November 8, 2009
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healthcare reform passes house… oh joy…
If you don’t know I’ve been strongly in favor of health care reform since the moment I first started caring about politics. And I’ve advocated strongly in favor of the current reform efforts. I thought and think these efforts are not just important but essential for our nation’s future economic security.
So why then do I meet the passing of this bill with almost no enthusiasm and only a sense of depressed melancholy? Why can I not bring myself to express more than lukewarm praise for this so called “success”?
Because at this point, this bill is starting to look as close to being pure suck as it could possibly be and still justify passing.
Worst and latest on this bill’s downward path to futility came in the form of an amendment passed in the House just before the bill was voted on. It’s called the Stupak amendment. It’s about abortion.
If you hear the hype about this amendment you’d think the original bill would have somehow opened some unseen floodgates allowing some mysterious enormous new funds to come in to the health care system and magically seize control of women’s minds forcing them to have abortions against their very will. Thank goodness the Stupak amendment stopped that from happening!
The problem is, this is all hype. The bill as stated before amended did not allow any federal funds to go toward abortions. That was already the status quo and even if the bill had said nothing about it, federal conscience guidelines would have remained in place requiring the government not to fund abortion. The Hyde amendment was passed in 1977 and already restricts public funds from going toward abortion coverage. How many rules against this do you need!?!?
But since people complained, to provide clarification the bill even included a section that required that women who receive federal subsidies through the bill still pay for their actual abortions using their own money. That’s right abortion services would have been offered but you gotta use your own cash to get them. Simple and reasonable enough right? Not a single dime of federal money could have possibly gone toward paying for an abortion.
I, being an actual liberal, considered THAT status quo to be totally unacceptable. Federal conscience guidelines ought not exist. Abortions should be covered just like any other medical procedure. The Hyde amendment was a terrible thing that ought never have existed. When we extend health care coverage to the poor women who currently can’t afford it we should totally be also giving them abortion coverage. The ability to chose whether to have an abortion has real meaningful positive impact on the quality of life of women in this country. Denying them that right is cruel no matter how it is done.
But that’s a fight for another day. We all KNEW about these rules. We knew that the bill in no way changed these things. And yet pro-choice people were willing to accept it so long as we all got better health care. Equally. Fairly. It wasn’t the best system but it would help.
However, the pro-life movement was not similarly impressed. For them, the status quo STILL wasn’t good enough.
The Stupak/Pitts amendment flips the whole thing around. Rather than a restriction on government funds it’s a new regulation on insurance companies. It says to them that they CAN’T offer abortion services on an insurance plan if even ONE of the members on that plan receives even a tiny amount of government subsidies to help pay for health insurance. So get that, you pay 95% of your insurance premiums yourself and get a tiny government subsidy to help pay a little bit of the costs and the result… all plans you sign up for can’t offer abortion coverage. At all.
Do you see the effect?
Obviously this bars any public option health insurance plan from offering abortion coverage but that’s hardly surprising.
Much more significant is that it creates a strong incentive for insurance companies to normalize the plans they offer to the individual insurance market by taking OUT all abortion coverage. Roughly 80% of the customers on the exchange are likely to receive some form of government subsidies to help them pay for insurance. Why would any company risk losing all those lucrative customers? Remember the government is footing the bill for these people. And the people are MANDATED to buy the insurance. So in effect the insurance companies are getting paid for free. Of course they want those customers! By far the easiest thing to do will be to simply take out abortion coverage for everyone. They have absolute zero incentive to try and come up with accommodations to ensure that abortion services are still offered in individual plans to those who pay without government subsidies.
Consider the long term impact of this. Ultimately the insurance exchange is supposed to fully replace private market insurance. That’s the point of it. Everyone is going to be a part of the exchange so that they can pool resources and pool risk making things cheaper for everyone. Whenever anyone wants private coverage they’ll go to the exchange. Indeed they’ll be MANDATED to do so or else face severe fines. And any company who wants to offer insurance to the uninsured will go to the exchange and put a plan up there to get all the new customers. But now all the plans the companies will put forth will not have abortion coverage. So that means basically it will be effectively impossible for a woman to get insurance coverage for abortion if they don’t have insurance through their employer.
That’s a radical shift from the status quo. Right now 85% of all private insurance plans DO offer abortion coverage. That will shrink to near zero.
I would not be surprised if insurance companies ended up simplify removing abortion coverage from their plans altogether, except for the gold plated cadillac plans. Really in a lot of companies the plans for individual insurance are very similar to some of their employer based plans. Why should they have to differentiate? Indeed, not providing abortion coverage except for the most expensive employer based plans may prove the safer route for them altogether. It would prevent the insurance companies from having to deal with criticism from the anti-choice crowd.
Keep in mind also that a lot of conservative think tanks regularly publish articles describing various plans to eliminate the employer based insurance market. And many economists do believe that ultimately employer based insurance should be phased out for reasons of efficiency and competition. If that ever happens then ALL insurance will be private. And by extension nearly everyone would not have access to insurance plans that cover abortion. An effective pseudo ban on abortion. Abortions only for the rich. Just like in the good old days.
