Tuesday, November 10, 2009

Health Care for All --- Except You, Lady!

On Sunday, the House of Representatives passed the Democrats' health-insurance reform bill, but not without some "collateral damage," to use Echidne's phrasing.

The bill that was passed contained an amendment, the Stupak-Pitts amendment (full text here), which would bar any government-sponsored health insurance from covering abortions. More than that, it would require any private insurance plans that might receive government subsidies, or be purchased by individuals receiving government subsidies, to strip abortion coverage from their publicly available plans, and put it into a separate category of coverage that people would have to buy for themselves (or get through their employer).

The amendment would remove all references to abortion coverage from the parts of the bill describing "Essential Benefits" (Title II, Subtitle C) --- i.e., coverage to be extended to everyone, whether directly through a government-run public insurance option or indirectly through government subsidies or exchange programs intended to make private or employer-based insurance more generally accessible --- and add this text at the end of Title II (Protections and Standards for Qualified Health Benefits Plans):

a) IN GENERAL. --- No funds authorized under this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the results of an act of rape or incest.

b) CONSTRUCTION ON OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. --- Nothing in this section shall be construed as prohibiting any non-federal entity (including an individual or a State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes coverage for such abortions, so long as ---

  1. such coverage or plan is paid for entirely using only funds not authorized or appropriated by this Act; and
  2. such coverage or plan is not purchased using matching funds required for a federally subsidized program, including a State's or locality's contribution of Medicaid matching funds.
c) CONSTRUCTION ON OPTION TO OFFER SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. --- Notwithstanding section 303(b), nothing in this section shall restrict any [Qualified Health Benefit Plan] offering entity from offering separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as ---

  1. premiums for such separate supplemental coverage or plan are paid for entirely with funds not not authorized or appropriated by this Act;
  2. administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and
  3. any nonfederal QHBP offering entity that offers a plan that includes coverage for abortions for which funding is prohibited under this section also offers a plan that is identical in every respect except that it does not cover abortions for which funding is prohibited under this section.
As Ezra Klein, Jodi Jacobson, and Jenn all point out, this will seriously aggravate the systemic inequality of access that already pervades both health care in general, and abortion and contraception in particular, in this country.

The Hyde amendment already barred women on Medicaid, women in (federal) prison, federal employees, and military personnel from receiving insurance coverage for abortion, and now the Stupak amendment will ensure that lots of other categories of women join them.

Robin Marty also points out that the amendment --- containing as it does such restrictive language surrounding when publicly-funded abortions are permissible --- could have the unintended consequence of forcing women who've miscarried to go through with their already-aborted pregnancies, because removing the dead fetus would technically be an abortion, and thus ineligible for public funding (or --- to reiterate, because I think this is the most invasive aspect of this law --- private funding by any insurance plan participating in a public insurance-exchange program or open to people receiving federal subsidies):
Hospitals and doctors in general do not have terminology to classify a difference between the termination of a live pregnancy and one in which the fetus has already died. To them, a D&C is a D&C, regardless of the state of the "conception materials" removed. Regardless of how many times I made sure to mention to the staff, either for the sake of my sanity or to spare me some sort of imagined shame, that I was ridding myself of my "dead fetus," to them it was all the same.
I also could not fail to notice the amendment's omission of mental illnesses from the list of acceptably serious health problems sufficient to justify terminating a pregnancy with federal assistance.

That omission is interesting to me, because pregnancies resulting from rape and incest are on the okay-to-abort list, even though such pregnancies may not be particularly dangerous or life-threatening. You might think that Rep. Stupak included those categories out of respect for the intense mental and emotional suffering a woman (or girl) is likely to feel, giving birth to her attacker's child, but then you wonder, if he really is so concerned about suffering, where's his consideration for women suffering suicidal depression, or terrifying psychotic breaks? Many psychiatric medications can't be taken during pregnancy, after all, and depression in particular can worsen dramatically as soon as the depressed pregnant woman gives birth.

