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Solving The Stupak Problem: Eliminate The Exchange

By Big Tent Democrat, Section Other Politics
Posted on Tue Nov 10, 2009 at 09:23:22 AM EST
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Jeralyn quotes Rachel Morris on the Stupak Amendment:

Where pro-lifers won big was on the second part, which could significantly limit the availability of private insurance plans that cover the procedure. That’s because Stupak’s amendment doesn’t just apply to the public option—the lower-cost plan to be offered by the government.

(Emphasis supplied.) That problem is easily solved - eliminate the exchange (see Jon Walker inadvertently demonstrate that in fact the exchange is the catalyst for the Stupak problem) and apply the federal subsidies to purchase of insurance under the public option. In short, eliminate the availability of federal subsides for the purchase of private insurance. That way, private insurance companies will never be impacted by the Stupak Amendment.

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    Solving The Stupak Problem: Eliminate The Exchange | 91 comments (91 topical)

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    But (5.00 / 2) (#2)
    by Emma on Tue Nov 10, 2009 at 09:38:44 AM EST
    if the ban on giving any federal funding (through subsidies) to private plans that provide abortion continues, the effect is the same.  Women will be subsidized to buy plans that don't cover abortion and will be forced to buy supplemental plans that do, leading to all the practical issues that have been pointed out already.

    Moreover, if Stupak becomes the new template, Hyde could be expanded to impede or practically prohibit state funding for abortions on the same rationale:  no federal subsidies to any program that provides abortions, even if the funding is kept separate.

    There is a difference between banning funding for abortions and banning funding for programs that provide abortions.  Isn't that what the global gag order was about:

    Let's make sure, for a minute, that the meaning of the President's executive order -- known by opponents as the "global gag order" -- on Tuesday is properly understood. Third World family planning facilities have never been able to use U.S. funds to either conduct or promote abortion. What Bush's order does is deny all U.S. funding to such institutions that may have been using other monies for programs discussing or promoting abortion.

    The "fix" needs to go further, if you're accepting Hyde as the status quo.  There can be no ban on federal funding going to insurance plans that provide abortion coverage.

    Moreover, you don't address the other gender-based inequality in funding -- the failure to mandate that plans cover ob/gyn well care.

    Your fix doesn't seem to be a fix.

    I would eliminate federal subsidies to purchase (5.00 / 1) (#3)
    by Big Tent Democrat on Tue Nov 10, 2009 at 09:40:53 AM EST
    private insurance, i.e - eliminate the exchange.The subsidies can only be used to purchase the public option insurance.

    Your comment is not comprehensible to me.

    Parent

    But (5.00 / 3) (#9)
    by Emma on Tue Nov 10, 2009 at 09:58:59 AM EST
    the problem with access to abortion services is not solved by eliminating subsidies to private insurers, it's simply made more acute.

    Without Stupak, women who got federal subsidies for private insurance could purchase plans that include abortion coverage -- so long as they paid some part of the premium for that plan.

    With Stupak they can't do that.  And with your solution, they're pushed into the public option and, again, all the practical problems re:  access to abortion apply.

    Unless, of course, the public option will provide coverage fpr abortions that are not subsidized by federal money, i.e. they are paid for by the premium money paid in by plan participants.  Then, like State Medicaid programs, it's just an accounting tweak.  Is that what you're envisioning?

    Otherwise, if the public option can't offer abortion coverage at all, your solution, like Stupak, expands the pool of women who will be unable to get insurance coverage for abortions.  Therefore, it's not a solution.

    As to the other inequality, no, it doesn't have anything to do with Stupak.  It has everything to do with pointing out what Dems are willing to bargain away for no benefit.  Women's reproductive wellness care has been bargained away for what?  Nothing.  And no fol-de-rol about "how to bargain correctly" puts it back in.  So, no, I'm not inclined to think that these bargaining solutions you're proposing actually are solutions to the inequality either narrowly, re: abortion, or more broadly.

    Parent

    Do you have a problem with Medicaid Expansion? (5.00 / 1) (#11)
    by Big Tent Democrat on Tue Nov 10, 2009 at 10:05:48 AM EST
    Which is also in this bill?

    With the public option? Or single payer for that matter?

    It seems to me you must if you are believing what you write there.

    Let us repeat the title of my post - the Stupak problem.

    As I understand it, you envisioned HCR as an expansion of insurance coverage for abortions. To maximize that then, it seems to me you should oppose single payer, the public option, the expansion of Medicaid and favor expanding subsidies for the purchase of private health insurance sans a Stupak Amendment.

    That is certainly a position, but not one I favor. Indeed, I would vehemently oppose such a proposal.

    The problem, as described in the Mother Jones piece, is the fear of a spillover effect of the Stupak Amendment to policies not subject to the exchange.

    Your problem seems to be with the notion of public insurance plans period.

    Parent

    No (4.40 / 5) (#17)
    by Emma on Tue Nov 10, 2009 at 10:18:44 AM EST
    it isn't.  I'm telling you what my problem is, you're redefining it in some weird way to avoid what the actual problem is and making something up about what I "envisioned" health care reform to be.

    Medicaid isn't the issue.  I get the Medicaid problem, that is the Hyde Amendment.  

    I'm not stupid, I'm not "shocked", I'm not naive or any other insult you want to throw at me.  I've been saying for months that Federal money going to subsidize private insurance plans was going to run into this issue:  what does it mean that Federal money can't go to pay for abortions?

    Under Stupak, it means something different than under Hyde.  The public option is NOT Medicaid.  It's an insurance plan, AFAIK.  So, the public option insurance plan, for which people pay premiums, should be free to offer abortion services just so long as those abortions are not paid for with Federal funds, i.e. they are paid for with the premiums paid into the system by the insureds.  Is that going to be the case?  With Stupak it can't be. Without Stupak, it only might be.  

