Friday, November 13, 2009

Stupak Explained

Some folks have contacted us wondering exactly what Stupak-Pitts means, since without the amendment Hyde wouldn't have been violated. The National Organization for Women outlined the amendment on this form to contact your Senators:

The Stupak-Pitts amendment explained:

  • The ban on abortion coverage in insurance would apply to both the proposed public option and to private health insurance plans sold in the new regional health insurance exchanges. It is estimated that some 36 million uninsured persons would be purchasing insurance policies through new exchanges and would be eligible for federal affordability subsidies.
  • Health insurers may not sell plans that cover abortion to customers who are paying without a subsidy, if even just one person who is receiving the federal affordability credits (the subsidy) were to purchase a plan. In other words, even if you are paying 100 percent of your insurance costs, abortion coverage would not be available in your plan if anyone with affordability credits joins the same plan.
  • Women may purchase a separate abortion "rider" for coverage, though many doubt that these riders would be offered by the insurance companies.
  • Small companies (fewer than 100 employees) would also likely purchase health insurance through the exchange, but if any of their employees received affordability credits no abortion coverage could be included.
  • Eighty-seven percent of employer-based insurance plans now cover abortion services, but if employers withdraw coverage and send their employees to the health insurance exchanges, those employees would likely lose abortion coverage under these new prohibitions.

There may be a modified version of this harmful amendment that is included in the Senate health care reform bill that will be debated next week. We want to make sure that Stupak-Pitts language is not used and that no variation of this harmful amendment is passed. Please send a message to your senators that you oppose any restrictions on insurance coverage of abortion.

How to respond to pro-Stupak arguments

The following is a cross-post with ChoiceUSA.

"Why should the health care plan cover abortion if the procedure is elective?"

This is a question all choice advocates need to be prepared to address, and one I myself have gotten many times since the passage of the Stupak Amendment last weekend. Unfortunately, like many choice-related debates, there isn't a quick and simple answer readily available.

To even begin to address the issue we must first acknowledge that abortion is a part of reproductive health care. Like an IUD insertion or an annual PAP test, pregnancy termination must be included in any health care plan in order for women to be able to exercise control over their reproductive organs as they choose. If we deny the fact that abortion care is health care, we've already lost the battle.

From there we need to be ready to address the issue of an "elective" procedure as opposed to a "medically-indicated" procedure. It is in this discrepancy that antichoice factions have been allowed to gain headway with those who would normally be sympathetic to our concerns. Likening abortion to a sort of cosmetic surgery, refrains of "Why Should We Have To Pay for Something You Don't Really 'Need'" fall on reasonable ears. However, if we look to other facets of reproductive health care, or health care in general, we see that there are numerous cases where so-called "elective" procedures remain covered under any proposed health plan:
  • A woman has a small, benign ovarian cyst. There is no "medically-indicated" reason to get the cyst removed, but monthly ovulation is uncomfortable and she wants to undergo surgery to prevent further discomfort. Very few would argue that this woman's surgery should not be covered even though it would technically be an "elective" procedure, and to be sure, labor contractions are far more uncomfortable than the pain of ovulating with an ovarian cyst.

  • A 35 year old woman has some history of breast cancer in her family and chooses to begin having yearly mammograms even though medical research doesn't indicate the need for this procedure until age 40. This woman's screening procedure would be fully "elective," and yet no one is proposing amendments to restrict early preventative care to detect abnormal growths in her breasts.

  • Even procedures generally labeled as "cosmetic" are covered under many health plans and have not been attacked by legislative restrictions. Many private insurance companies offer coverage for reconstructive surgery following a mastectomy (which basically amounts to breast implants), a truly elective, non-medically indicated, very cosmetic surgery. No one is kicking up dust about breast cancer survivors obtaining new breasts on a federally-subsidized plan, nor should they.
Additionally, anyone who thinks abortion is a 100% elective, non-necessary procedure has never needed one themselves or never spoken to someone who has. Women who choose abortion do not feel as though the procedure is something they've "elected" to do; these are women who have found themselves pregnant unintentionally, and most cases feel as though abortion is their only option. This feeling arises from a number of factors: financial restrictions, relationship issues, life stage considerations, and medical concerns, to name a few. Because we simply cannot list every reason a woman might choose to terminate a pregnancy, this option must be left open, unconditional and unrestricted, for women to be able to access a complete range of health care options.

Another argument against our fight for comprehensive reproductive health care comes from folks who are generally sympathetic but believe we're kicking up too much dust over a relatively inexpensive procedure when there are people who need thousands of dollars in health coverage now. I do not wish to navigate into the murky waters of "he started it," but it was not "our side" that initially kicked up all that dust. The initial health bill proposal allowed for private insurance companies that would be receiving federal subsidy to continue covering abortion as their policies indicate; it was not until Rep. Stupak embarked on a mission to "compromise with" (read: capitulate to) antichoice congress members that we had any reason to complain whatsoever. In the initial health bill, shot down by Congress last Summer, representatives chose to delay providing much-needed health coverage to thousands, in part because of the abortion coverage private insurers would be able to continue providing.