Those incongruities suggest to me that either Rep. Stupak is really ill-informed about mental illness, pregnancy and women's health (which wouldn't surprise me --- Rep. Stupak is not a doctor), or he ascribes to the distressingly common, misogynistic view that women abort pregnancies on a whim, and that female sexuality, decoupled from marriage and socially-sanctioned procreation, is an inherently destabilizing force that must be contained.

If restricting abortion is not really about fetal life, but about female sexual agency, as Amanda Marcotte frequently --- and quite persuasively --- argues, then it makes sense that abortion bans almost always contain rape and/or incest exceptions. If the sex wasn't chosen, the woman isn't a threat; she's a pitiable victim. In the usual "elective abortion" narrative, a woman who chooses to have sex is obliged to accept the "consequences" of her decision --- i.e., pregnancy --- and any attempt by her to exert further control over her fate, say, by taking emergency contraception or, if she should become pregnant anyway, having an abortion, is an overreach; she sins, she cheats, she gets away with too much. Her impunity makes people nervous. The victim of rape or incest is not "overreaching" in this way; she's just trying to get back to normal.


Butters said...

The reason mental illness is not included as an exception in the thinking of pro-life people (including myself, broadly), is that mental illness is a broad enough category that many unjustified abortions can take place if we include it as an exception. A woman who is depressed qualifies as mentally ill, but this should not justify her having an abortion.

The moral reasoning behind this is simple. 1. The right to life (if one believes in rights, which I don't necessarily, but it's a useful discourse so I'll stick with it for now) is more important than the 'right' not to get more depressed than one already is. Depression is bad but death is worse.

2. Even a depressed woman can prevent pregnancy. Depressed people are not compelled to having intercourse without contraception. On the other hand a woman who is severely mentally ill, e.g. suffering from a psychotic disorder, is likely to be in a protected environment, and will probably be deemed incapable of consenting to begin with. As such, if she does get pregnant, it will necessarily or very probably be a case of rape, which is already exempted.

Butters said...

Additionally, there are good reasons to oppose abortion with the exception of cases of rape or incest, besides the need to control women's bodies.

In fact, the reason abortion is acceptable in cases of rape, is that it prevents rapists from using rape as a means of controlling women. In societies far more patriarchal than this one (I speak of Canada when I say 'this one', and the more patriarchal societies would be such societies as Pakistan, etc.) rape is used as a way of forcing a woman into a relationship or marriage, as the pregnancy leaves her with no other 'honourable' choice.

The message being sent to rapists is that they can use rape to spread their seed, and to pull women into marriage. Such a message should not be sent.

Furthermore, moral responsibility falls on an individual according to how much freedom they have to choose. A woman who has been raped has no freedom to choose whether she had 'sex' in that instance, but a woman who consents does. Personal freedom effects your moral responsibility, as we all already know (when we don't choose to ignore it for ideological reasons).

White Horse said...

For goodness sake, assisting someone to kill their baby is not "healthcare."

Stephanie said...

Finally, a productive advocacy group, NOEWAIT.

I recommend everyone go visit the site, print out the documents and mail them to your congress people. I am definitely doing this. Today. I'm on the waiting list.

Do something productive.

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Muser Grace said...

I tend toward being anti-abortion, but I agree with you on the need for a mental health exception, esp. when it comes to women with a history of postpartum psychosis. Butters' take on mental illness strikes me as much too simplistic as prenatal depression, post-partum depression, and especially post-partum psychosis all can and often do lead to death (and in the case of psychosis, also the death of other children and/or family members). So, depression is, in fact, often as bad as death. And you can risk losing both mother and baby. I suffered from prenatal depression, ppd, and post-partum ptsd and chose to keep my baby, but had I not had years of therapy previously that helped stem my suicidal depression, it's really likely I would have killed myself during my pregnancy and lost myself and my baby. And your point about how often people can't take the meds they need to (often literally) stay sane during pregnancy is hugely important. About 1/2 of all pregnancies are unplanned, and a good portion of those result despite the responsible use of contraceptives. To force a mentally ill woman to carry a pregnancy to term when that means risking her own health and life (and potentially others' as well) due to being unable to take her medication is dangerous and small minded.