    If you're going to argue a fix to Stupak, you have to argue that the public option insurance plan will provide abortion services so long as they're not paid for by fedeal subsidies.

    Parent

    I also (5.00 / 1) (#22)
    by Emma on Tue Nov 10, 2009 at 10:37:50 AM EST
    understood very long ago the Hyde Amendment problem to a single payer plan.  For me, any single payer plan would have had to include abortion services.  But, since we never seriously talked about any kind of single payer plan, those types of issues never became germane.

    So, in keeping with your standard theme:  this is the political reality we're in now.  Not some hypothetical single payer that I'm hyothetically assuming will mean free abortions for everybody.  I'm trying to talk about what's on the table now.

    Does the public option provide abortion services or not?  If not, it's not a solution to Stupak.

    Parent

    In a nutshell (5.00 / 1) (#24)
    by Militarytracy on Tue Nov 10, 2009 at 10:46:41 AM EST
    One thing will remain a reality.  If you are poor or lower middle class.....you will not be receiving insurance paid for abortion services.  That the existing reality, and that reality will not change if we get rid of the exchanges.  Otherwise, nobody will receive abortion services covered by their insurance.....and that is a significant change.  I'm not saying that the way things are is okay.  I agree with BTD on this "fix", and it will not change the current plight of poor women seeking abortion services.  I'm willing to make a such a sacrifice and continue to do all I can to support the needs of the poor and fight for those.  I think we have a much better chance of those needs being met in the future by taking the reform we get with the stripping out of the exchanges.

    Parent
    And I've had no coffee (none / 0) (#25)
    by Militarytracy on Tue Nov 10, 2009 at 10:47:37 AM EST
    Sorry for typos

    Parent
    PO will never cover (none / 0) (#43)
    by gyrfalcon on Tue Nov 10, 2009 at 12:08:43 PM EST
    abortions.  If there's any question about it (and I don't think there is since it's not going to magically appear, it will be set up and administered by the federal government, even if it's ultimately spun off to some completely independent newly created entity), bet on specific language being inserted into the final bill to make sure it's clear that Hyde will apply.

    Parent
    Right. A PO designed by this lot (5.00 / 3) (#54)
    by Pacific John on Tue Nov 10, 2009 at 12:49:56 PM EST
    ...will never make sense. What people want, in the few polls that have been commissioned, is all of the services of a private plan, administered under something like Medicare, but that's waaaay to simple, and way too dangerous to the insurance lobby.

    The tell that nothing is going to make sense in these games is that incremental expansion of Medicare down to something like 55 was never on the table. If party leadership is completely unwilling to expand on what works, it's certain they are up to no good.

    The other tell that something is seriously wrong is the opaque nature of this batch of sausage. They don't have to worry about hiding anything if they advocate what makes sense.

    Parent

    If that's true (none / 0) (#52)
    by Emma on Tue Nov 10, 2009 at 12:48:43 PM EST
    then pushing all the subsidized people into the public option doesn't fix the Stupak problem.  It's the same problem.

    Parent
    If your position is (5.00 / 2) (#55)
    by andgarden on Tue Nov 10, 2009 at 12:50:28 PM EST
    that you won't accept any healthcare reform that doesn't cover abortions, then this whole proposal was always a nonstarter for you.

    Parent
    Control others money (5.00 / 2) (#59)
    by waldenpond on Tue Nov 10, 2009 at 01:50:36 PM EST
    So if someone buys into the PO with their own funds (BTD: expand the PO argument comes in here) it is OK for the government to restrict their medical decisions?  It would be laughable if it wasn't such a clueless position.  

    So according to the celebrants of this bill....If a woman is in the exchange, govt says she can't get coverage for a legal procedure, suck it up and compromise..  In the PO (again... expand the PO!!!! woopee!) can't get abortion coverage, stop whining and support Obama.  

    [you won't accept any healthcare reform that doesn't cover abortions, then this whole proposal was always a nonstarter for you.]

    Huh?  That isn't what this legislation does.  It bars women who are NOT getting subsidies from getting abortion coverage with their OWN hard earned money.

    Parent

    This: (5.00 / 1) (#61)
    by andgarden on Tue Nov 10, 2009 at 02:07:46 PM EST
    It bars women who are NOT getting subsidies from getting abortion coverage with their OWN hard earned money.
    Is simply false.

    As for this this:

    So if someone buys into the PO with their own funds (BTD: expand the PO argument comes in here) it is OK for the government to restrict their medical decisions?

    With respect for what will be covered, not only is that OK, it has to be true.  Surely you didn't think that even under the best system you would get every treatment covered, right? Now as for abortion, I absolutely think that it should be covered in the public plan. But the political reality makes this essentially impossible now. Hence the comment you are responding to.

    Parent

    Hey, (1.00 / 1) (#66)
    by Emma on Tue Nov 10, 2009 at 02:46:02 PM EST
    I thought we were done?  Of course, telling other people what they think is so hard to pass up.

    Parent
    Dealing with the import of (5.00 / 1) (#70)
    by Big Tent Democrat on Tue Nov 10, 2009 at 02:56:14 PM EST
    your own words seems impossible for you.

    Parent
    Well, (none / 0) (#88)
    by Emma on Wed Nov 11, 2009 at 09:14:08 AM EST
    since you're professing your inability to understand what I'm saying, I'll take that with the grain of salt it deserves.

    Parent
    It's NOT the Stupak problem (5.00 / 2) (#64)
    by gyrfalcon on Tue Nov 10, 2009 at 02:14:34 PM EST
    it's the 30-year-old Supreme Court-approved Hyde amendment problem.  The Stupak problem is far graver because it extends for the first time the abortion ban into essentially private transactions, which has many more very serious ramifications down the road for many more people if it's allowed to stand.

