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November 08, 2009

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"The penalty for failing to purchase insurance is set at 2.5% of
income, up to a $750 per-person cap, or $3,000 for a family of four."

That's the Senate Finance penalty, I think. The House is 2.5% up to the
average cost of a premium in the exchange. everything else is fairly
accurate.

The Exchanges are hugely important in a world without the public option, and even with it.

The Stupack amendment is vile and wrong, and in 8+ years could be overturned by a court, if need be (or if done smartly, appealed to the Ninth Circuit and then set the Administration to run out the clock on an appeal to the Supremes). If not, hope it comes out in the Senate Bill or at Conference. It's an attempt to nullify Roe v. Wade, and that's wrong.

Luke, I'm not really sure why Stupak is unconstitutional. What am I missing?

I admit I am moderately worried about the mandates, but only because I am not sure how easy it will be to cap an income for the nation's working poor that gives them an exemption.

Well, it's written poorly enough to be problematic in its implementation in relation to other parts of the bill. It's more damaging than its proponents suggest.

Though appealing to the current Supreme Court certainly wouldn't hold water (oh, hi Antonin), based on O'Connor's screw the poor plan, by the time the plan goes into effect in 2013 and a case shows up by, say, 2016, you've got a Roberts court that is significantly to the left (?-Koh-Woods-Sotomayor-Alito-Roberts-(Thomas-Kennedy-Scalia) it in effect denies whole classes women access to abortion in a discriminatory fashion.

I'm less worried about the mandates. That'll be fixed over time, unfortunately.

I'm sorry, I don't see why the fact that it's written poorly is problematic.

What you are suggesting is that:

1) Congress cannot differentiate among health care that can be covered by its bill.

2) This is somehow different than the preeexisting Medicaid exemption for abortions.

I don't see it. But I'm open to persuasion.

Your complaints are a bit amusing, though. Government interference in medical procedures if exactly what you get when a government exerts growing influence over health care, no?

I meant that it's problematic in the way that it may interact with the other clauses of the bill, as a hastily written amendment. See http://wonkroom.thinkprogress.org/2009/11/10/stupak-reac/ for details. This is indeed different from the Hyde Amendment and is worse than it in that:

"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.

Right now, the exchanges are restricted to the self-employed, the uninsured, and certain small businesses. But there are provisions in both the House and Senate bills to open the exchanges over time.

...[W]ith the Stupak amendment, every one of those expansions, to mid-size and then large employers and possibly even individuals who are offered employer coverage, would further restrict coverage for reproductive choice services. If the exchanges do expand – and they should – the result would be making all abortions purely an out-of-pocket scenario."

Put another way: "Once again, just like in the pre-Roe days, the wealthy will have access to abortion, those who can't scrape several hundred dollars together won't. Because of how the exchange is structured, most of people covered through it will be receiving credits or subsidies. Therefore, most of the participants will not have access to a legal medical procedure. ... Right now, nearly 90 percent of private, employer-based plans cover abortion services. This legislation could result in many of those plans dropping it, to make administration of plans simpler and more cost-effective.

...This is the most expansive restriction on access to abortion Congress has passed. It goes well beyond Hyde, which has never been codified and which only governs federal, public plans. It's particularly galling that it comes under the umbrella of healthcare "reform.""

My complaint, I suppose, is amusing if one is being facetious. The difference between health care reform as conceived of by Kennedy-Dingell and Stupak is that in the case of the former, the job is to expand access to affordable care to all--"No one in America should go broke because they get sick"--but does not seek to interpose itself between patients and doctors in what is a fundamental right and a private decision, based on someone else's sense of morality thrust on a specific class of people. This is more expansive than Hyde as it is attempting to make abortion prohibitively expensive as a means eliminate it--which, studies show, leads to dead women.

The rest of the bill does not enumerate or eliminate access to any other sort of medical care that people are entitled to--but the Stupak Amendment is part of a running battle where female members of the house attempted to include regular "well visits" and got blocked by the anti-choice folks. It's a big step back with regards to women's rights if it gets passed, though given limited pressure from the White House, threats from 50 House Dems, and six key Senators, it make be stripped out or line-item vetoed.

What's more, this opens the way towards interfering in RU-486, other forms of birth control, and reproductive services. (I'd take the time to point out that while Hyde fought to cut off federal funds from the poor, he also fought to maintain federal funds for hair plugs and Viagra.)

The fight over segregating funds v. denying funds is highly amusing in the way that the Council of Bishops fought for this, yet they get cash for parochial schools in the same manner proposed to fund abortion--the funds are segregated from the funds they use to buy Bibles. Let's laugh at that.

Luke,

I'm not sure why you're expecting pressure form the White House on this. Emmanuel had a "frank" talk with NOW and other groups today, and the Obama administration has hardly been vocal about defending abortion thus far.

Hrm.

I was not in fact expecting pressure from the White House, given what this is worth; I was laying out options that could remove or undo the Stupak Amendment.

The problem with it strategically is that it came late in the game after 1) The White House made promises to NARAL, et. early in the process even before the Pitt Amendment in House Energy/Commerce, to defend women's rights--consistent with the party platform, and largely were successful in doing so in committee and all the way through the House process. which leads to 2) That women's rights groups were not anticipating a last minute attack because of this promise, and were caught flat footed by Stupak's move which leads to 3) this late in the game, it's really really hard to get this back out of the bill, not because of some idea of "momentum" but because of the way that the process has to move forward.

Tactically, I understand Emmanuel's need to pass the bill, to protect the WH and the party in general, even at terrible cost. It's wrong, and it may open an enthusiasm gap at the midterms, or cost the DNC/DCCC/DSCC funding that instead goes direct to candidates.

I think it's a mistake to say it's "Emmanuel's need."

The Stupak amendment fits very nicely with some of the other things the Obama administration and DNC have done. Gay rights, the utter failure of the climate change bill, the repeal of FISA, The Guantanamo/Bagram debacle, and now this blatant sell out of the party's pro-abortion plank (which is apparently now a splinter) all suggest, TBH, that what you're seeing is a reshaping of the Democrats along... Hrmm. More purely economic lines? That doesn't quite make sense, given the party's timidity along those lines, but I think there's something to it. It's probably most obvious on GLBT issues, but it's very interesting.

Of course, since the GOP is running towards insanity, little relief can be expected.

There is another blog run by a mutual friend where emotions are running high.

It seems that the big problem with Stupak is that if the exchanges are ever extended, it will cause insurance companies to drop abortion coverage. Is that correct?

My impression of the immediate effect is that people who don't currently have abortion coverage (because they don't have insurance) will continue to lack it. That seems far less problematic.

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