We know that the House healthcare reform bill passed after an eleventh-hour compromise (you might say betrayal) on abortion access. We know the compromise, the Stupak-Pitts amendment, is bad. But do we know exactly how it’s bad for women (and their partners)? Here’s a quick primer on what the amendment actually means for any woman accessing healthcare through the newly-created health insurance exchange.



Over the summer, legislators struck an agreement on abortion funding in which private plans offered through the health insurance exchange couldn’t use federal dollars to cover abortion care. They could, however, cover abortion care with funds from individuals’ premiums, and the agreement, the Capps Amendment, required at least one plan in every region to offer abortion care, and at least one not to. As many observers predicted, the Capps Amendment didn’t mollify anti-abortion crusaders, namely the US Conference of Catholic Bishops, which commands an outsize role in the debate over healthcare reform.



So what we ended up with was drastically worse. After the initial compromise fell apart, Rep. Bart Stupak introduced the eponymous amendment, under which any plan purchased with any federal subsidy cannot cover abortion services–even with private funds. Plus, the public plan won’t cover abortion care. While plans participating in the health insurance exchange are legally permitted to offer a version of the plan that does cover abortion–enrollment limited to those who pay for the entire plan without any subsidy–it’s unlikely plans will go the extra mile to offer that coverage, Planned Parenthood’s Laurie Rubiner said this morning on the Brian Lehrer Show. That would be "awfully complex," Rubiner explained. Because the majority of Americans purchasing insurance through the exchange would be using affordability credits, the plan without abortion coverage will become the "standard plan." Rubiner also cited privacy concerns over purchasing abortion-inclusive coverage. The Wall Street Journal observed, "Insurers may be reluctant to [set up abortion-inclusive plans] because it could complicate how they pool risk and force them to label policies in a way that could draw attention from abortion opponents."



At Change.org, Jen Nedeau pointed out that even women who currently have employer-based insurance that does cover abortion care (and 87 percent of employer-based plans do) may ultimately be affected. "Since the plan for the uninsured is designed to open up to everyone over time, including large employers, it is likely that women will lose access to abortion coverage as part of any health insurance plan available for purchase," Nedeau explains.



In defending his amendment, Stupak made one misleading and one outright false claim. He argued that women could purchase "abortion riders" on top of their insurance, much like they might purchase a dental or vision rider. Such an abortion rider doesn’t exist now, and the legislation does not provide for its creation. Rubiner pointed out that in states where private coverage of abortion care is outlawed, riders don’t exist either. Besides, they defy logic: "Women would have to plan for their unplanned pregnancy," Rubiner added. "It’s illogical to think they would look for a plan that includes abortion."



And for the falsehood: Stupak claimed that his amendment "goes no farther than Hyde," the amendment banning federal Medicaid funding for abortion care except in cases of rape, incest, or threat to the woman’s life. In fact, the amendment goes farther than Hyde in stipulating what kind of coverage a woman can purchase with private dollars. "It’s the equivalent of arguing that women who receive abortions should not use public buses or highways to travel to the abortion clinic," Igor Volsky at Wonk Room points out.



In the Stupak amendment, the exceptions to the coverage ban read as follows: rape, incest or "where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death." The Center for American Progress’s Jessica Arons writes, "Given insurance companies’ dexterity in denying claims, we can predict what they’ll do with that language." And in case you wonder what that leaves out entirely: "Cases that are excluded: where the health but not the life of the woman is threatened by the pregnancy, severe fetal abnormalities, mental illness or anguish that will lead to suicide or self-harm, and the numerous other reasons women need to have an abortion."