    You're right, the end result in immediate practical terms is the same for subsidized coverage. But it was never going to be any different.  That's been the law of the land for 30 years and likely to be so for at least another 30 or 100.

    It is not possible in this country to have both government health care assistance and abortion coverage.  Under no circumstances.

    The question then is whether it's worth having subsidized coverage for people who currently have no coverage at all or who are being crushed by rising insurance premiums that leaves out abortion.

    Parent

    I think this is pretty much right (none / 0) (#65)
    by andgarden on Tue Nov 10, 2009 at 02:26:03 PM EST
    However, this point:

    The Stupak problem is far graver because it extends for the first time the abortion ban into essentially private transactions
    isn't exactly right IMO. First because using a government subsidy isn't quite a private transaction (though if it were, the restriction would really be on the individual buying the plan*), and second because it's not clear to me that the amendment actually prevents buying supplementary abortion coverage.

    *An "undue burden" IMO, but I doubt the Republican-packed courts will agree with me.

    Parent

    "supplementary abortion coverage" (5.00 / 3) (#75)
    by Steve M on Tue Nov 10, 2009 at 03:20:12 PM EST
    seems basically to be a unicorn, as far as I can tell.

    Parent
    That may be (none / 0) (#78)
    by andgarden on Tue Nov 10, 2009 at 03:26:45 PM EST
    but it is not prohibited. The question is whether abortion coverage would disappear for those with group plans. I doubt it would.

    Parent
    If the plans in the exchange accept subsidies (5.00 / 1) (#80)
    by nycstray on Tue Nov 10, 2009 at 04:14:14 PM EST
    they cannot offer abortions in their plans is how I'm reading it.

    Sen Gillibrand today, pls watch.

    Parent

    Problem (none / 0) (#36)
    by waldenpond on Tue Nov 10, 2009 at 11:48:44 AM EST
    Rep DeGuette stated yesterday on Maddow that there were 41 refusing to vote for a final bill with the Stupak language before the vote was even finished.  Her words: the public option is barred from abortion coverage as some would have subsidies to buy into the public option.  

    So, as I pointed out yesterday, I thought the PO was the nose in the tent and the goal was to expand the PO.  I thought it was to the good if the shift was from employer based to a non-profit public option?  Wasn't the ultimate goal complete enrollment in the PO?  Theoretically, there could be zero individuals with subsidies in the PO and the PO is still barred from abortion coverage.

    Parent

    The Public Option was always subject (5.00 / 2) (#39)
    by Big Tent Democrat on Tue Nov 10, 2009 at 11:53:24 AM EST
    to the Hyde Amendment.

    The Stupak Amendment changed nothing on that.

    Parent

    Expansion (5.00 / 2) (#42)
    by waldenpond on Tue Nov 10, 2009 at 12:04:47 PM EST
    The goal is to move away from private insurance by expanding a FEDERAL program.  As you shift individuals from private insurance to a Federal program fewer will be able to get abortion coverage.  The majority of the discussion has not been an expansion of Medicaid (where states can provide abortion coverage,) it has been expansion of the PO.  If 100% are in a Federal program, private insurer no longer exist, and the states will have to fight to provide abortion coverage.  This is 'creep.'

    Another example of oppressive creep....  Wal-Mart is a crap policy that does not provide abortion coverage and wages are so poor, people qualify for Medicaid.  Some states provide abortion coverage with State funds.  This new legislation mandates that employees must accept employer coverage.  The states are no longer in a position to provide abortion coverage in the current system.

    Parent

    but (none / 0) (#56)
    by Emma on Tue Nov 10, 2009 at 12:51:24 PM EST
    Hyde and Stupak are not the same thing.  Stupak's ban is much broader, regardless of whether it's applied to the public option insurance plan OR private insurance plans.

    Parent
    Well (5.00 / 1) (#57)
    by Big Tent Democrat on Tue Nov 10, 2009 at 12:56:25 PM EST
    You seem under the impression that the public option would cover abortion. Why you think that is not apparent to me.

    Parent
    Actually, (5.00 / 1) (#67)
    by Emma on Tue Nov 10, 2009 at 02:48:14 PM EST
    I'm under the impression that the public option will NOT cover abortion.   Which is why, as I've said about a dozen times, your "solution" is no solution.  It exacerbates the Stupak problem.

    Parent
    Then you are AGAINSt the public option (5.00 / 1) (#69)
    by Big Tent Democrat on Tue Nov 10, 2009 at 02:54:57 PM EST
    and single payer, increased eligibility for Medicaid, etc.

    Because, as you say, those would EXACERBATE the Stupak problem.

    We need to eliminate public insurance entirely and have only privater insurers is your position.

    Thank you for your honesty.

     

    Parent

    No (5.00 / 1) (#89)
    by Emma on Wed Nov 11, 2009 at 09:24:34 AM EST
    that's not my position.  I've stated my position a number of times, you keep making up what you want my position to be to score rhetorical points.

    Under Hyde, both private AND public insurance plans CAN offer abortion services just so long as no federal money goes to pay for abortions.  That is, so long as the insurance plans show that non-federal money -- like premium payments or State subsidies, for example -- goes to pay for abortion services.  That's not only possible, it's what's being done right now with State and Federal Medicaid money.

    In the less than perfect world we live in, THAT'S my preferred option.  Obviously, that's not what's going to happen if the public option does not cover abortion services.

    Stupak was created specifically to stop the first scenario I described. Under Stupak, a plan that recieves ANY federal subsidies can NOT offer abortion services to anybody in the plan under any circumstances.

    That's what I don't want.

    In my perfect world, of course, we'd have single payer and no Hyde Amendment.

    I don't get what's so hard to understand about all this.  Rather than engage and try to understand, you insult and take shots and deliver cryptic one-liners.  There's nothing confusing about this unless you're determined not to understand.

    It's very, very simple:  Stupak is the domestic equivalent of the global gag rule.

