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Tilting at Windmills

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November 9, 2009

THE FUTURE OF THE STUPAK AMENDMENT.... As significant and encouraging as Saturday's night was on health care reform, the House bill came with a bitter, odious pill: the Stupak/Pitts amendment.

The House Democratic health care plan already restricted use of public funds to pay for abortion services. For opponents of abortion rights, that was insufficient -- backed by the U.S. Conference of Catholic Bishops, these lawmakers demanded a provision restricting coverage in both public plans and private plans that receive taxpayer subsidies. For women with insurance through the exchange, the ability to exercise reproductive rights would be dependent on their ability to cover out-of-pocket costs.

The amendment, championed by Reps. Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.), became a painful prerequisite -- without it, Dems couldn't pass the larger bill. Stupak/Pitts was approved, 240 to 194, with 64 Dems joining the Republicans. (A total of 26 center-right Dems voted for Stupak/Pitts, and then against health care reform.)

The fight over this provision, however, is just getting started.

[A]bortion-rights supporters are vowing to strip the amendment out, as the focus turns to the Senate and the conference committee that would resolve differences between the two bills.

Although House liberals voted for the bill with the amendment to keep the process moving forward, Rep. Diana DeGette (Colo.) said she has collected more than 40 signatures from House Democrats vowing to oppose any final bill that includes the amendment -- enough to block passage.

"There's going to be a firestorm here," DeGette said. "Women are going to realize that a Democratic-controlled House has passed legislation that would prohibit women paying for abortions with their own funds....We're not going to let this into law."

The WaPo report also had a good description of the problem with Stupak/Pitts policy: "[A]bortion coverage would be unavailable not only to working-class women buying coverage with government subsidies, but probably also to women buying coverage on the new marketplace without federal assistance. The amendment suggests that women could buy separate 'riders' covering abortions, but abortion-rights supporters say it is offensive to require a separate purchase for coverage of a medical procedure that for most women is unexpected."

For months, the health care debate has centered around a variety of key issues: subsidy rates, mandates, public-private competition, etc. Now, abortion is up front and center, and it will be another needle in need of threading -- too many restrictions and pro-choice Dems will be in a position to defeat the bill; too few and opponents of abortion rights are prepared to do the same.

Steve Benen 8:00 AM Permalink | Trackbacks | Comments (32)

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I would like to commend the few brave democrat congressmen and senators who have stood with our republicans to prevent federal tax dollars from being spent on abortions.

The actions taken so far have been the correct ones, but have been insufficient. We need to see this legislation include prohibitions of the spending of federal tax dollars for birth control, mastectomies, hysterectomies, mammograms, and other female reproductive medical needs. If it isn't a male medical issue, it should not be paid for with federal tax dollars. Also, diseases that do not affect white males should not have medical care paid for with federal tax dollars.

As we move to a gender and racial bias free nation, it must be remembered that paying for any medical treatments that do not impact white males is exhibiting gender and/or racial bias. It is regretable that we continue to have senators and congressmen who are female and/or of racial minority status, as we all know that only white males are capable of being bias-free.

Posted by: RepublicanPointOfView on November 9, 2009 at 8:11 AM | PERMALINK

"Rep. Diana DeGette (Colo.) said she has collected more than 40 signatures from House Democrats vowing to oppose any final bill that includes the amendment -- enough to block passage."

Would these folks be among the "progressives" that pledged/promised to vote against any bill without a strong public option based on Medicare rates? THAT worked out really well, didn't it!

I think passage of the bill was certainly "significant" (if not exactly encouraging)in that it shows how little the constituents figure into the political calculus that drives our government, and ultimately how little can actually be done to reform just about anything when business owns the Congress and the President is apparently free of leadership ability and/or the desire for progressive or even populist change. The bill is just another in a series of capitulations and retreats, and yet another wasted opportunity to resolve a systemic cancer.

Posted by: Spresso on November 9, 2009 at 8:15 AM | PERMALINK

It is interesting how strongly the Right opposes ANY government intervention in the lives of the American People: Environmental and pollution rules, taxation in any form, consumer protection laws, gun control.

