Health Bill Abortion Clause May Derail Insurance Observers say 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.

Health Bill Abortion Clause May Derail Insurance

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This is WEEKEND EDITION from NPR News. Im Scott Simon.

Today most of the health insurance policies cover abortion. Republican National Committee discovered earlier this week, to some chagrin, that its been covering the procedure for its employees for years. Now NPRs Julie Rovner reports that language adopted by the House last week as part of its health overhaul bill could change that.

JULIE ROVNER: The dispute centers around the impact of language authored by Michigan Democrat Bart Stupak. In the new marketplaces the bill would create, called exchanges, the language would forbid health insurance plans from offering abortion as a benefit to people who get federal subsidies. Now, Stupak says that people who buy their own coverage in the exchange but who dont get subsidies, called affordability credits, will be able to buy policies with abortion coverage.

Representative BART STUPAK (Democrat, Michigan): 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 credit.

ROVNER: Thats true but theres a catch - health insurers who offer plans with abortion coverage to people who pay their own premiums will also have to offer identical plans, except without abortion coverage, to people who are getting subsidies. And most insurance experts say thats not likely to happen.

Mr. ROBERT LASZEWSKI (Consultant): I think it would really be impractical.

ROVNER: Bob Laszewski is a health insurance industry consultant. He says the problem is that the vast majority of people who will be shopping in the new exchanges will be getting subsidies, so they wont get abortion coverage. So offering a separate plan with abortion coverage would only be available to a small universe of buyers, and it simply wouldnt make much business sense.

Mr. LASZEWSKI: Its not an ideological issue. Its not about abortion or not abortion. Its about what is administratively simpler, easier to administer. It just adds a level of complexity they will likely avoid.

ROVNER: Sara Rosenbaum, a health insurance lawyer at George Washington University, agrees that health insurers are unlikely to cover abortion in the exchanges, even for people paying the full freight.

Ms. SARA ROSENBAUM (George Washington University): If you speak to insurers in the industry, they will tell you that they simply cant operate under this kind of set of circumstances. They need to be able to offer standard products that get administered in a standard way for everybody.

ROVNER: The other option for getting abortion coverage under the House language is that women could use their own money to buy a separate policy that just covers abortion. But thats not likely to happen either, says Laurie Rubiner of Planned Parenthood. She bases her conclusion on the experience of the five states that already prohibit private insurance from covering abortion.

Ms. LAURIE RUBINER (Planned Parenthood): And not surprisingly, we havent been able to find any kind of separate abortion rider, and it doesnt surprise us because theres no market for it. Why is that? Because no woman plans to have a catastrophic pregnancy or an unintended or unplanned pregnancy. Therefore she doesnt think about buying coverage separately for abortion, and since theres no market for it, the product doesnt exist.

ROVNER: And it may or may not be what backers of the abortion language intend, but insurance consultant Bob Laszewski says the ultimate impact of the amendment could be to change abortion from a procedure thats routinely covered by most private insurance plans to a procedure thats routinely excluded.

Mr. BOB LASZEWSKI (Consultant): If more plans dont have it than have it, then that becomes the standard of competition and everything else is the exception.

ROVNER: Rosenbaum agrees and says that could become a financial catastrophe for women who encounter problems later in pregnancy, exactly the opposite of what health insurance is supposed to do.

Ms. ROSENBAUM: And the consequence of that is to exclude from the insurance system a procedure that can be, depending on the circumstances under which its needed, an incredibly costly procedure, and even when its not life-threatening, leave a woman or a family with thousands of dollars in unpaid bills.

ROVNER: Of course the debate over the health bill and abortions role in it is far from over. The Senate version could come to the floor next week.

Julie Rovner, NPR News, Washington.

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