Planned Parenthood Statement on the Impact of Stupak-Pitts.

There has been much discussion about what the “real-life” impact of
the Stupak-Pitts amendment would be on women’s access to abortion
care. The following is an explanation of what this provision will
mean to women, if it is enacted. Essentially, the amendment violates
the underlying principle of health care reform, as articulated by
President Obama, that “no one will lose the benefits they currently
have.”

The truth is that under the Stupak-Pitts amendment, millions of women
would lose benefits that they currently have and millions more would
be prohibited from getting the kind of private sector health care
coverage that most women have today. To put a fine point on it,
millions of women would lose private coverage for abortion services
and millions more would be prohibited from buying it even with their
own money. Simply put, women’s access to private coverage for
abortion would be restricted by health care reform.

The New Health Insurance Exchange
The new health insurance exchange is intended to provide a new source
of affordable, quality coverage for the roughly 46 million uninsured
Americans and the millions more whose current coverage is unaffordable
or inadequate. The House bill is expected to cover 96 percent of all
uninsured Americans by offering subsidies for private coverage or the
choice of a public plan. Depending on their income level and the
final package approved by the Congress, individuals would receive
subsidies on a sliding scale to purchase private insurance through the
exchange. In the House-passed bill, all individuals with incomes up
to 400 percent of poverty ($88,000 for a family of four) would receive
subsidies to help purchase health insurance. However, not everyone in
the exchange would have subsidized coverage — a significant portion of
people (for instance, those currently purchasing in the individual
market and those working for small businesses) who would buy insurance
in the exchange would not receive any subsidies, also known as
affordability credits.

The Stupak-Pitts Amendment
The Stupak-Pitts 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. It also
prohibits private health insurance plans from offering through the
exchange a plan that includes abortion coverage to both subsidized and
unsubsidized individuals. Thus, if a plan wants to offer coverage in
the exchange to both groups of individuals, it would have to offer two
different plans: one with abortion coverage for women without
subsidies and one without abortion coverage for women with subsidies.
These private insurance plans would need to be identified as either
providing or not providing coverage for abortion. Health insurance
plans are highly unlikely to operate in this manner, and it is not
even clear that this is feasible under the administration of the
exchange and affordability credits. As one alternative, the Stupak
amendment purports to allow women to purchase a separate, single-
service “abortion rider,” but abortion riders don’t exist. In the
five states that only allow abortion coverage through a separate
rider, there is no evidence that they are available. Furthermore,
women are unlikely to think ahead to choose a plan that includes
abortion coverage, since they do not plan for unplanned pregnancy. In
addition, it is not clear that health plans would even be allowed to
offer two separate plans under other provisions of the act, such as
the anti-discrimination and guaranteed-issue provisions. Those
elements of the bill, which are very important to consumers, may make
it impossible for plans to provide two separate plans, one that
includes abortion and another that does not. Realistically, the actual
effect of the Stupak-Pitts amendment is to ban abortion coverage
across the entire exchange, for women with both subsidized and
unsubsidized coverage.

Who Would Be Covered in the Exchange
Most immediately, the exchange would offer coverage to many of the 17
million women ages 18–64 who are uninsured. It would also be a source
of coverage for the 5.7 million women who are now purchasing coverage
in the individual market. Typically, these are women who are not
receiving health coverage through an employer — they may be self-
employed, underemployed, or unemployed. Small employers (with fewer
than 100 employees) are also likely to transition their health
insurance to the exchange where they may be able to find more
affordable options. In most of these cases, women will lose abortion
coverage that they currently have — in the current private insurance
market, the majority of health insurance plans include abortion. A
self-employed graphic designer or writer, buying coverage from Kaiser
Permanente in the individual market, will likely have abortion
coverage. Under the health reform plan amended by Stupak, she would
purchase that same plan from Kaiser Permanente in the exchange, but it
would not include abortion coverage because it would be barred. This
ban would be in effect even if she were paying the full premium.
Similarly, a woman working for a small graphic design firm, who
currently has abortion coverage through her company’s plan, would lose
it under reform if the company decides to seek more affordable
coverage in the exchange.

Roughly 60 million women aged 18–64 get their coverage through their
employer or through their spouse’s employer. For some of these women,
nothing will change immediately. But if current trends continue in
the erosion of employer-sponsored health care, more and more women
will be getting their health care through the exchange. Women are
much more likely to be covered as dependents on their husbands’ health
insurance plans, and more and more employers are eliminating dependent
coverage as a way to cut costs. Where will these women get covered?
They will get health insurance from the exchange where abortion
coverage is prohibited.

Moreover, women are much more likely to lose employer-sponsored
insurance coverage as a result of a husband’s death or divorce. While
they will be able to purchase coverage in the exchange, their coverage
will not include abortion coverage. Moreover, the House bill opens
the door to large employers joining the exchange by giving the
commissioner the authority to allow large employers into the exchange
beginning in the third year of the enactment of health reform. If
this proves to be true, over time, women who get coverage through
large companies would lose access to abortion coverage entirely.

The Two-Tiered Health Care System
The House-passed health care system adds a huge swath of the female
population to the “have nots” column of an already two-tiered health
care system when it comes to abortion coverage in the United States.
Prior to the passage of the House bill, our health care system was a
system in which only women who could afford to pay for abortions with
their own money or through their insurance plans would have access to
abortion. Consider the current restrictions already in place:
• low-income women on Medicaid
• federal employees, their spouses, and female dependents
• women serving in the military overseas
• women in federal prisons
• women in the District of Columbia

The House-passed bill would add to this list of women who do not have
coverage millions of women who are getting their health insurance
through the exchange. Consider just a few examples:
• working mothers in families that earn up to $88,000
• women who are self-employed and paying the entire cost of their
coverage and don’t have access to employer-sponsored coverage
• young women entering the job market for the first time who are the
least likely to have employer-sponsored coverage
• women who were insured through their husbands’ employers, but now
are divorced and have to purchase coverage on their own through the
exchange
• women who work in small businesses whose owners decide to seek more
affordable, quality coverage through the exchange

Over the last six months, we have heard much about how important it is
to reform the health care system to meet the needs of women. Women
are much more likely to be left out of the current employer-based
system because this system wasn’t designed for them — it was designed
for higher-wage, full-time earners who have dependents at home —
namely, men. Women tend to be in lower-wage or part-time jobs that
don’t offer insurance, move in and out of the workforce because of
childbearing and childrearing responsibilities, and become uninsured
because of divorce or death of a spouse. But these are the very same
women who are targeted by the Stupak-Pitts amendment. And they will
join the growing ranks of women who are denied coverage of a legal
medical procedure. It’s turning out to be a strange sisterhood: the
poor, the incarcerated, the federally employed, the stateless, the
soldier, and now the middle-class in the exchange.