-Until it comes to a woman's reproductive system. . .

Posted by: DAY on November 9, 2009 at 8:22 AM | PERMALINK

The party over at NO Headquarters was especially poignant with the contributions of local woman lining up to be sacrificed to the gods of avarice , greed , and betrayal . Such loyalty ...

Posted by: FRP on November 9, 2009 at 8:25 AM | PERMALINK

American men don't like women very much.

Posted by: zhak on November 9, 2009 at 8:29 AM | PERMALINK

Congress will keep adding restrictions on reproductive choice up to, but not beyond, the point where this might restrict the ability of upper-middle-class voters and (more important) campaign contributors to get quick, low-cost abortions for their daughters. Stupak-Pitts follows this hallowed tradition.

The effective response is not trench warfare or empty threats (there's no way Pelosi will let DeGette et al vote against the final bill), but calling their bluff: have someone propose an amendment to forbid any qualifying healthcare plan from covering abortion. You'll see how quickly the holy warriors, R and D, find themselves isolated as the saner members of Congress turn tail.

Posted by: Basilisc on November 9, 2009 at 8:31 AM | PERMALINK

It's galling as hell, but the salient point is that an abortion only costs around $500. This just isn't the most important aspect of health care reform, and we can't let HCR be held hostage to the culture wars.

Just swallow hard and let them have their way on this one. Most people can come up with the 500 on their own, and activists can develop ways to help those who can't. We need HCR because of the big ticket items: cancer, heart attacks, major accidents, kidney failures, etc. If women's other medical needs are being met, most will be able to deal with the relatively small cost of abortion. Abortion just isn't a big financial consideration, and in the end this is all about how things are paid for.

Don't sweat the small stuff.

Posted by: Virginia on November 9, 2009 at 8:33 AM | PERMALINK

Submit an amendment that allows for a tax credit equal to the cost of a legal abortion and call it the "why do you hate women and tax cuts so much" bill. Fund it by charging congress-critters the full fair market value of their own heavily subsidized health insurance.

Posted by: Chopin on November 9, 2009 at 8:33 AM | PERMALINK

...good luck with that we-don't-really-hate women-progressive caucus action to strip Stupak from the jealthcare bill...

maybe them and the we-dontreallythat much caucus will be able to do it...

but, as our fearless hopey-changey leader told us yesterday, its time for the clown car senate to act...

i wonder what "a happy woman is a happy nation" tricks they are wiling to commit to?

it is gonna take awhile to even think about our fearless Dimocratic party without feeling sick at my stomach...feelings which dont generally lead to me reaching for my wallet.

Posted by: neill on November 9, 2009 at 8:43 AM | PERMALINK

Virginia, that might be good advice if the rest of the bill were actually any good; the problem is, it was already a turd that will probably make things quite a bit worse- and the Democrats VERY unpopular- in the short run, since there's nothing to prevent the insurance shysters from jacking up rates to cover the costs of being unable to deny coverage. And the public plan is a bad joke that will probably have higher rates than competing private plans, so it will do less than nothing to quell anger over the individual mandate.

This turkey should be taken out back and shot. Shame on every so-called progressive who voted for it.

Posted by: Steve LaBonne on November 9, 2009 at 8:45 AM | PERMALINK

Was involved with a back and forth on the Stupak amendment here yesterday; while I'm not sure I agree that it will lead to women, even those who buy from the exchanges without subsidies, having no access to policies which provide this coverage, one thing did occur to me: this is a mighty, mighty bludgeon to use to force insurers to cover the costs of birth control. Most of them currently don't, and on top of that, many policies these days require a "maternity rider" which must be purchased before a woman becomes pregnant in order to cover medical costs associated with pregnancy and childbirth; otherwise the pregnancy is deemed a "preexisting condition" and it's left to either the couple (or woman) or Medicaid to pick up the costs. Even quite a few women with employer-provided insurance have run up against this trap; with the explosion of costs over the past 20 years, many employers change insurers on an annual basis and many, many women have had their pregnancies deemed "pre-existing" by the new insurer and thus, not covered.