Besides, if Congress was really out to save money and not impose an antichoice agenda over our health care options, things like abortion and contraception would be a priority. The average cost of "elective" abortion in this country remains in the $450 range, though due to financial assistance and low-cost clinic care the average amount paid tends to be in the $300s. Women can access hormonal contraception starting at $15 a month, and implantation methods average around several hundred dollars for 12 years of pregnancy prevention. Due to restrictions on public funds going towards any of these procedures and the lack of private insurance coverage of most, many women are forced to pay out of pocket for pregnancy prevention and termination. However, women in the United States can receive hospital-based maternity care from Medicaid: hospital births average around $7000 for uncomplicated vaginal delivery and between $12,000 and $16,000 for cesarean births. The government pays millions a year for pregnancy and birth costs, not to mention the subsequent costs from WIC programs and pediatric care, yet provides no funding for women who wish to avoid pregnancy or terminate an existing pregnancy. It is in these statistics that the true agenda of antichoice government agencies shines through: they would rather pay thousands for a woman to carry to term than address the moral quandary that is abortion care.

The real restrictions on abortion and contraception coverage remain inextricably attached to moral, not reasonable, qualms about what should be covered when. There are many conditions that are technically "elective" that remain covered by private insurance and government programs alike, and yet antichoice legislation continues to buck cost-saving reproductive health care to bend to an overlying agenda of control over women's bodies. The health care debate cannot continue without comprehensive health care being taken into account, no option left behind.

Tuesday, November 10, 2009

Stupak, pregnancy, and insurance coverage

We were sent this today:

Will the Stupak Amendment Affect Insurance Coverage for Miscarriages? I Think So

No surprises here, right? For sure it is another example of how anti-choice amendments such as the "personhood amendment" can impact all pregnant women, even those who are not seeking an abortion.

When I was in labor with my son, I was given limited options. My doctor required me to be lying flat on my back for delivery, and I was basically confined to the bed during labor. I was eventually taken to the OR for a cesarean which I agreed to after being told I "needed" one.

Fast forward a month or so. I'm a new mom, single, young, broke, and getting by with nothing more than the committed care of my mother. I had fantastic health insurance, however, and was able to have what I came to call "mac daddy pre-natal care." That didn't stop my insurance company from denying coverage for the cesarean I "needed" to have.

What happened was, after laboring for about 6 hours, my obstetrician told me I needed to deliver soon. I was scared for my son's life, exhausted, and fuzzyheaded from the epidural. So I said okay. Turns out the c-section had been noted as "elective" in my charts. When I called the doctor she told me it had to be noted that way since there was no medical emergency or even medically-indicated reason to cut me open! Shocked, exhausted, and still recovering from the c-section that I'd endured over a month prior, I ended up paying for half the surgery out-of-pocket.

People assume reproductive rights activists are all about abortion access. While we do work for abortion rights and abortion access, we do it under an umbrella of protecting reproductive health care in all its facets. Just as we connect pregnancy and birth rights with abortion rights, attacks on abortion rights and abortion access will almost always affect those who want to be pregnant and have a say in the way they choose to birth.

Sunday, November 8, 2009

Statement Regarding Last Night's Vote

Dear Friends and Supporters,

Last night, the U.S. House of Representatives passed the Affordable Health Care for America Act (or HCA), a bill designed to make health care more affordable and accessible by placing stricter codes on insurance companies. The bill, passed in a narrow 220-215 vote, disallows insurance providers from denying coverage due to "preexisting conditions" or charging higher premiums based on gender.

The bill did, however, pass with the Stupak Amendment in tact. This amendment bars private insurance companies receiving federal subsidy from covering abortion procedures (even if the insurer previously covered it). Patrons of the insurance companies have no say in whether or not their insurer becomes federally subsidized, but it is the patrons who will be left to front the bill from a federally-mandated lack of coverage. Women covered by these insurance providers have the option to purchase an "abortion plan" in addition to their basic health coverage. Touted by some to be a "compromise" with antichoice factions of the legislature, the passage of the Stupak amendment has already garnered a wealth of criticism from women's groups and medical organizations alike.

As a reproductive justice advocacy resource, CPC Watch as an entity applauds any effort to make health care more affordable. While we generally lean to the "left" of social debates, we are non-partisan and strive to keep partisan sectarianism far from our ranks. However, we simply cannot hail last night's vote as a victory in women's health. Any effort to increase the affordability of basic health care cannot, in our opinion, leave certain facets of health care in the dust. We believe that abortion, a procedure that 1 in 3 women will require in her reproductive life, is no less a vital medical service than any other reproductive health procedure. The idea that a woman will actually plan on needing an abortion and go ahead and purchase additional coverage is laughable at best; our work advocating for women's health has told time and time again that women never plan on needing an abortion, and it is ridiculous to expect them to.

