From the very beginning, a central tenet of health care reform was that no one would lose coverage they already have. That’s why so many women are outraged by the Stupak amendment to the health reform legislation recently passed by the House.  It goes against one of the fundamental tenets of health care reform: do not leave anyone worse off than they were before reform.   

Under the Stupak amendment, millions of women would either lose access to health care benefits, or worse, lose benefits they currently have if they purchase health insurance in the new exchange. The Stupak amendment prohibits any coverage of abortion in the public option and prohibits anyone receiving a federal subsidy from purchasing a health insurance plan that includes abortion coverage. It also prohibits private health insurance companies participating in the exchange from offering a plan that includes abortion coverage to both subsidized and unsubsidized individuals.

This leaves few possibilities for abortion coverage: An insurance company could offer a separate plan for women without subsidies that includes abortion coverage in its basic package. Also, an insurer could theoretically offer a single-procedure rider for abortion coverage, separate and apart from its broader health insurance policies. At best, the logistics involved make this a highly unlikely option. At worst, other provisions of the bill actually prevent health plans from doing so. 

Realistically, the actual effect of the Stupak amendment would be to ban abortion coverage across the entire exchange–for women who receive a subsidy and for women who pay 100 percent of their premiums with their own money. This is very significant because up to 30 million Americans may purchase health care insurance through the exchange.

The Stupak Amendment Would Greatly Extend Existing Limitations On Abortion Access

There are a number of restrictions on abortion access already in effect under current law.  Only women who can afford to pay for abortions with their own money or through their insurance plans have access. This excludes low-income women on Medicaid who live in states that don’t cover abortion care with state funds; federal employees, their spouses, and female dependents; women serving in the military overseas; women in federal prisons; and women in the District of Columbia – not an insignificant group!

The Stupak amendment extends the group of women ineligible for abortion coverage far beyond its current breadth. It is essentially a middle-class abortion ban. The exchange would offer coverage to many of the 17 million women ages 18–64 who are uninsured, along with the 5.7 million women who are now purchasing coverage in the individual market. In addition, small employers are also likely to purchase their health insurance through the exchange where they may find more affordable options. Because the majority of health insurance plans in the private insurance market currently include abortion, many women will lose coverage that they already have in an exchange where abortion coverage is not permitted.

Where does that leave the working mother in a family earning up to $88,000? Or the self-employed woman who is paying the entire cost of her coverage and who doesn’t have access to employer-sponsored coverage? Or the woman who works in a small business whose owners purchase coverage through the exchange? 

The Stupak amendment leaves them without coverage for a legal medical procedure. Simply put, women’s access to private coverage for abortion would be restricted by health care reform. One thing is certain: Women should not be left worse off after health care reform than they are now.