The New Scarlet Letter -- A is for Abortion

The Stupak-Pitts amendment takes me back to the days when abortion was not legal and the shame of an abortion was very much like wearing a big red letter A on your forehead.
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Many bloggers have explained what the Stupak-Pitts amendment to the House health reform bill could mean for abortion rights in this country. Women in Congress are assuring us that this amendment will not survive the Senate bill, and we trust that they are correct. But as a mother and grandmother of a daughter, daughter in law and a granddaughter, this means more to me than just statistics. This takes me back to the days when abortion was not legal and the shame of an abortion was very much like wearing a big red letter A on your forehead.

It is bad enough that poor women in this country cannot get federal funding for the choices they must make when they become pregnant and cannot sustain the pregnancy. The cost of an abortion can range from $300 to $900 in the first trimester and up to $18.000 in the second trimester. Even middle class women would find this overwhelming. It's not just the cost of abortions that is at issue, however.

The stupid Stupak amendment would do more than reinforce the current prohibitions under the Hyde Amendment -- it could make the Hyde Amendment permanent without any opportunity to ever offer abortion coverage to poor women in this country. But it would do more than just embed abortion prohibitions more strongly in future law -- it would extend its tentacles into the lives of women who do not rely on public funding now or in the future.

Jessica Arons explains the details of this amendment well in her Huffington Post piece today. But what has not been made very clear is how such an amendment would actually work in a newly reformed health system.

There is a lot of dispute about how the Stupak prohibitions would be implemented within the Exchange. Health plans -- private OR public -- that receive federal subsidy money (and the money does go to the plan not the individual) would not be able to offer abortion coverage. How that would be sorted out is where the big A comes in -- The most likely and practical outcome would be for all plans to simply drop abortion coverage, which would force women to buy some sort of "abortion rider" to get the coverage they expect or even used to have. That is highly impractical as well. Who plans on having an abortion when they sign up for insurance coverage? And what is the stigma attached to someone who does decide they want the coverage? Are you in Plan A (for abortion) or not? (See this article in Kaiser Health News for some good Q and A on how this might actually work in practice.)

For purely economic reasons, the cost to the health plan of an abortion rider would be close to zero, since the cost of most abortions is much cheaper than a pregnancy. However, the administrative costs of offering riders is not zero. That is one of the reasons why most insurance plans in America currently offer abortion coverage, even if they don't advertise it. It just makes economic sense to include both contraceptive coverage and abortion coverage for women of childbearing age. In those states that do offer abortion riders, insurance companies do not seem to want to offer them, so they are a phantom alternative.

But this segregation of women -- into those seeking abortion coverage and those who do not -- is akin to nothing else I can think of. Do we have any other legal medical condition that would require that? Would men who might get prostate cancer have to buy a prostate cancer rider or be told their legal condition is not accessible to them?I realize pregnancy is a unique condition, but abortion is still legal, so making it even more difficult to get seems punitive, at best. And it will be very hard to administer this amendment.

It's pretty clear that the Catholic bishops and those C street guys who wrote and sponsored this amendment didn't really talk to the insurance industry, because I'm quite sure they would have been told how difficult this would be to implement.

It will not be simple to figure out how to separate out federal money in an Exchange. But if we don't want to take that step backward of wearing the new scarlet letter, we had better get busy. We need to make our voices heard to those in the Senate who are going to have to figure this out.

Here's one very postive way we can make our voices heard. Support the Congress members who voted no on Stupak. Check out this website:

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