After reading through the transcript of the NPR report on the Stupak amendment, I began to wonder if the House Bill, even with the Stupak amendment, would actually broaden access to publicly funded abortion. For low-income women who find themselves with an unplanned pregnancy, this could be very important. But even moderate-income women might gain increased access to abortion, though not through public funding directly.
How would access to publicly funded abortion increase?
Possibility 1. Through Medicaid in 17 states:
The House Bill expands the number of people (including women of child-bearing age) who can enter Medicaid. And there are seventeen states that currently fund abortion services through Medicaid. I'll quote from NPR's report last night: "If you get your health insurance through your state, as in Medicaid, your state could buy supplemental abortion coverage for everyone it insures. And 17 states already do this under Medicaid."
I checked that "17" number, it's from the Guttmacher Institute, a well-respected reproductive health advocacy group that is an offshoot of Planned Parenthood. I don't think those 17 states do that out of conscience entirely, but out of a desire to prevent future costs to the state. So in this economically perilous environment, I would expect the number of states that buy supplemental abortion coverage to increase as the number of women on their rolls increases under new legislation. (Pro-life forces are one thing; state budgets are another.) As well, those seventeen states that already provide coverage are likely to buy additional coverage, as it is less costly to provide more access to abortion than to bring a pregnancy to term.
Possibility 2. Indirect Funding for Riders
Say you're like me, still (barely) of child-bearing age, but unable to afford insurance. The exchange would give me access to insurance, and at my current low income, I might even qualify for a federal subsidy. That means I would be getting insurance that would have been previously out of my reach.
But that insurance, under Stupak, doesn't cover abortion. Ostensibly, this should be no problem, since, through either the exchange or the public option, I would have access to oral contraceptives like Ortho Tricyclen Lo, which are now, BTW, entirely more sophisticated and low-dose compared to earlier versions of "the birth control pill."
But say that even while taking the low-dose Ortho Tricyclen, I am worried about accidental conception. (I don't know how I would be, given how effective the pill is, but this is all hypothetical.) In that hypothetical case, there is a solution: I could buy an insurance rider to cover abortion out of my own pocket. That out of pocket expense for the rider would be made more affordable by the fact that I'm already being subsidized for the insurance in the exchange.
Let's think about pricing for the rider. If you're a major health insurer, how much do you want to charge for an abortion coverage rider? From a cost-benefit analysis, wouldn't insurers want to provide this rider at low cost, as they save more money if a woman doesn't go to term? In fact, the company might provide the rider for a very nominal fee, one that is easily dwarfed by the subsidy the individual receives from the government.
Having said that, I think this is the time to voice objection to the Stupak amendment. But I don't think it's worth abandoning the entire effort just because of Stupak.
Separately: The Media Focus On the Bishops:
I thought the media's focus on the Catholic Bishops' letter was out of place - whenever I've interacted with anti-abortion protesters or tea partiers, it's been pretty clear I'm dealing NOT with Catholics, but evangelicals. (It was also odd that almost no one in the media seemed interested in what the Bishops had said on non-repro health issues - e.g., their insistence that health care cover immigrants.)
Almost all of my friends who either attended Catholic school or who remain within the Catholic Church have rejected traditional church teaching on birth control and other issues relating to sexual matters. So I wasn't surprised when Rachel Maddow revealed on Monday night what most of us already know - the Catholic Bishops have about as much influence on Washington D.C. as they have on actual Catholics. That is to say, not much.
But Stupak and eight of the men who voted for Stupak's amendment belong to C-Street's "family" - the conservative evangelical organization. Mr. Stupak even lives at the C-Street complex. Apparently, we'll get to know a lot more about C-street over the next few years, since, as Maddow points out, they've effectively infiltrated the Democratic party.
Here's an essential quote from Rachel Maddow's interview with Jeff Sharlet (transcript here), who has written extensively on "The Family" and "C-Street":
MADDOW: Well, let me ask you about some of the other conventional wisdom here, because the sort of conventional explanation for this is that this anti-abortion amendment to health reform resulted mostly from the Catholic bishops pressuring Catholic politicians to support it. But I know that you think that it's bigger than that. Can you explain why?
SHARLET: Well, I think it's unfair to Catholics. I think it's unfair to Evangelicals. First of all, most of the press has focused on Catholics despite the fact that a number of the congressmen involved in this are not Catholic including congressman Pitts, including Congressman Shuler, who you mentioned.
And frankly, the majority of American Catholics are pro-choice. That's not true of the majority of American Evangelicals. I think it's a very comfortable story to tell ourselves this is just traditional Catholic conservatism rather than facing the fact there's a growing and new Evangelical - conservative Evangelical influence within the Democratic Party."
P.S. Vince Hall of Planned Parenthood had a response to what I wrote, I will post it verbatim if he gives his permission.
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