By: Emily Beaver

Abortion has long been a hot political topic--and now it's becoming part of the health care debate. So what does abortion have to do with health care? Members of Congress are arguing about which health insurance plans should cover abortions.

When the House of Representatives passed its health care reform bill earlier this month, some Democrats persuaded House leaders to include a last-minute amendment that would ban some health care plans from covering abortions.The representatives who proposed the Stupak amendment, named after Democratic Rep. Bart Stupak of Michigan, say they want to prohibit the federal government from spending money on abortion. The amendment would ban the Medicaid program from covering abortions and would prohibit anyone who receives a government subsidy to buy a plan that covers abortions in the health insurance exchange, except in the case of rape, incest or if a woman's life is in danger. Since the government already bans federal spending on abortions, supporters of the Stupak amendment say they are just maintaining the status quo for abortion policy.

How much does an abortion cost if you are paying out-of-pocket? Check out this Youth Radio video:

But some critics say the amendment would restrict abortion coverage for many women because health reform is designed to cover most of the uninsured through Medicaid and the health insurance exchange. Anyone receiving a government subsidy wouldn't be able to purchase a plan that covers abortion through the health insurance exchange.

 

Based on the Kaiser Family Foundation's subsidy calculator and the House's health reform bill's income limits for Medicaid, a single 24-year-old who earns between $16,245 and $37,600 a year would receive a subsidy to buy insurance through the exchange. (Under the bill, a single person who earned less than $16,245 would qualify for Medicaid.) That means that many women who are uninsured now -- and young adults ages 19 to 29 are more likely than any other age group to be uninsured-- could have a hard time getting health plans that cover abortion.

 

"The health reform bill would expand access and lower costs, but the Stupak provision needs to be removed because it would restrict access for women and it goes too far," says Tait Sye, a spokesperson for Planned Parenthood, an organization that provides and advocates for sexual and reproductive health care, including abortion.

The Senate voted Saturday to begin debating its own health care reform bill. Right now, the Senate bill would allow women to choose insurance plans that cover abortion if they receive a government subsidy and would allow insurers to sell plans in the exchange that cover abortion, but women would have to use private funds to cover abortions. Some anti-abortion legislators want the Senate bill to include restrictions on abortion similar to the ones in the Stupak amendment.

Medi-Cal, the California Medicaid program, covers abortions because the state supreme court ruled the Medi-Cal program could not cover prenatal care but not abortions (or vice versa), says Jennifer Templeton Dunn, executive director of University of California San Francisco/Hastings Consortium on Law, Science and Health Policy. Many other states' Medicaid programs also cover abortions, Dunn says.

California uses its own money to pay for Medi-Cal abortion coverage, but it's not clear how Medi-Cal would be affected if the Stupak amendment is passed into law, says Lupe Rodriguez, program and policy director for ACCESS/ Women's Health Rights Coalition in Oakland. ACCESS helps women get reproductive health care services and runs a telephone hot line that provides information about pregnancy, parenting, abortion and adoption at 1-800-376-4636 (and 1-888-442-2237 in Spanish). Rodriguez says that she is concerned the amendment could affect funding for other parts of the Medi-Cal program, or could cause Medi-Cal to stop funding abortion coverage.

Most employer-sponsored health insurance plans cover abortion, according to the Guttmacher Institute, a social science research and public policy organization that supports abortion rights. Under the Stupak amendment, most women who don't get health insurance through an employer (or a spouse or parent's employer) would have to pay for abortion out of their own pockets.The Stupak amendment allows women to purchase supplemental coverage for abortions, but Dunn says that since most women don't expect to have unplanned pregnancies, this isn't a realistic solution.

Critics of the Stupak amendment are also worried that insurance companies will stop offering plans that cover abortion because people who purchase insurance through the exchange won't be able to buy those plans. Without insurance coverage, a first trimester abortion at a clinic can cost $350-$900, Sye says. With complications, an abortion can cost up to $10,000.

In California, women who want abortions but don't have insurance coverage can apply for full Medi-Cal insurance or Medi-Cal pregnancy coverage, Rodriguez says. Women under 21 can apply for the minor consent program, which provides prenatal care and abortions. For women who don't qualify for any of these programs, ACCESS can help fundraise, Rodriguez said. But when women don't have insurance coverage for abortion, they often face more hurdles obtaining abortions, which can cause them to delay the procedure, she says. Abortions that occur later in pregnancy are riskier and more expensive.

Young women, women of color and low-income women face already many barriers to get abortions, including a lack of access to health insurance and social services, and misinformation about health care services available, Rodriguez says. She says the Stupak amendment and some of the compromise language being discussed in the Senate could make it even harder for these women to get abortions.

"People who are not receiving care will continue to not receive care and continue to be left behind," she says.

Previously:

• How Much Does an Abortion Cost?
• Sex, Abortion, and Contraceptives
• Impossible Motherhood: Testimony of an Abortion Addict

 

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