There's a very good basis here for insisting that all plans cover birth control; the ability to bear children is the central issue in women's health, and a ban on coverage for elective abortion can only be defended if there is coverage for the care, meds, etc. required to help women avoid becoming pregnant in the first place. In addition, all policies must be required to cover pregnancy and childbirth, because those outcomes are guaranteed under any system that doesn't include coverage for elective abortion. Only then could anyone advance an even marginally reasonable case for denying coverage for elective abortion; without those pre-conditions, such a position becomes entirely indefensible - though to my mind, it pretty much is already indefensible. I say "marginally reasonable" because abortion in most cases is elective...but it's not "elective" in the same way plastic surgery is because it is going to utterly change the future course of life for anyone who has a child in every way imaginable - financially, emotionally, etc etc. In other words, if you don't get those breast implants, your self-esteem may suffer but you aren't going to be faced with $250,000 for college 18 years down the road. Looking at it from this angle, it's fairly difficult to equate abortion with other elective medical care or procedures.

So...if Stupak is allowed to stand, that should be the line in the sand - if you aren't going to cover abortion, then you ARE going to cover birth control and maternity and childbirth, no outs. At the very least, this would start to move us away from insane wingnut male position that the exercise of women's sexuality is something to be punished rather than what it is - an integral part of human existence.

Posted by: Jennifer on November 9, 2009 at 8:46 AM | PERMALINK

Anyone have an informed idea about whether the amendment could be overturned by the SC at some point?

Posted by: converse on November 9, 2009 at 8:48 AM | PERMALINK

The Stupak/Pitts amendment is just the first step, okay the second step if you include the "public option" that is an option that 95 percent of Americans will be prohibited from choosing.

As the bill proceeds, watch for other odious provisions to be inserted until progressive Democrats will have no choice but to vote against it. The one I'll be waiting for is the provision that will limit fines to a few thousand dollars for insurance corporations that continue to recind coverage for policyholders who get sick or who refuse coverage to people with pre-existing conditions.

Then the DINOs and the Republicans will have won for their corporate johns -- they'll have killed heath reform and they won't even have had to go on record voting against it.


Posted by: SteveT on November 9, 2009 at 8:50 AM | PERMALINK

Here's my plan: regulators must force insurance companies to offer the abortion rider at net cost to the insurance company plus a small profit. Since abortions are way cheaper than childbirth (especially for pregnancies the pose undesired risks to a woman's well-being) a rider would mean a refund.

Posted by: paul on November 9, 2009 at 8:55 AM | PERMALINK
Then the DINOs and the Republicans will have won for their corporate johns -- they'll have killed heath reform and they won't even have had to go on record voting against it.

That already happened, quite a while ago. There is nothing on the table at this point that bears even the most distant resemblance to genuine, effective reform. The bloodsuckers can't lose no matter what happens to this crap bill.

Nice "democracy" we have. Before we lecture the rest of the world about democracy maybe we should figure out how to run one ourselves.

Posted by: Steve LaBonne on November 9, 2009 at 8:59 AM | PERMALINK

So, a misogynistic turd 'healthcare reform' bill outta "Dah People's House" -- Great!

Caint hardly wait to see how the Clown Car Senate puts the finishing touches on it...

Posted by: neill on November 9, 2009 at 9:06 AM | PERMALINK

Us guys don't like to think about all that icky stuff "Down There"; we prefer the round, bouncy things "Up Top". Oh, and we can't relate to your "monthlies" and PMS and The Vapors, either. like the professor said, "Why can't a woman be more like a man?" Although Audrey Hepburn was nice to look at. . .

Posted by: DAY on November 9, 2009 at 9:13 AM | PERMALINK

Food fight like it's 2099

One gets the feeling that 90 years from now this great big dumb country of ours, if it still exists, will still be shooting itself in the face over abortion.

There is no end in sight for the Culture War.

