The Stupak amendment would prevent any private health insurance plan from covering elective abortion, if even one of its customer used even one dollar of affordability tax credits. The problem is that the Stupak amendment will conflict directly with other parts of the bill. The bill would require “guaranteed issue.” This means that any insurer offering coverage to individuals on the health insurance exchange must accept all customers.

If the insurance companies offering plans on the exchange are not allowed to turn down any customers, it means no basic insurance plan on the exchange could cover abortion. There would be no way to prevent that at least one of the plan’s customer would be using affordability tax credits to help purchase the plan. So the effect is no plan sold on the exchange could offer abortion coverage as part of its basic package.

The contradiction could be solved in a different manner. The decision could be that insurance companies who offer plans covering abortion on the exchange would be allowed to turn down customers using affordability tax credits. This would create a dangerous loophole for the new guaranteed issue rule. This could lead to the ghettoizing of the health insurance exchange. Insurers would know that offering plans that cover abortion would prevent low income Americans from being able to sign up. Low income Americans tend to have higher medical costs and are less profitable, less desirable customers. Offering abortion coverage would be a simple way for an insurance company to keep them out of their risk pool. Since the exchange has dangerously weak risk adjustment mechanisms, this Stupak Amendment could become a profitable tool used by insurers to discriminate against low income Americans.

It seems the Stupak Amendment would either effectively ban any basic health insurance plan sold on the exchange (the individual and small business market) from covering abortion or would create a way to discriminate against low income Americans. Either way the Amendment will have far reaching ramifications for our health care system.