The amendment is supposed to have two conditions to make it more palatable. The one is that it excludes abortions in cases of rape, incest, and when there’s risk to the life of the mother. That’s at least good. But that just means women in those situations will be put in the uncomfortable position where they have to explain their abortion to some insurance company bureacrats and “prove” that their abortion was “necessary”. That’s sort of sick. It ought to be a decision made between the woman and her doctor with perhaps her family’s input. An insurance company should not stand in the middle of that.
The second mollifying provision is that supposedly women will be able to purchase a single separate Abortion Rider on top of their insurance using their own money.
The Abortion Rider is nothing but a lie.
It’s been tried before. There are states that have mandated this kind of an Abortion Rider to cover abortions. No insurance companies have ever found it profitable to sell actual abortion riders. That’s because nobody buys them. Pregnancies that require an abortion tend to be unplanned. People generally don’t plan in advance and buy insurance coverage to cover abortions “just in case”. No they assume they won’t need an abortion because they won’t get pregnant until they want to.
It would be as if you had to buy a diabetes rider to get coverage for diabetes. You tend to assume you WON’T get diabetes especially when you’re young and healthy. Heck try mandating heart attacks be put under an Cardiac Arrest Rider. See how many people under the age of fifty ever buy it.
This is precisely the problem that mandated insurance is SUPPOSED to solve. Most people wouldn’t even buy car insurance if it weren’t required for you to do so. They tend to think the accidents won’t happen to them.
Riders are dumb ways to provide insurance. Comprehensive insurance has become the norm because it’s the system that makes sense. It’s the most cost effective. The Rider provision of the amendment will most likely never come into effect simply because knowing how illogical they are no company will bother to offer them.
And that means women who buy coverage on the private market will just be shit out of luck. Anyone who currently has insurance not through an employer and anyone who ever buys insurance not through an employer will most likely lose abortion coverage.
OK, so if that’s what the cost is, is there any gain? Will this actually reduce abortions?
No. We’ve seen that out and out bans of abortion don’t significantly reduce abortions. Why should we expect thsi to do so? No, it will just make more and more women suffer extreme financial hardship on top of everything else when they get the abortion they were going to get anyway. Abortions can be expensive. Obviously the way to mitigate that cost is to pay premiums into an insurance program. No such program will exist for many more women than in the past. So women will go into debt to pay for a lifestyle choice.
That’s the best case scenario. The worst is women again resorting to finding other much more dangerous means of getting an abortion.
NARAL and Planned Parenthood have both come out strongly in condemnation of this amendment. Planned Parenthood went so far as to say they can no longer support health care reform at all if this amendment is a part of the process. That’s quite an extreme statement from a group that has been in favor of health care reform from the very beginning.
It’s interesting to note that the people who voted for the Stupak amendment were almost all the very same people who voted AGAINST the health care reform bill when it went for passage. That includes almost every single republican in the House and a small and heavily influential group of conservative democrats. So these people aren’t really in favor of Health Care Reform. They didn’t pass the amendment because it would make the bill good enough for them to vote for it. No they passed the amendment just to make the bill worse. They knew it was likely going to pass anyway, but perhaps they hoped it would turn enough Democrats against the bill to cause it to fail. Judging from the outrage emanating from the progressives in Congress it very nearly did. The bill only passed 220-215. They only got two more votes than they needed to pass it and one of them was a Republican.
And so now we have yet another even worse variation on the Health Care Reform bill.
I’ve seen this bill get weakened, watered down, gutted, piece by piece, step by step for months on end. With each new revelation I thought, well that’s still better than doing nothing. It’s a testament to how really bad our Health Care system is and how bad it’s projected to get that I could tolerate all this idiocy in the hopes of just getting something done. As logn as the good outweighed the bad it would be enough. As long as you could bend that cost curve it would be better than nothing. New bills could be passed in the future to make it even better, but we just needed to have something, anything, that worked. Even if only a little. So I supported it.
Now, I’m not so sure. There are a lot of things that are uncertain. Some things in this bill might make things better or might not. But now there’s one thing in the bill that will unquestionably make things worse. It’s going to turn women into effectively second class citizens when it comes to Health Care. They get to either choose no insurance and facing fines or insurance that doesn’t cover their basic needs. That’s intolerably unfair.
And this isn’t over yet. The Senate is generally more conservative than the House. The bill still needs to pass there. What kind of disgusting watered down corruptions will we get out of that? Then the bill will have to be reconciled. What will be lost in that process to appease both houses?
I’m terrified that in the end Health Care reform will indeed prove to have been a great big giant waste of time. Not because Health Care reform isn’t important but because all the stupid infighting resulted in a bill that does as much harm as it does good.
I hope I’m wrong. Maybe this will be the worst that we will hear. Maybe people will be able to fight to get that Stupid Stupak amendment removed in reconciliation. Maybe the bill will still be worthwhile.
