes abortion (it will almost certainly be more than that). But it is safe to say that the vast majority of, if not all, women in the exchanges will not be allowed to have abortion coverage in their benefits packages. These will be almost exclusively poor and middle-class women.
And their ranks are likely to grow. Over time, the reform packages under consideration allow ever larger employers to participate in the exchange, which will happen if the exchange keeps premiums down. “As employers go into the exchange over time…more and more women will be subject to these new rules,” says Jessica Arons, who directs the Women’s Health and Rights Program at the Center for American Progress.
“Coming from an employer plan that’s likely to cover abortion…they’re going to be losing coverage going into the exchange, either because they’ll need an affordability credit, or because there’ll be such a disincentive to cover abortion that insurance companies won’t do it,” Arons adds.
What does this mean for the number of abortions financed by insurance? As noted above, Guttmacher concluded that only 13 percent of all abortions in 2001 were paid for by private insurers. In theory, by increasing coverage, and transparency, health care reform should increase that number. But though the number of insurance-funded abortions will likely grow, the impact of the Stupak amendment would likely be to tamp down on that growth significantly.
What conclusions to draw from this? The uncertainties are substantial, but it’s safe to say that, initially, a minority of women, and a minority of abortions will be impacted by the Stupak amendment. Those women will be very disproportionately poor and middle-class. And their ranks will grow as the exchanges open to larger businesses and a greater percentage of the population.