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With abortion as one of the biggest remaining stumbling blocks in the health care reform push, Rep. Bart Stupak has been in high demand on political talk shows.
An antiabortion Democrat from Michigan, Stupak says he and at least 11 other House Democrats would vote against the Senate language on abortion, which he says would allow federal funding for abortions.
His biggest issue is in the proposed government-created health exchange (for people who do not get their insurance through their employer), government subsidies could go to people who choose plans that cover abortions.
But Stupak has repeatedly raised another point as well.
"The bill that they're using as the vehicle is the Senate bill, and if you go to page 2,069 through page 2,078, you will find in there the federal government would directly subsidize abortions, plus every enrollee in the Office of Personnel Management enrolled plan, every enrollee has to pay a minimum of $1 per month towards reproductive rights, which includes abortions," Stupak said in a Good Morning America interview with ABC's George Stephanopoulos on March 4, 2010.
Stupak made similar statements in a Politico article on March 4 as well as in an interview with MSNBC's Chris Matthews on March 3.
The Senate language on abortion was written by Sen. Ben Nelson, D-Neb., who is an abortion opponent. While the language Stupak penned for the House version would prohibit insurance companies in the exchange from offering abortion services, Nelson's plan would allow companies to offer abortion services. But Nelson sought to ensure those services would be paid through patient premiums, not federal subsidies.
In order to accomplish that, the Senate bill requires that all enrollees in plans that offer abortion services "without regard to the enrollee’s age, sex, or family status" pay a separate amount to cover the actuarial value of abortion services for the entire population covered by the plan. The insurer "may not estimate such a cost at less than $1 per enrollee, per month."
So that's where Stupak gets his $1 a month figure.
This is not necessarily an add-on cost. Many health insurance experts quietly acknowledge what Slate's Timothy Noah referred to as the "gruesome reality" that it actually costs insurance companies less to pay for abortions than it does to pay for prenatal care and delivery. But the Senate bill specifically states that the actuarial estimate "may not take into account any cost reduction estimated to result from such services, including prenatal care, delivery, or postnatal care."
So the set-aside for abortions is at least $1, regardless of whether it costs less than a dollar, or whether it actually saves insurance companies money.
In other words, this $1 a month is not really over and above what someone would pay for their insurance otherwise. It's a mechanism to segregate a pot of money from insurance premiums (rather than federal subsidies) that would pay for abortions.
But Stupak didn't say the $1 a month was an additional cost, only that it would go "towards" abortion services. And that's correct.
But Stupak errs when he says that "every enrollee" would have to pay the $1 a month. That extra dollar would be separated out only for people who select a plan that offers abortion services. Someone could just as easily choose a plan that does not cover abortions.
In fact, the Senate bill requires that "with respect to multi-State qualified health plans offered in an Exchange, there is at least one such plan that does not provide coverage of (abortion) services." In other words, if you don't want to participate in a health plan that offers abortion, and for which you'll have to pay into an account specifically for abortions, you don't have to.
We further note that the Senate bill also says that a state "may elect to prohibit abortion coverage in qualified health plans offered through an Exchange in such State if such State enacts a law to provide for such prohibition."
So it's not required for states to offer plans in the exchange that cover abortions; but if they do have plans that offer abortion, they must also offer plans that do not.
Lara Cartwright-Smith of George Washington University's public health school explains:
"The legislative language he's referring to is about how the government determines the value of abortion coverage for plans offered through the Exchange to ensure that federal money is not used to pay for that coverage," Cartwright-Smith said. "This section does not apply to people who are covered outside of the Exchange, such as through an employer’s health benefit plan. Everyone buying insurance through the Exchange will have the option to enroll in a plan that does not include abortion. Those people will not pay any amount for abortion coverage and no federal funds for that plan will have to be segregated.
"If, and only if, an enrollee selects an insurance plan that includes abortion coverage, then the value of that abortion coverage must be calculated and that amount must be segregated from the value of the rest of the benefits of that plan, so that the enrollee can pay for the abortion coverage separately with their own private money. The calculated value of the abortion coverage must be at least $1. This process is to ensure that federal funds aren’t used to pay for abortion coverage. These rules only apply to plans in the Exchange that include abortion coverage, so people who select a plan that does not include abortion will not have to pay for abortion coverage even if other plans in the Exchange do offer it."
It's also important to note, she said, that these rules are about abortions for which federal funding is not allowed, such as elective abortions. Abortions for which federal funding is allowed, such as in cases of rape, incest or when necessary to save the life of the mother, may be covered by any plan in the exchange.
We called Stupak's office, and they provided a statement from the congressman essentially acknowledging that his statement only refers to people who opt for a plan that covers abortions. But he warned that many people will be unaware that a portion of their premium would be earmarked for abortion.
Stupak is correct that people who select a plan that covers abortions would have at least $1 a month of their premiums set aside for a fund that would pay for abortions performed for people in that plan. And everyone in that plan, even men, would have to pay into that account.
But Stupak misspoke when he said, repeatedly, that "every enrollee" would have to pay into an account that would pay for abortions. In fact, the issue doesn't apply at all to people who choose a plan that does not cover abortion. And every state must offer a plan that does not offer abortion. Furthermore, people would have to be told up front if the plan they are considering covers abortions. So when Stupak says that "every" person would need to set aside this abortion money, it's not only wrong, we think it stokes misplaced outrage on an already highly charged issue. We rule Stupak's statement False.
Patient Protection and Affordable Care Act, as passed by the Senate
Slate, "Why Stupak Is Wrong: The Senate bill doesn't fund abortions. Here's why he thinks it does." by Timothy Noah, March 4, 2010
AP, "A policy change on abortion, but how radical?" by Ricardo Alonso-Zaldivar, March 9, 2010
PolitiFact, "Boehner claims that the Senate health care bill includes an abortion fee," by Catharine Richert, Nov. 20, 2010
Politico, "Stupak Negotiating on Abortion," by James Hohmann, March 4, 2010
Interview with Lara Cartwright-Smith of George Washington University's public health school, March 9, 2010
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