    Parent

    But (5.00 / 1) (#90)
    by Emma on Wed Nov 11, 2009 at 09:29:07 AM EST
    of course you're determined to believe that Stupak is the same as Hyde when it is not.  It's much farther reaching.

    Expansion of Medicaid will not put the same limits on abortion services as Stupak would for two simple reasons:  1) the abortion payment restrictions in Stupak are stronger than in Hyde and 2) Stupak prohibits any Federal money going to any PLAN that provides abortion services.

    I don't see how the Federal government refusing to provide federal subsidies to State programs/plans, such as Medicaid, that provide abortion services raised Federalism concerns, but maybe you could tell me so that I'd understand.  Because if the federal government can withhold highway funds to states that have a speed limit over 55, I don't see why it can't withhold federal Medicaid money to state Medicaid agencies/programs that provide abortion services under the Stupak rationale.

    Parent

    It should for those (none / 0) (#60)
    by waldenpond on Tue Nov 10, 2009 at 01:58:07 PM EST
    that are buying into it with their OWN money.  If a particular woman does not want to be held hostage by the insurance cartel, she should be able to buy into the PO if she chooses (here comes the nose under the tent, expand the PO argument.)  If she is not using a subsidy, she should be able to buy whatever effing plan she wants even if it provides abortion coverage.

    I thought you wanted the PO open to more people.

    Parent

    Even IF (5.00 / 1) (#68)
    by Emma on Tue Nov 10, 2009 at 02:50:56 PM EST
    she uses a subsidy, she "should" be able to get abortion coverage so long as the PLAN itself doesn't spend any federal money on abortion services.

    Parent
    Should is different than would (none / 0) (#63)
    by Big Tent Democrat on Tue Nov 10, 2009 at 02:13:42 PM EST


    Parent
    Well, (none / 0) (#91)
    by Emma on Wed Nov 11, 2009 at 09:29:51 AM EST
    maybe then you should be working on making "should" into "will", if of course that's something you have a commitment to.

    Parent
    Eliminating the exchange (none / 0) (#51)
    by MKS on Tue Nov 10, 2009 at 12:46:16 PM EST
    It sounds like diabolical, delicious mischief.

    Making the public option even stronger as the price for Hyde Amendment-like restrictions....

    I would like our side to do better on procedural infighting....Republicans seem to often have the advantage on that score, Barbara Boxer excluded.

    Parent

    As for OB/GYN care (5.00 / 1) (#4)
    by Big Tent Democrat on Tue Nov 10, 2009 at 09:41:55 AM EST
    As far as I know, Stupak is not the problem on that issue.

    Please reread the title of my post.

    Parent

    No the problem on that issue is weak Democrats (5.00 / 6) (#33)
    by BDB on Tue Nov 10, 2009 at 11:43:18 AM EST
    It's gotten to the point that Democrats with huge majorities are still too scared to bring up girly parts so that women can get basic healthcare:

    None of the bills emerging from the House and Senate require insurers to cover all the elements of a standard gynecological "well visit," leaving essential care such as pelvic exams, domestic violence screening, counseling about sexually transmitted diseases, and, perhaps most startlingly, the provision of birth control off the list of basic benefits all insurers must cover. Nor are these services protected from "cost sharing," which means that, depending on what's in the bill that emerges from the Senate, and, later, the contents of a final bill, women could wind up having to pay for some of these services out of their own pockets. So far, mammograms and Pap tests are covered in every version of the legislation.

    Granted, Congress can't--and shouldn't--get into the business of spelling out every possible cause for a trip to the doctor. No one wants the process to collapse under a mountain of requests from special interest groups à la the Clinton mess in 1993. But women, half of all adult patients, are not a special interest group. And since both the House and Senate bills include lists of specific services that must be covered by health insurance companies and be provided without asking patients for additional money, it's hard to understand why all the services provided in a basic well-woman visit to the gynecologist isn't on them along with maternity care, newborn care, pediatric dental and vision services, and substance use disorder services.

    The fault for the initial omission can be laid at the feet of Democrats, who shied away from the issue, not wanting to invite controversy, according to women's health advocates who tried unsuccessfully to get women's preventive health care included in the basic benefits package. Some of the concern had to do with cost. Adding any required service to the basic benefits package would mean the Congressional Budget Office would give the bill a higher score, or price tag, leaving it more vulnerable to attack by budget hawks. But another part of the problem clearly stems from the fact that women's bodies have become political lightening rods, even when abortion is not the issue.

    Even without Stupak, the Dems have basically crafted a bill that purports to cover all of men's health needs.  Women are more or less just along for the ride.  And a crappy, unfair ride it is.

    Much like gays and lesbians, I increasingly question why any woman, including myself, would vote for either party at this point.  The GOP hates us.  The Dems are more or less fine with that hate just so long as they can declare victory afterwards.

    Parent

    Perhaps (none / 0) (#46)
    by Zorba on Tue Nov 10, 2009 at 12:16:26 PM EST
    if enough of us (at least, those of us women who are Democrats and/or progressives) pulled a Lysistrata maneuver, the Democratic men (those who are in relationships with women, at any rate) might get the message.

    Parent
    As for impeding states (5.00 / 1) (#6)
    by Big Tent Democrat on Tue Nov 10, 2009 at 09:53:46 AM EST
    The Hyde Amendment does all it can on that anyway. The federalism issue is probablh what prevents them from going further.

    Stupak does not deal with states, it deals with private insurance companies, at least in the part that concerns people.

    Parent

    I hadn't (5.00 / 2) (#10)
    by Emma on Tue Nov 10, 2009 at 10:05:03 AM EST
    considered the Federalism issue.  I don't have an analysis of that.

    I get that Stupak applies to private insurance plans.  I'm not stupid.  But the issue re:  Stupak is really akin to the global gag order issue.

