I started the week biting my nails thinking about how the logic behind Stupak-Pitts could be more broadly applied. A Politico report about how Americans get $250 billion a year in tax breaks to buy employer-based plans, many of which offer abortion coverage, is to blame. I picked up the phone and called some of the amendment's supporting Congress members and anti-choice organizations to ask whether they might target such plans. Of course, my phone calls got me nowhere -- why would they reveal their long-term strategy to me? -- but, no matter. Now I realize my question was naive to begin with, because according to new analysis by George Washington University, it's possible the amendment itself could essentially bring about the same result.
Based on how the insurance industry "adjusts its products over time to conform to the regulatory environment in which it operates," the report concludes that Stupak-Pitts would "have an industry-wide effect." In short, it wouldn't just impact plans purchased through the new health insurance exchange. The most dramatic of those wide-reaching changes is that it will eliminate "coverage of medically indicated abortions over time for all women." That's no typo -- they truly mean all women (in the United States). The analysis explains:
The health benefit services industry, like any large producer of goods and services functioning in a national economy, depends on standardization and norms. If certain types of products are excluded in certain large markets, over time the market as a whole for the product can be expected to shift, as manufacturers move to accommodate their product to reflect the regulated design.
Insurance coverage of contraception offers a choice example of how this works:
Prior to the enactment of state contraception coverage mandates, most health plans did not provide the benefit. As state laws regulating the inclusion of contraceptives have become more prevalent, the broader health benefit services market has been affected. National health benefit services companies report today that they routinely include contraceptive coverage in their plans in all markets, not only those directly affected by state law.
As I mentioned earlier, those of you covered by employer-based plans should also take heed -- we aren't just talking about plans sold in the new exchange: "As the proportion of women of childbearing age covered by an abortion-related treatment exclusion grows, companies offering coverage products in the employer-sponsored market ultimately may elect to simply remove the procedures from their products so that they can be sold in all markets." The report also predicts that "health plan administrators will err on the side of coverage denial" when "interpreting and applying the exclusion." Why? Because of course "the legal risks associated with coverage determination are all on the side of incorrectly awarding coverage, not erroneously denying it." Ah, great.
Finally, there is the issue of those already much-maligned "riders." "It is essential that the supplemental coverage be administered in conjunction with basic coverage," the report says -- but, of course, Stupak-Pitts' requirement of strictly separate cash flow channels prevents this from actually happening. In other words, "the terms and impact of the Amendment will work to defeat the development of a supplemental coverage market for medically indicated abortions."
So goes a week in my post-Stupak life: I start off with one nail-nibbling concern and just a couple of days later I have many, many more.