And "exhaustion" doesn't seem likely for this war either. Murdoch and Limbaugh can drive the basic division forward until the sinews of the country snap. There is nothing, and no one, to stop the shouting. In fact there is big media money to be made in the war. So compromise is impossible. And since abortion is the Culture War's key component, all the other hates just get layered over the top of it.

I don't think America will be going to Mars or the Moon again. I don't think Barack's vision of our country leading the world again in college graduates is even remotely possible. In fact I don't think any "big vision" thing is possible for this country. We got nothing to look forward to but an endless bitter internal conflict over abortion and the slow death of our empire...

A House divided will not stand?
No. This gridlock is much more horrific...
How about this as your morning aphorism:

An empire with two heads gnawing on each other has no future.

Posted by: koreyel on November 9, 2009 at 9:26 AM | PERMALINK

Abortion is a woman's choice; a woman should pay for it. Why should other taxpayers pay for an elective procedure that progressives have been saying all along is a woman's prerogative and should be between the woman and her doctor.

If the abortion is to save the life of the mother, then let the insurance cover it. If the abortion is because the mother simply doesn't want a child, then she can pay for it herself. Or maybe get the father to help pay for it as well.

Posted by: LMD on November 9, 2009 at 9:27 AM | PERMALINK

LMD - under most current policies, insurance doesn't cover birth control. And then, if a pregnancy occurs, it doesn't cover prenatal or delivery costs, unless the woman has been paying a hundred dollars a month or more extra for a "maternity rider" which must be purchased prior to becoming pregnant. Since most elective abortions are elected by women who weren't planning to start a family yet, these are the very same women who are most unlikely to have a maternity rider on their health insurance. Have any idea how much prenatal care and delivery costs? Didn't think so.

Barring coverage for a legal procedure that is 100% guaranteed to be needed by some women can only be defended if you're willing to make insurers cover both birth control and maternity care. Otherwise, your "plan" is to punish the bitches because they have vajayjays and worse yet, sometimes use them.

Sounds like your solution is "women should learn to keep their legs together". Be careful what you wish for; you just might get it.

Posted by: Jennifer on November 9, 2009 at 9:35 AM | PERMALINK

Can we stop with the bald assertion that "abortions cost 500" dollars? A therapeutic abortion in a hospital for a pregnancy gone wrong does not cost 500 dollars. Asprin doesn't cost that little in a hospital setting. Maybe a D and C at a planned parenthood costs that much but the kind of abortions that women need in the course of a wanted pregnancy are not those d and cs. This amendment would prohibit insurance companies from offering abortion services as a package to any women in the exchange if they also were offering any services to poor women buying their coverage with subsidized funds. All women would lose the ability to buy complete insurance coverage for maternity/abortion services on the grounds that their medical needs were compromising some third party's morality clause.
Its disgusting and it should be unconstitutional. I'd like to see an amendment which denied *anti abortion* people coverage of their legitimate medical needs on the grounds that people like me don't want to pay for bigots to get health care at all. Its basically the same argument, isn't it? Why should I pay for health care for people I don't like, who use their health to promote policies I consider immoral?

aimai

Posted by: aimai on November 9, 2009 at 9:51 AM | PERMALINK

A therapeutic abortion in a hospital for a pregnancy gone wrong does not cost 500 dollars. Asprin doesn't cost that little in a hospital setting. Maybe a D and C at a planned parenthood costs that much but the kind of abortions that women need in the course of a wanted pregnancy are not those d and cs.

These would be covered under the health-of-the-mother exclusion, no?

Posted by: shortstop on November 9, 2009 at 10:05 AM | PERMALINK

Two things:

Basilisc wrote:
calling their bluff: have someone propose an amendment to forbid any qualifying healthcare plan from covering abortion. You'll see how quickly the holy warriors, R and D, find themselves isolated as the saner members of Congress turn tail.

That's what the Stupak amendment does - prohibits any insurance company who offers any plan purchased by those receiving subsidies from offering any plan that covers abortion. Therefore, even people buying insurance on the exchange with their own money won't be able to buy a policy with abortion coverage. It might also be interpreted to forbid any company who offers a plan in the exchange to offer a plan with abortion coverage outside the exchange, either.

