That Washington

Does "Health Care for All" Include Women?

By Josh Feit December 22, 2009

This editorial about the senate version of the health care reform bill supported by all 60 Democrats was written for PubliCola by Dana Laurent, political director for Planned Parenthood Votes! Washington.

Eight months ago Planned Parenthood began one of the most aggressive legislative campaigns we’ve ever waged. The goal: Quality, affordable health care for all (and, yes, “all” does include women).

When Rep. Bart Stupak’s (D-MI) abortion ban passed as a part of the health insurance reform bill in the House in early November, I sent an email to friends and coalition partners saying the Stupak Ban was “effectively a legislative end to Roe v. Wade.” (Stupak's amendment prevents anyone who receives public subsidies from purchasing a plan that covers abortion; stops any public option—there's a public option in the House plan—from covering abortion; and makes it impossible for insurance companies covering abortions to offer a plan to both subsidized and unsubsidized individuals—creating an abortion ban within the new health care system).

My email warning was met by some measure of shock and disbelief, but a few weeks later, a George Washington University Medical Center analysis corroborated the bad news for women. They found that the Stupak Ban, “…Will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women…” I’m not sure what it means to have a legal choice if you are unable to purchase or access your options.

One of the reasons Rep. Stupak got away with his draconian abortion ban language was that he said women could purchase a so-called “abortion rider"—meaning they could purchase a single-service insurance policy for abortion. The problem with abortion riders is this: Women do not plan for an unplanned pregnancy, nor to have severe complications with their pregnancy. In the five states (Idaho, Kentucky, Missouri, North Dakota, and Oklahoma) that only allow abortion coverage through a separate rider, rider plans do not exist.

On December 8, we were relieved when senators dismissed the Senate version of the Stupak ban introduced by Senator Ben Nelson (D-Neb). However, this Saturday we woke up to another dark day for women’s health when, in an effort to appease Senator Nelson and get the 60th Democratic vote to break a GOP health care filibuster, senate leadership introduced an unacceptable provision that makes it nearly impossible for health plans to offer comprehensive insurance coverage—for women that is.

Saturday's cave to Sen. Nelson—giving states the option of prohibiting abortion coverage in exchange plans and mandating that insurance companies establish two different systems if they want to offer comprehensive care for women—effectively creates an abortion rider. Individuals who choose a health plan that includes abortion would have to write two separate checks, one for abortion care and one for everything else. This stigmatizes women’s health, and intentionally creates an unnecessary burden on women. As for insurers—they would then have to deposit the payments into two separate accounts, presumably as a way of ensuring only private funds are used for abortion care.

This is a completely unnecessary hoop to jump through for insurers as well as individuals. Health care plans already have a way of separating private funds from public funds because of the Hyde Amendment—which has been restricting federal funding for abortion since 1976. Requiring insurers to establish and work within two separate systems means that they will likely just forgo offering abortion coverage.

The Nelson abortion check provision creates enormous administrative burdens on health insurance plans and individuals that would likely eliminate abortion coverage for all individuals in the exchange and tens of millions of women--planting a scarlet “A” on women which stigmatizes both them and abortion care.

The Nelson provision also removes one of the key protections of the original Senate bill that required that each income level in the exchange has at least one plan that offers abortion care.

We understand that leadership wants to move forward, but this provision does nothing more than make women’s health a political football. Given this provision, Planned Parenthood has no choice but to oppose the Senate bill.

In Washington, family planning providers face a 70 percent funding cut in 2010 as a result of the budget passed in 2009. This could result in 25 percent of all family planning clinics in the state closing their doors and a massive increase in unplanned pregnancy rates. This cut, along with new restrictions on women’s health in federal health insurance reform, and the fact that women pay 60 percent more in out of pocket costs for our health care—makes women second class citizens when it comes to health care access and coverage.

In Washington State, Planned Parenthood has made over 50,000 calls and turned out hundreds to counter teabaggers at town halls in support of health insurance reform. Our coalition partners in labor, social justice, and other community groups have been fighting with us.

Senators Murray and Cantwell have been champions for women’s health, but the Nelson provision is unacceptable. We are committed to continuing to work with Senators Murray and Cantwell, helping them in any way we can, to ensure the Nelson abortion language is fixed in conference and women aren’t worse off after health insurance reform than they are today.

Dana Laurent is the Political Director for Planned Parenthood Votes! Washington (PPVW). PPVW is the advocacy and political arm of Planned Parenthood in Washington State. Planned Parenthood health centers serve nearly 142,000 women, men and teens in 35 clinics around Washington State, and nearly 3 million patients in 48 states nationwide.
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