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 abortion amendment added to the House health bill has two parts. There's little debate about the impact of the first part: It 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.
The dispute is over the second part of the amendment, authored by Rep. Bart Stupak, a Democrat from Michigan. It 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 says people buying coverage in the exchange who are not getting subsidies — technically known as affordability credits — will be able to buy policies with abortion coverage.
"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.
Indeed, Stupak's 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 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.
Laszewski says 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."
Sara Rosenbaum, a health lawyer and professor at George Washington University, agrees that it's 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."
There is another option for getting coverage under the House language: Women could use their own money to buy a separate policy that just covers abortion. But that's not likely to happen, either, says Laurie Rubiner, vice president of public policy and advocacy for Planned Parenthood of America.
Rubiner bases her conclusion on real-world experience. Five states — Missouri, Idaho, Kentucky, Oklahoma and North Dakota — already ban private insurance from covering abortion.
Yet, she says, "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."
So, even if lawmakers don't intend for it to happen, both insurance consultant Laszewski and health lawyer Rosenbaum say the House abortion amendment could dramatically reduce the availability of insurance coverage.
Says Rosenbaum: "The consequence of that is to exclude from the insurance system a procedure, depending on the circumstances under which it's needed, an incredibly costly procedure — and even when it's not life threatening, leave a woman and her family with thousands of dollars in unpaid bills."
Of course the debate over the health bill, and abortion's role in it, is far from over. The Senate version could come to the floor next week.