Shortstop wrote:

These would be covered under the health-of-the-mother exclusion, no?

There IS NO "health of the mother" exclusion. Only an exclusion for the life of the mother.

Posted by: KarenJG on November 9, 2009 at 10:24 AM | PERMALINK

Okay, of course I think this is ridiculous and also a violation of church and state. I notice in CA, the reps voting for this are all Catholic, and the Cardinals had their folks lobbying for Stupak.

But beyond this, I think I am now against the bill.

Go back to HuffPo and read what Dr. Angell has to say.
http://www.huffingtonpost.com/marcia-angell-md/is-the-house-health-care_b_350190.html

I pretty much totally agree with that.

This bill is too convoluted, too long, too much room for the powers that be (insurance and big pharma companies) to have stuff in their favor in the fine print.

I am not seeing how this will be an improvement, with it costing people more but still we have the broken system.

I agree the reforms in Medicare she suggests are a big deal and should be done. Part D is an abomination. Reform it... roll out Medicare over time.

We don't want people to say, "Oh they tried healthcare reform," when it isn't really much reform at all.

Posted by: Clem on November 9, 2009 at 10:26 AM | PERMALINK

KarenJG: There IS NO "health of the mother" exclusion. Only an exclusion for the life of the mother.

Right you are. Horrifying.

Posted by: shortstop on November 9, 2009 at 10:39 AM | PERMALINK

I am a nurse and I worked in the ER before abortions were legal. The statistics of women who die because of illegal abortions will rise dramatically as a result of Stupak. Hopefully there is someone left in Congress with a moral fiber who will put in legislation to nix this amendment. Of course the Republican answer will be the woman should have abstained from sex.

Posted by: mljohnston on November 9, 2009 at 11:11 AM | PERMALINK

But you're killing a baby! And I am their savior!

Posted by: Lord of Humans on November 9, 2009 at 11:14 AM | PERMALINK

The procedure discussed above does in fact come under the "life of the mother" because if the fetus is dead, it needs to come out now or the mother will die from septicemia (also known as "stupak") when the dead fetal tissue begins to decay.

Posted by: Texas Aggie on November 9, 2009 at 12:40 PM | PERMALINK

Texas Aggie@12:40 The key phrase you write is "if the fetus is dead." I found out at week 17 that my baby had anencephaly. My husband and I chose to end the pregnancy. Some anencephalic babies survive to birth, only to die w/i a day or two out of the womb. According to your scenario I would have to wait, suffer the emotional trauma of continuous visits to the doctor surrounded by expectant hopeful woman, while I would wonder is this the time I'll learn my baby is dead. There's also the matter that as the fetus gets bigger, the risks to terminating the pregnancy increase. All I can say is I'm so glad I don't live in the US and I didn't back then either.

This whole situation makes me sick. It is offensive and I'm angry that the Dems participated in this maneuver. I'm also damn tired of the assumption that woman who want to end a pregnancy are doing so b/c of birth control. I wanted my baby, but it wasn't meant to be. Sometimes it just isn't meant to be.

Posted by: tokyo expat on November 9, 2009 at 4:39 PM | PERMALINK

How does this affect women who are bleeding to death from an ectopic pregnancy? If the fetus is not removed, both it and the mother will die anyway.

I read about at least one woman dying in a country with strict anti-abortion laws because her doctor couldn't get a waiver until it was too late. He was afraid he would end up in jail if he operated w/o a waiver. And if you think there aren't prosecutors and judges in this country who would allow that, you don't know what goes on in this country (most people don't).

Posted by: patricias on November 9, 2009 at 6:58 PM | PERMALINK

The procedure discussed above does in fact come under the "life of the mother" because if the fetus is dead, it needs to come out now or the mother will die from septicemia (also known as "stupak") when the dead fetal tissue begins to decay.

Posted by: Texas Aggie on November 9, 2009 at 12:40 PM | PERMALINK
===============================
But what if the woman bleeds to death before the fetus dies?

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