Imagine your insurance provider was restricted from covering open heart surgery for some vague reason regarding public morality. You could obtain coverage that was affordable and encouraged you to receive regular preventative care and cardiovascular exams, but in the even you needed bypass surgery you would not be covered. For those concerned with paying for heart surgery out of pocket, the provider offered a "heart surgery plan" for an additional cost. Being a generally healthy human being, maybe young and active with a decent enough diet, my guess is you wouldn't bat an eye at this extra expense; open heart surgery is something very few people expect to need, and yet many require such a procedure, even if they have taken necessary precautions to avoid it. Obviously there is no "moral dilemma" surrounding open heart surgery, so this scenario seems ridiculous. But for those of us who believe abortion qualifies as basic health care as much as heart surgery, the passage of the Stupak amendment is insulting.

Given the percentage of women who will have an abortion before age 45, we have to ask if Representative Stupak's expectation for women to pay more for "abortion coverage" is even legal given the bill's restriction against higher premiums based on sex and gender. After all, an additional "abortion plan" is hardly something a man would or could buy for himself, and while comprehensive men's health is 100% covered by the HCA, a portion of coverage for basic women's health care requires additional payments.

The question that remains is, should we laud the passage of what is indeed a step in the right direction for the majority of the country's health care needs, or should we reject this bill outright due to its sweeping cut of basic women's health coverage? Do we hope for better in the Senate, or are we supposed to get used to these capitulations disguised as bi-partisan compromises?

Whatever happens, we can assure our supporters that we will continue to spread the truth about women's reproductive health and pregnancy options, and will continue to fight for our overlying mission to ensure full, unbridled reproductive justice for each and every woman and girl.

In Solidarity Always,

Lauren Guy-McAlpin
Crisis Pregnancy Center Watch
Project Coordinator

Additional Commentary

In Pelosi's House, 64 Democrats Sell Women Out -- Huffington Post
The Answer to Stupak? Overturn Hyde Now. -- RH Reality Check
Whose health care victory? -- Feministing

Take Action Against Stupak-Pitts

via Planned Parenthood Action Fund
via NARAL Pro-Choice America

Monday, November 2, 2009

Baltimore City's CPC Bill

A Baltimore City Council panel is scheduled to vote today on a bill that would require crisis pregnancy centers to disclose their contraception/abortion services (or lack thereof) on a sign in front of the center.

The bill comes after a series of actions led by NARAL Pro-Choice Maryland, whose volunteers investigated Baltimore CPCs and found the same disturbing trends found in most CPCs around the country: inaccurate information about abortion side-effects (breast cancer, depression, infertility), a lack of information or referrals for effective contraception, and overall manipulative tactics used to dissuade women from choosing abortion.

While CPC directors claim they are being unfairly targeted, those of us on the Choice side all seem to have taken a similar stance: if your center already doesn't deceive women about its services, what's the problem? If you're not claiming to be a medical clinic and never have even attempted to trick women into thinking you'd provide legitimate information on abortion, what's the big deal about displaying a sign stating such a fact?

If anything, Baltimore CPCs that tout their commitment to "help[ing] you face one of the greatest personal experiences of your life" and believe "it is important to be well-educated" should welcome such a bill with open arms, right? I mean, as has been repeated over and over by Choice advocates, "it's just a sign." A sign stating the facts... isn't that what CPCs claim to do, state the facts?

Obviously Baltimore area CPCs have more than a little to be concerned about; first the sign tells clients you don't provide contraception or abortion, then what? Soon people will start to realize that the information you give out is anything but unbiased. Pregnancy Center West, for example:
  • claims that "women who undergo one or more induced abortions carry a significantly increased risk of delivering prematurely in the future. Premature delivery is associated with higher rates of cerebral palsy, as well as other complications of prematurity (brain, respiratory, bowel, and eye problems)." The source of this "fact" is, a CPC referral site that cites outdated and methodologically-unsound research to hype the supposed risks of abortion. Comprehensive studies suggest there is no direct connection between abortion and breast cancer, infertility, or psychological trauma.
  • will not diagnose a pregnancy via ultrasound until 8 weeks LMP, a clear attempt at delaying a woman's decisions and limiting the kind of abortion procedure she could choose. Pregnancy is detectable by ultrasound around 4-5 weeks LMP.
  • claims that emergency contraception (the "morning after pill") can "abort" a baby. This dangerous claim can only harm women, since women who are opposed to abortion will be hesitant to access EC as a last-resort measure to prevent pregnancy. In truth, EC does not cause an abortion because it prevents pregnancy from beginning in the first place; it has no effect on an established pregnancy.
  • highlights the dangers of many STDs while providing absolutely no comprehensive information on preventing them other than abstaining from sexual activity all together.
If CPCs like Pregnancy Center West are pushing such biased and incomplete information about sexual health and pregnancy options, the public needs to know. Investigations by NARAL Pro-Choice Maryland reveal even more disturbing trends from inside the doors of Baltimore area CPCs.

If you are a Baltimore City resident, it may be too late to contact your councilmembers at this time, but I would recommend staying up to date with NARAL Pro-Choice Maryland as they continue to expose the tactics and biases of nearby crisis pregnancy centers. For now, let's hope the panel votes in favor of the Limited-Service Pregnancy Centers Disclaimers Bill.