The Stupak amendment reaches far beyond any of the reporting so far. It could effectively stop many employer-provided health insurance plans from covering abortions for tens of millions of Americans. It reads:
In General – No Funds authorized under this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case…[of a risk of death of the mother, rape, or incest].
The big problem is that HR 3962 touches many insurance plans directly and indirectly.
Of course, there is the new exchange. The exchange has a risk adjustment mechanism that will help redistribute premiums among all the plans on the exchange based on the characteristics of each plan’s risk pool. The goal is to prevent cherry-picking and risk selection by insurance companies. The CBO projects that roughly $64 billion will be redistributed by the risk adjuster. Therefore every plan on the exchange will probably get some money from “this Act.”
If the risk adjuster does not make every plan on the exchange run afoul of the Stupak amendment, the guaranteed issue clause will. Insurance plans must accept all comers. This means each plan on the exchange would have at least one customer using tax credits, so no plan on the exchange could cover abortion. (Unless insurers could use the amendment to discriminate against low income Americans by offering abortion coverage and avoid being part of the exchange risk adjustment mechanism.) This is a serious problem because, as Dayen points out, the goal is to eventually expand the exchange to cover more and more people.
The plans on the new exchange are only a minority of insurance plans financially affected by HR 3962. The health care reform bill would also provide for a $10 billion temporary reinsurance plan for employer-provided insurance plans that cover early retirees. The reach of this temporary reinsurance plan could be huge, and, therefore, the reach of the Stupak amendment could be huge. Many large businesses, which employ tens of millions of Americans, would probably take advantage of the program. Since these large employer plans are getting some money from “this Act,” they could be required to stop providing coverage for abortions because of the Stupak amendment.
HR 3962 also provides money for “wellness program grants.” This money goes to small employers that offer wellness programs as part of their employer-provided insurance plan. Since these insurance plans would technically be getting funds from “this Act,” they might be forced to stop providing coverage for abortion.
The Stupak amendment would not just stop the insurance plans for the roughly 30 million people on the exchange from covering abortion. (That assumes the exchange is not expanded like some hope it will be.) There are many parts of the bill that provide some direct money to many employer-provided insurance plans. There is the retiree reinsurance plan, the small business tax credits, and the wellness program. A literal interpretation of the Stupak amendment could force employer-provided insurance plans to stop covering abortion for tens of millions of Americans. The long reach of the Stupak amendment could have huge ramifications on the current aviability of insurance coverage for abortion services.