During a strategy call with activists and journalists, it was clear that Planned Parenthood Federation of America president Cecile Richards has a lot on her plate. Just days after the reproductive-rights community took a blow with Stupak-Pitts, Richards was doing her best to assure us that there were plenty of reasons to remain optimistic that health care reform would not come at the expense of women’s health issues.
And to Richards’ credit, there are some reasons to hope that in the short-term Stupak-Pitts won’t become law. Richards drew attention to the fact that attempts to insert almost identical language into the Senate version of the bill never succeeded. Richards also noted that despite positioning otherwise, it will be nearly impossible for conservative Democrats like Ben Nelson (D-NE) to hold up passage of a bill that doesn’t include Stupak-Pitts language. Finally, Richards pointed to the surge in grass-roots energy and efforts to push back the amendment as signs that momentum is with the choice community.
Throughout the call Richards stayed focused on the immediate task at hand- making sure that any Stupak-like language stays out of the reconciliation efforts in Senate committees, educating those who originally voted to support the measure, and the public at large, about the practical effect of discriminating against women in health care choices. She stressed that both Congressional leaders and the rank-and-file members need to hear from the public about the dangers of this proposal. She noted that PPFA was helping organize strategic initiatives between progressive organizations and Congress to defeat the measure, including meetings next week and a national lobby day on December 2nd in Washington D.C. The goal, Richards stressed, was to dominate the health care reform conversation from now until final passage.
In fact, nothing short of dominating the policy conversation right now will work because women stand to lose too much if we don’t.
Under Stupak-Pitts, millions of women would lose insurance benefits they already have, and millions more would lose the chance to get the private sector health care coverage that exists today. Here’s the breakdown. Under the House bill exists the concept of a health insurance exchange. The exchange would cover roughly 46 million uninsured Americans and the millions more who can’t afford to keep their current coverage or who are considered underinsured. The exchange accomplishes this goal by providing either subsidies to purchase private insurance or the choice of a public insurance plan. Obviously a lot of details remain unsettled, but the general idea is that individuals would receive subsidies on a sliding scale (dependent on income level) to purchase private insurance through the exchange.
However, not everyone in the exchange would have subsidized coverage. A majority of those in the exchange, such as those currently purchasing insurance in the individual market and those working for small businesses) would buy insurance in the exchange without the assistance of subsidies. They would buy private insurance with private dollars, just as they do now.
That’s where Stupak-Pitts does the most damage. Stupak-Pitts prohibits any coverage of abortion in the public option and prohibits anyone receiving a federal subsidy from purchasing a health insurance plan that includes abortion services. It also prohibits private health insurance plans from offering, through the exchange, a plan that includes abortion coverage to both subsidized and unsubsidized individuals.
That means that if a plan wants to offer coverage in the exchange to both groups of individuals, those receiving government subsidies and those without the subsidy, it would have to offer two different plans: one plan with abortion services covered for women without subsidies and one that excludes abortion services for those women receiving subsidies. Because insurance is a system that depends on uniformity even at the expense of rationality, such a reality would never come to be. Instead the practical reality will be the offering of one plan that, because of Stupak-Pitts, does not provide coverage for abortion-related services.
Stupak-Pitts supporters argue that those women who wish to have abortion-related services covered could simply purchase an additional policy–known as a rider–to supplement existing coverage. But this is a red-herring argument. Insurance-riders do nothing to address the lack of coverage for these services since most states do not allow riders and there’s no promise from the industry that they would be made available. In short, insurance riders are an illusory solution to a very real problem.
So the message from Richards was clear: press on and press on hard.
Given what is on the line, reproductive rights activists have no choice. We need to be vocal. We need to lobby our elected officials to reject discriminating against women in terms of access to health insurance. We need to elect officials who understand that the abortion debate is a debate about womens access to a myriad of health services.
But this should also rattle activists because we have some hard work to do. If our efforts to beat back Stupak-Pitts are successful then we need to face down and answer the criticism that it wasn’t until the reproductive rights of middle class women were on the line that mainstream womens groups fought back. Even Richards acknowledged the deal struck in the initial drafting of the House bill and that the CAP amendment in the Senate bill sets in stone the Hyde Amendments– laws that prohibit federal funds from going to support abortion services. That the mainstream pro-choice community would start from the position that limiting access to abortion services is okay for those who cannot afford them is troubling to say the least and represents one of the long-term problems it is going to have to tackle.
But back to the problem at hand. What happens if Stupak-Pitt is a poison pill that results in either the death of health care reform or, more realistically, the enabling of inadequate legislation that does nothing but solidify the current insurance regime? Do we have any reason to believe it will be the Council of Bishops who gets blamed if health care reform doesn’t happen?
These were questions Richards was careful to redirect, but they are questions that the pro-choice community is going to have to figure out answers to.
The truth is that the task of answering those questions sits with those of us who understand that reproductive rights are fundamental in any society that values freedom and equality. It’s up to us to explain how Stupak-Pitts represents a chronic misunderstanding of womens health issues– a failure to grasp that a woman who suffers a missed miscarriage would no longer be insurable under Stupak-Pitts if and when she needed to surgically remove the dead fetus, for example. Or that abortion-serivices would become the only gender-specific coverage exclusion allowed in the entire insurance industry despite a campaign that used discriminatory insurance industry practices targeted at women as a foundation for lobbying for health care reform.
But that’s not the message behind the debate right now, and in more ways than she may have intended that meant Richards was right on message. And for now we have a more pressing matter–defeat of Stupak-Pitts and any related efforts to strip women of equal access to health insurance coverage and to make sure that any reform that is passed does not come at the expense of health care for millions of American women.
Make your voice heard and join Care2.com’s efforts to defeat Stupak-Pitts.
photo courtesy of ProgressOhio via Flickr.