    Stupak prohibits any Federal funding of insurance plans that provide abortions.  The earlier scheme prohibited Federal funding of abortions.  

    Under the earlier scheme, plans could still offer abortion coverage and get federal subsidies so long as they worked their accounting to keep federal funds from paying for abortions.  That is, so long as premiums paid by the insureds covered abortions, for example.

    It's like the global gag rule:  overseas programs which offered abortion services could get U.S. money so long as they didn't use it to fund their abortion services.  Under the global gag rule, overseas programs could not get U.S. funds if they offered abortion services.  The latter restriction is clearly more sweeping than the former.  That's what Stupak does.  Stupak is the domestic equivalent of the global gag rule.

    Parent

    Indeed (5.00 / 1) (#13)
    by Big Tent Democrat on Tue Nov 10, 2009 at 10:10:03 AM EST
    "Stupak prohibits any Federal funding of insurance plans that provide abortions.  The earlier scheme prohibited Federal funding of abortions."

    And the reason why the Hyde amendment did not go as far is because of the federalism issue.

    That is my point to you. The involvement of private insurance companies, through the exchange, is the catalyst of the Stupak problem. It is precisely why he offered his amendment.

    I am offering Stupak and those like him a different solution. Do I have other motives in mind? Certainly I do.

    The first is eliminate the subsidy to private insurance companies.

    The second is to strengthen the public option.

    The third is to make INSURANCE COMPANIES fight against the Stupak Amendment.  

    That is why I would offer this solution.

    Parent

    Yes, (5.00 / 1) (#18)
    by Emma on Tue Nov 10, 2009 at 10:20:43 AM EST
    I get it.

    The question remains:  what are the parameters of the public option insurance plan?

    Will it be allowed to offer abortion services?  If yes, it's a fix to Stupak while keeping Hyde intact.  If no, it's not a fix to Stupak.

    Parent

    No, it will not (5.00 / 2) (#44)
    by gyrfalcon on Tue Nov 10, 2009 at 12:12:13 PM EST
    It's not a question, Emma.  Abortion services will not be an option in the public plan, if there is one.

    Parent
    Stupak is domestic equivalent of global gag rule (none / 0) (#85)
    by FoxholeAtheist on Tue Nov 10, 2009 at 08:34:20 PM EST
    I just wanted to repeat that Emma - thanks.

    Parent
    Isn't the reason there is an exchange (5.00 / 2) (#19)
    by Anne on Tue Nov 10, 2009 at 10:25:15 AM EST
    in the plan the fact that without it, there was not enough Congressional support for a/the public option (not to mention the gasket the insurance industry blew at the very thought that they might actually have to compete with a public plan)?  I mean, the exchanges, if I am remembering correctly, were deemed to be the lesser of the evils of exchange, co-ops and triggers, and were the trade-off for there being any public option allowed to exist at all.

    And I think there is still some question in the Senate about the public option, so I don't see the elimination of the exchange as being even reasonably possible.

    I don't think we can or should discount the anti-choice forces at work now - there's a much bigger chink in the armor on our side of the aisle, and Stupak exploited it quite well.  Stupak's (the Representative) goal is to limit the choices women have to obtain abortions, and with allies in the Senate like Casey and Nelson of Nebraska, the exchange has even more appeal to them because over time, as more people are eligible for the exchange, the reach of Stupak's amendment expands and more women will potentially not have coverage for a legal medical procedure.

    I don't think they're going to give it up; for one, these guys are better at strategy than the progressives, since apparently all they have to do is say, "no amendment, no exchange, no bill" to get what they want.  For another, it's been awfully quiet at 1600 Pennsylvania Avenue on this issue, which tells me things that make my stomach lurch.

    Single payer would have eliminated Rube Goldberg from the design element - and yes, I know it never had a chance, but it would have been good to have included it in the discussions at least.

    Bingo (5.00 / 1) (#45)
    by gyrfalcon on Tue Nov 10, 2009 at 12:15:44 PM EST
    Except that single-payer wouldn't pay for abortions, either, meaning that nobody at all would get coverage for them.

    Parent
    WHile HCR related , this is (somewhat) OT, but (5.00 / 2) (#23)
    by steviez314 on Tue Nov 10, 2009 at 10:43:30 AM EST
    funny anyway:

    A source at the White House for the president's meeting with Israeli Prime Minister Benjamin Netanyahu reports that Obama ended the event with a modest proposal for the domestic politics of both men.

    At the meeting's conclusion, the two leaders walked out to the adjoining room where the Israeli and American delegations were talking.

    "So," Obama announced, according to the source in the room, "we've decided that we are going to trade our Lieberman for their Lieberman," referring to the independent American senator and the hard-line Israeli foreign minister.
    OMG (5.00 / 2) (#27)
    by Steve M on Tue Nov 10, 2009 at 10:55:01 AM EST
    That is priceless.

    Parent
    Quit (5.00 / 3) (#30)
    by Ga6thDem on Tue Nov 10, 2009 at 11:23:08 AM EST
    trying to fix this piece of garbage IMO and just put it in the trash. The senate isn't going to improve it.

    Rep. Diana DeGette is working hard (5.00 / 3) (#38)
    by Jeralyn on Tue Nov 10, 2009 at 11:49:14 AM EST
    to make sure Stupak doesn't go beyond Hyde. Her aide says:

    "Current law under the Hyde Amendment basically says federal funds do not go to perform abortion services," he says. "The Stupak amendment says private money cannot be used to purchase a plan that offers abortion services. If you're in the Exchange [the current term for the public option], money cannot be used to purchase a plan that offers abortion services -- not even your private dollars. And you can't use private dollars to buy into private plans if they accept any subsidies from the system.

    I think there will be a compromise, limiting it to the Hyde Amendment.