But I wouldn’t bet on it.
Comments (10)
hear, hear
The next few months debate and writing on this will be interesting. The closeness of the voting seems to show that it wasn’t the mandate they had hoped for.
“The Stupak/Pitts amendment flips the whole thing around. Rather than a restriction on government funds it’s a new regulation on insurance companies. It says to them that they CAN’T offer abortion services on an insurance plan if even ONE of the members on that plan receives even a tiny amount of government subsidies to help pay for health insurance…
Hmmm… I wonder if there are Constitutionality problems with this.
The part where the bill forces every individual to purchase health insurance sucks. I doubt it’s even constitutional, and it’s basically a massive handout to the insurance companies.
@ModernBunny - If you want everyone to be able to get insurance at a reasonable price without regard to pre-existing conditions, you have to have universal care. Otherwise, people would wait to buy health insurance until they get sick. This would be like buying life insurance when you know you are dying. It is not an economic model that will work for either a public option or insurance companies.
If abortion is a legal medical procedure and we are a capitalist society, why are we telling insurance companies what they must EXCLUDE from policies that they sell to consumers independent of government subsidies?
I propose THE PATERNAL RESPONSIBILITY AMENDMENT (also known as PAY TO PLAY). “Pro-life” must include continued concern for the welfare of children of single mothers. Therefore, we should have MANDATORY paternal identification for every pregnancy (with DNA testing, if necessary). Fathers will be required to offer to contribute $10,000/year for 18 years toward the cost of raising the child (adjusted annually for inflation). Alternately, if the father consents to abortion he will be required to pay half the cost. Therefore, men also may wish to pay for “abortion riders” when they buy their health insurance (particularly many of our Congressmen!)
Being “Pro-life” must not just extend from conception to birth!
@redhairedgrrl - @ModernBunny - Mandatory insurance is an interesting discussion. President Obama was against it in the primaries but ultimately he changed his mind. Why? Depends on how you look at it. In one sense a personal insurance mandate ensures that more people get insured because more people buy insurance even if they feel they don’t want to or can’t afford it. That unquestionably lowers costs and makes health care more “universal”. On the other hand, it’s also basically putting a greater financial burden on people who are already pummeled by financial burdens. Worse, it consists of a big cudgel it beats people with in the form of a fine if they happen to choose not to get insurance or just forget or don’t know enough to know that htey have to purchase it.
The solution for hte people who can’t afford insurance is to use subsidies. Basically you have to buy insurance but the government will help you out. In effect that’s basically the same as the government paying the insurance companies directly to insure people.
From a political perspective a Mandate with subsidies is pure Win. Your big company constituents all get more money and more business. A lot of that new money they get is from government subsidies, IE tax payer money, but what do they care about WHERE the money is coming from? They’re getting paid. That’s what matters to them. For a talking point a “Mandate” reaps huge dividends. You end up with something much closer to universal coverage. So you can say “Thanks to MY Plan, such and such million more people gained health insurance”. You don’t have to mention that it’s because you MADE them get it. People who already have insurance feel better knowing that there are less uninsured people around. Last but not least you have the subsidies to mollify the people and say you’re looking out for them. And in a certain sense you really are. You’re lowering costs and you’re literally making it possible for people who couldn’t have gained insurance to gain insurance.
Whether or NOT you have a mandate you still have to convince people to actually buy insurance. That’s a huge educational effort. It’s just a little easier if people are worried that they’ll be fined if they don’t buy insurance.
The real problem with mandates is not that they don’t work, it’s that they are totally unnecessary.
You can achieve every single benefit of mandates without ANY of the problems with a very very simple alternative. Rather than mandating people buy insurance, GIVE PEOPLE INSURANCE. People can’t choose not to have insurance if they’re born with it and unable to discard it for as long as they are alive.
But the best and perhaps only way to do THAT fairly is to have a single payer system. And because we’re a weird messed up backwater country, single payer is considered “politically infeasible”
So basically what we have is, instead of using taxpayer
money to pay the doctors, nurses, hospitals, and clinics to provide
care for people, we”re paying people back with taxpayer money who used their own money to pay insurers who in turn used that money (taking a cut for themselves for profits of course) to pay
doctors, nurses, hospitals, and clinics to provide care for people. It
ought to be blindingly obvious that that’s two useless steps too many.
@nephyo - I agree with you about a single payer system, because it also will streamline and cut administrative expense. Right now, the patchwork of different insurance company plans is a nightmare for health care clients and increases overhead. But I don’t think people in the U.S. will ever accept it.
If they’re so “pro-life”, they’d be jumping at the chance to make paid maternity leave mandatory like it is in the rest of the world, right? Because then women wouldn’t be afraid to lose wages/their jobs due to pregnancy, so they’d be more comfortable about keeping the baby, right? …Right?… Damn, for a minute here I imagined I was living in a world where things actually make sense.