    This seems incorrect to me (none / 0) (#49)
    by Big Tent Democrat on Tue Nov 10, 2009 at 12:25:32 PM EST
    "The Stupak amendment says private money cannot be used to purchase a plan that offers abortion services. If you're in the Exchange [the current term for the public option], money cannot be used to purchase a plan that offers abortion services -- not even your private dollars. And you can't use private dollars to buy into private plans if they accept any subsidies from the system."

    The bold is incorrect imo. In particular, the EXCHANGE is NOT the current term for the public option. It has NEVER been the term for the public option.

    There can be an EXCHANGE whether there is a public option or not and there can be a PUBLIC OPTION whether there is an exchange or not.

    It seems to me Degette is spreading disinformation.

    Parent

    BTD... (none / 0) (#86)
    by FoxholeAtheist on Tue Nov 10, 2009 at 08:41:13 PM EST
    Are you absolutely, 100% certain that you are not unwittingly "spreading disinformation".

    Parent
    I am (none / 0) (#93)
    by Big Tent Democrat on Wed Nov 11, 2009 at 10:07:15 AM EST
    But certain people are intent in believing whatever they want to believe

    Parent
    And who could be more (none / 0) (#94)
    by FoxholeAtheist on Wed Nov 11, 2009 at 07:43:46 PM EST
    "intent in believing whatever they want to believe" than you, BTD? Given that you are "absolutely, 100% certain that you are not unwittingly spreading disinformation" regarding your take on the Stupak Amendment. You have made a claim to infallibility. Good luck with that. Seriously.


    Parent
    Browers quotes Barbra Boxer (5.00 / 1) (#40)
    by andgarden on Tue Nov 10, 2009 at 11:58:46 AM EST
    "If someone wants to offer this very radical amendment, which would really tear apart [a decades-long] compromise, then I think at that point they would need to have 60 votes to do it," Boxer said. "And I believe in our Senate we can hold it."

    "It is a much more pro-choice Senate than it has been in a long time," she added. "And it is much more pro-choice than the House."

    Which is exactly what I said on Saturday.

    Digby contends Stupak/Pitts is broader (5.00 / 1) (#47)
    by oculus on Tue Nov 10, 2009 at 12:20:06 PM EST
    than Hyda amendment.  Here is the relevant portion of today's post on this subject:

    All women will be losing coverage for necessary abortions when a wanted pregnancy goes wrong. It only has an exemption for the life of the mother, but not for her her health, nor for severe and fatal fetal abnormalities.

    mcjoan discussed yesterday at DK also.

    So eliminate the exchanges (none / 0) (#48)
    by Big Tent Democrat on Tue Nov 10, 2009 at 12:21:53 PM EST
    if that is true.

    Parent
    Further study of Hyde amendment (1977) (none / 0) (#72)
    by oculus on Tue Nov 10, 2009 at 03:03:15 PM EST
    reveals there is no exception for "health" of pregnant female nor for severe and fatal fetal abnormalities.  

    But Hyde has been upheld by the federal courts.  And that isn't likely to change, given composition of SCOTUS.  

    Parent

    Especially with the comment (5.00 / 3) (#87)
    by Cream City on Tue Nov 10, 2009 at 09:26:03 PM EST
    from on high, from Obama, that nobody will be allowed to "sneak" a change on Hyde into this bill.

    I think that is an offensive verb choice.  The pro-choice side is hardly the "sneaky" side on this.

    Parent

    I'll admit... (none / 0) (#1)
    by Addison on Tue Nov 10, 2009 at 09:37:51 AM EST
    ...that this part of your proposal seems like a good way to get private insurers nervous enough to push Democratic Senators into passing something that protects their ability to tap into the subsidy cash. And it makes a Stupak-like Senate amendment into the major obstacle to achieving that goal, which is nice.

    And? (none / 0) (#5)
    by lentinel on Tue Nov 10, 2009 at 09:49:59 AM EST
    What you are saying makes sense. And it is simple.

    So why do you suppose that they will not do anything like what you propose? (Just my prognostication)

    Because the insurance overlords... (5.00 / 1) (#7)
    by kdog on Tue Nov 10, 2009 at 09:55:08 AM EST
    want that federal subsidy money...if it can't go towards an abortion, all the better for the insurance overlords...out of pocket ladies.

    Parent
    Then they will work to kill Stupak (5.00 / 2) (#8)
    by Big Tent Democrat on Tue Nov 10, 2009 at 09:56:44 AM EST
    Sort of the point no?

    Parent
    I might be confused... (5.00 / 1) (#12)
    by kdog on Tue Nov 10, 2009 at 10:09:58 AM EST
    don't the insurance cos love Stupak?  It allows them to deny coverage of a procedure...good for their bottom line.

    Parent
    Not really (5.00 / 1) (#14)
    by Big Tent Democrat on Tue Nov 10, 2009 at 10:11:04 AM EST
    Abortions are relatively inexpensive as compared to taking a pregnancy to term. They would rather have it covered and used to be frank.

    Parent
    I see... (5.00 / 2) (#15)
    by kdog on Tue Nov 10, 2009 at 10:15:23 AM EST
    though I doubt many women who decide on abortion are gonna change their mind and carry to term just because the insurance co won't cover the abortion because of Stupak.  More likely, they will pay themselves out of pocket somehow, or if they're short on cash, go to Planned Parenthood.

    Parent
    Forgot the worst case possible scenario... (5.00 / 2) (#16)
    by kdog on Tue Nov 10, 2009 at 10:17:28 AM EST
    go the back-alley route.

    Parent
    But if you can sell supplemental (5.00 / 2) (#20)
    by Anne on Tue Nov 10, 2009 at 10:27:43 AM EST
    policies to women for a specific procedure that may never be done over her reproductive lifetime, that has to be pretty nice financial reward for the insurance companies, no?

    Parent
    Yes (5.00 / 3) (#21)
    by Emma on Tue Nov 10, 2009 at 10:32:21 AM EST
    Stupak sets up a double dipping scenario for insurance companies.  Instead of one policy, they get to sell two.

    Of course, if the price of having mandates is to get rid of Stupak, then BTD's right, the insurance co.s will fight Stupak tooth and nail to get to the pile of money that is mandates.

    Parent

    Exactly. 30-40 years of extra costs (5.00 / 4) (#34)
    by Cream City on Tue Nov 10, 2009 at 11:46:29 AM EST
    for a supplemental policy for women, for abortion alone (i.e., not counting all the other problems with the bill's discrimination against women) on the off chance that the pill or the foam or the condom or the guy's patience or whatever fails.  

    Looks like yet another instance of the elected and/or self-appointed deciders -- in Congress, on blogs, whatever -- not understanding realities of women's anatomy and biology.  It's so icky and all.

    Add up 30-40 years of premiums for extra policies and then tell me that insurance companies would rather pay for a pregnancy.

    Parent

    BUT.....abortions are cheaper (none / 0) (#26)
    by Militarytracy on Tue Nov 10, 2009 at 10:49:38 AM EST
    for insurance companies than pregnancies carried to term.  So I don't buy that they are super excited about covering the mandadated live births of this country.

    Parent
    See above... (none / 0) (#28)
    by kdog on Tue Nov 10, 2009 at 11:00:25 AM EST
    I know you wouldn't let the likes of congress or the insurance cos force you to carry to term via their funding/coverage prohibitions...if you wanted an abortion you'd get one...at Planned Parenthood or paid for on the charge if you had to...and the insurance co skates on the bill while collecting your federally mandated premiums.  Withold those and you pay the fed instead via fine/tax.

    I more I think about it, the insurance cos gotta love it.

    Parent

    What is the "exchange"? (none / 0) (#29)
    by Yes2Truth on Tue Nov 10, 2009 at 11:07:51 AM EST

    Would someone pls. explain what that means.  I
    keep reading about it, but no one ever says what
    it is.

    Thanks

    Better solution to Stupak, read the bill next time (none / 0) (#31)
    by vicndabx on Tue Nov 10, 2009 at 11:26:14 AM EST
    Posted this in error on another thread.  Seems more relevant here.

    p. 246
    (3) PROHIBITION OF USE OF PUBLIC FUNDS
    12 FOR ABORTION COVERAGE.--An affordability credit
    13 may not be used for payment for services described
    14 in section 222(d)(4)(A).

    Section 222(d)(4)(A):
    p. 110

    1 (3) COVERAGE UNDER PUBLIC HEALTH INSUR
    2 ANCE OPTION.--The public health insurance option
    3 shall provide coverage for services described in para
    4 graph (4)(B). Nothing in this Act shall be construed
    5 as preventing the public health insurance option
    6 from providing for or prohibiting coverage of serv
    7 ices described in paragraph (4)(A).
    8 (4) ABORTION SERVICES.--
    9 (A) ABORTIONS FOR WHICH PUBLIC FUND
    10 ING IS PROHIBITED.--The services described in
    11 this subparagraph are abortions for which the
    12 expenditure of Federal funds appropriated for
    13 the Department of Health and Human Services
    14 is not permitted, based on the law as in effect
    15 as of the date that is 6 months before the be
    16 ginning of the plan year involved.
    17 (B) ABORTIONS FOR WHICH PUBLIC FUND
    18 ING IS ALLOWED.--The services described in
    19 this subparagraph are abortions for which the
    20 expenditure of Federal funds appropriated for
    21 the Department of Health and Human Services
    22 is permitted, based on the law as in effect as
    23 of the date that is 6 months before the begin
    24 ning of the plan year involved.

    I'm missing where anything Stupak says changes this.  Is this simply a case of failure to RTFM?

    I accept that (5.00 / 1) (#37)
    by Big Tent Democrat on Tue Nov 10, 2009 at 11:49:07 AM EST
    the Stupak Amendment is not a model of clarity.

    Parent
    Thank you for that. (none / 0) (#41)
    by oculus on Tue Nov 10, 2009 at 12:01:35 PM EST


    Parent
    It's not that Stupak overrides or (5.00 / 5) (#58)
    by Anne on Tue Nov 10, 2009 at 01:44:51 PM EST
    changes what is in the bill - the cited portion, I believe, is essentially an affirmative incorporation of Hyde provisions - it is that Stupak extends the reach of those provisions.

    It says that no private company offering insurance through the exchange can cover elective abortion services if it accepts federal affordability credits on behalf of anyone purchasing insurance through the exchange - even if the individual seeking that coverage is, herself, not receiving any assistance and paying 100% of the cost with her own funds.

    Is that different from Hyde?  Yes, I think it is; there would have been no point to the Stupak amendment otherwise.

    From the FDL News Desk:

    The amendment designates two areas where abortion coverage could not be offered - the public option, and on any plan receiving subsidies in the exchange. Because insurance companies would have to take all comers and not deny anyone coverage under the new bill, they would not be able to restrict customers who receive subsidies. So effectively, every plan in the exchange would not allow abortion coverage.

    If you can show that the implications of Stupak are not as pretty much everyone else is interpreting them, I'd love to see it.


    Parent

    The Hyde amendment (revised 1997) (none / 0) (#71)
    by oculus on Tue Nov 10, 2009 at 02:56:48 PM EST
    includes:

    Section 510, subdivision (b):  Nothing in the preceding section shall be construed as prohibiting the expenditure by a State, locality, entity, or private person of State, local, or private funds (other than a State's or locality's contribution of Medicaid matching funds).

    Section 510, subdivision (c):  Nothing in the preceding section shall be construed as restricting the ability of any managed care provider from offering abortion coverage or the ability of a State or locality to contract separately with such a provider for such coverage with State funds (other than a State's or locality's contributions of Medicaid matching funds).  

    This language is not included in Stupak/Pitts final amendment.  The language that is included is not a model of legislative drafting.  Why so confusing?


    Parent

    I don't think it has to be there (none / 0) (#74)
    by Anne on Tue Nov 10, 2009 at 03:10:41 PM EST
    in order to apply; I think Hyde applies regardless of whether it is or is not restated.

    I do not believe Stupak overrides Hyde as much as it extends its reach to apply to private companies that participate in the exchange.

    Parent

    Hyde amendment specifically applies (none / 0) (#77)
    by oculus on Tue Nov 10, 2009 at 03:23:51 PM EST
    to Federal funding of abortions under the Medicaid program.  

    Parent
    Like others here, I disagree w/that interpretation (none / 0) (#73)
    by vicndabx on Tue Nov 10, 2009 at 03:06:31 PM EST
    There was nothing new in Stupak that wasn't already covered in the main bill.

     - no gov't money for elective abortions directly
     - no gov't money for a plan that covers elective abortion

     - nothing here prevents plans from offering coverage for elective abortion
     - Stupak's ammendment even says plans should offer the same plans.  1 w/elective abortion coverage 1 w/o.  Read thru it again here.

    Just because something could be interpreted one way doesn't mean that interpretation is valid.

    I'm really not impressed w/what is posted on some website.  Anybody can do that.  That really doesn't make these folks the ultimate source of all knowledge.

    Parent

    Then stop the freakin' presses (5.00 / 3) (#76)
    by Anne on Tue Nov 10, 2009 at 03:23:19 PM EST
    because you clearly have discovered something that almost no one else sees.

    If there was nothing new in Stupak then there was no point to the amendment, there would not be 40-some House members willing to reject a final bill that includes it, and Barbara Boxer would not be saying she did not think there were 60 votes in the Senate to be able to strip out the current language and replace it with language from the Stupak amendment in the Senate version.

    Are you seriously arguing that Bart Stupak played the entire Democratic leadership and essentially held the bill hostage all on the basis that he had an amendment that changed nothing that was in the bill?  That the Dems are that dumb that they did not see the real intent of the amendment - that it was meaningless?

    Seriously?  Please just stop; you're embarrassing yourself.

    Parent

    Rather than stoop to your level (5.00 / 1) (#79)
    by vicndabx on Tue Nov 10, 2009 at 03:41:42 PM EST
    I ask you, have you read the two documents yourself?  What is your own conclusion.  Don't regurgitate someone else's interpretation, what is yours?  

    That congressfolk may not have read the entire bill and got duped, no, that's never happened before.

    Parent

    What about this? (5.00 / 1) (#81)
    by nycstray on Tue Nov 10, 2009 at 04:20:23 PM EST
    - nothing here prevents plans from offering coverage for elective abortion

    Accepting subsidies as part of the exchange does. Which as a result limits/restricts/bans our access to them.

    Parent

    Just tell me, what was the point of this: (5.00 / 2) (#83)
    by Anne on Tue Nov 10, 2009 at 05:33:01 PM EST
    There was nothing new in Stupak that wasn't already covered in the main bill.

    Why was there so much struggle, why was the Catholic Bishops Conference working so hard with Stupak and Ellsworth to get this amendment through if it didn't add anything or change anything?

    What was the point?  

    I have no doubt that most of the members of Congress have not read any of the bills, but there are enough people involved on committees and in the leadership, that it simply defies logic that all of this is one giant head fake from the anti-choice contingent - but to what end?  If it doesn't change anything, why are the anti-choicers and the bishops so pleased?  Will Stupak just run off giggling at his super-duper practical joke when people discover that his amendment does not mean what he presented it as?  

    Please, just explain this for us, would you?  I would really like to know what you know that no one else does.

    Parent

    I reached my own conclusions (none / 0) (#84)
    by vicndabx on Tue Nov 10, 2009 at 05:53:50 PM EST
    You've done the same.  I wouldn't go so far as assume it's a head fake.  It could be as benign as "we didn't know that was already there." Too late to admit that once the cat is out of the bag. The fire is already lit.

    Either way, I've yet to be convinced the amendment changes the bill or status quo.  I would hazard to guess folks who read what I posted and then read Stupak can point to any substantive difference. Here's another question.  Forget the amendment for a minute. Who after reading what I posted feels any safer w/regard to coverage for elective abortions?

    Parent

    Considering the attitude toward (none / 0) (#82)
    by Inspector Gadget on Tue Nov 10, 2009 at 04:32:53 PM EST
    Democrats right now, using this scare tactic will certainly gain them some campaign contributions.

    Obama used the theme in his weekly address a couple of weeks ago (lobbyists are dropping millions in campaign contributions to convince your reps to stop HCR from going through), and the requests coming in the mail and via email for donations to fill the campaign chests are a daily occurrence.

    It's a big document, and it is nearly impossible to download completely. I'd like to know which congress members actually have read it.

    Parent

    So, even though Stupak/Pitts doesn't (none / 0) (#32)
    by oculus on Tue Nov 10, 2009 at 11:34:13 AM EST
    explicitly state, and in fact obfuscates, there is no question states which currently provide abortion coverage to Medicaid recipients, but entirely with state funds, may continue to do so post Stupak/Pitts (as currently worded)?

    That's my reading (none / 0) (#35)
    by Big Tent Democrat on Tue Nov 10, 2009 at 11:48:16 AM EST
    of it. An alternate reading would have federalism implications imo.

    Parent
    What are they? (none / 0) (#92)
    by Emma on Wed Nov 11, 2009 at 09:33:52 AM EST
    I'm really interested to hear.

    Parent
    Solving The Stupak Problem: Eliminate The Exchange | 91 comments (91 topical)

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