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The Stupak amendment: As much about class as about choice

Rep. Bart Stupak's amendment did not make abortion illegal. And it did not block the federal government from subsidizing abortion. All it did was block it from subsidizing abortion for poorer women.

Stupak's amendment stated that the public option cannot provide abortion coverage, and that no insurer participating on the exchange can provide abortion coverage to anyone receiving subsidies. But as Rep. Jim Cooper points out in the interview below, the biggest federal subsidy for private insurance coverage is untouched by Stupak's amendment. It's the $250 billion the government spends each year making employer-sponsored health-care insurance tax-free.

That money, however, subsidizes the insurance of 157 million Americans, many of them quite affluent. Imagine if Stupak had attempted to expand his amendment to their coverage. It would, after all, have been the same principle: Federal policy should not subsidize insurance that offers abortion coverage. But it would have failed in an instant. That group is too large, and too affluent, and too politically powerful for Congress to dare to touch their access to reproductive services. But the poorer women who will be using subsidies on the exchange proved a much easier target. In substance, this amendment was as much about class as it was about choice.

By Ezra Klein  |  November 9, 2009; 1:48 PM ET
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Ezra, slight clarification. It thought Stupak still left abortions that result from rape or incest, or imperil the health or life of the mother covered. But it effectively did away with any coverage of elective abortions, right?

Posted by: StokeyWan | November 9, 2009 1:53 PM | Report abuse

Bart Stupak--a real class guy.

Remember he lives or lived at the FRamily's C Street house, of Ensign and Sanford fame.

These guys have so many double standards it's a wonder they can stand up.

Posted by: Mimikatz | November 9, 2009 2:01 PM | Report abuse

It seems like the solution here is to move more people into the exchanges. This will make Stupak's politics impossible. Plus it can be done gradually by opening the exchanges to more people and phasing out the tax subsidy for employer coverage.

Posted by: CraigMcGillivary1 | November 9, 2009 2:10 PM | Report abuse

Personal opinion: this will not survive conference. There is no way pro-choice folks will allow it to.

Remember, most of the people who voted for the bill are pro-choice. A very small minority forced this amendment thru.

Unless something major happens in the Senate, I simply cannot see both the Senate and House supporting a bill with this amendment in it, considering the vast majority of the supporters of this bill do not want it there.

My guess is that a compromise (like the one that was in place previously) will be put in place.

Also, it's one thing to ram your amendment thru at the last minute by saying you'll withhold your vote otherwise. It's entirely another to sink the whole health care reform bill once it is out of conference.

Any Democrats that do not support the final bill will very likely be made into pariahs. And God help them the next election cycle. With what the left organizations will do to them, they'll think moderate republicans had it good.

Posted by: JERiv | November 9, 2009 2:23 PM | Report abuse

Re: StokeyWan

How is an abortion in rape/incest situations any less elective? Personally, my feelings on abortion are complex, but in general, I'm pro choice. But if you base your opposition to abortion on the notion that the fetus should have some sort of right to life, then why would it matter how the fetus was conceived? Does the fact that it wasn't the woman's "fault" mean the fetus should have less rights?

Posted by: jleaux | November 9, 2009 2:36 PM | Report abuse

I like your choice of words Ezra, and remember that in this country "class" derives simply from the possession of money, since there is no other cultural standard for snobbery.

(See Lewis Lapham's "Money and Class in America" for more.)

Posted by: rosshunter | November 9, 2009 2:36 PM | Report abuse


Just using the parlance of our times.

Posted by: StokeyWan | November 9, 2009 2:45 PM | Report abuse

If the Stupak ammendment makes it through conference, do you think this will limit the ability of the exchanges to grow? What woman would want this insurance?

Posted by: ideallydc | November 9, 2009 2:50 PM | Report abuse

I'm sorry Ezra, but this particular argument of yours has no credibility. Employer-paid insurance discriminates against many groups but the only issue that concerns you is abortion?

The excise tax on the mislabeled "Cadillac" plans for example, will protect employees like those at Microsoft who have 100% coverage with no premiums and co-pays...because the company is self-insured. At the same time, age-rating is preserved in the exchanges so that middle-aged women in many individual markets will find reasonable comprehensive coverage (e.g. $30 co-pays for doctor vists and 30% coinsurance for hospital stays), which are already priced above 8K, to be beyond their means.

Employer-paid insurance is the biggest reason that we do not have universal coverage of some sort in this country. The corporate tax exemption on health benefits distorts everything about health care financing and yet preserving that distortion has been the unifying feature of all "reform".

This latest twist, whereby families who pay their own way will be denied insurance coverage for abortion is bad but it is not the worst consequence of the false reform that you and others embrace.

Posted by: Athena_news | November 9, 2009 3:36 PM | Report abuse

Athena--My understanding is the excise tax *does* apply to the self-insured. And the Cadillac tax *is* a backdoor way to end the deductibility of employer benefits.

Ezra--abortion laws always hit poor women hardest. No one will ever be able to fully prevent rich women from getting abortions. But make no mistake, this provision will gradually become harder for even affluent women to have access to safe abortions.

Posted by: bmull | November 9, 2009 4:06 PM | Report abuse

The vast majority of abortions aren't even paid by private insurance dollars now. For example, at least 98% of abortions in Michigan were paid out of pocket.
Let the boyfriend, Planned Parenthood, and others pay for it. Not taxpayers and other members of the government-run exchange.
Pelosi and the pro-abortion lobby were trying to hoodwink America into another bailout, this time to PP and other abortion providers. Thankfully, she relented to the majority of the House. Hopefully she and her PP-funded lackeys allow it to remain past committee.

Posted by: cprferry | November 9, 2009 4:17 PM | Report abuse

"Rep. Bart Stupak's amendment did not make abortion illegal. And it did not block the federal government from subsidizing abortion. All it did was block it from subsidizing abortion for poorer women."

This goes beyond subsidizing abortion. That was always outlawed. This prevents POOR women from getting insurance -- that is available to people who get insurance from their employers-- from getting the same insurance.

This is just another denial of a right that rich women can afford.

Posted by: ENowak1 | November 9, 2009 4:56 PM | Report abuse

Ezra, why didn't you mention the elephant in the room: Cooper SUPPORTED the Stupak amendment. So by his logic, nobody in this country should have access to coverage for abortion services. Between employers, the exchange, the public option and Medicaid, pretty much everybody who's insured in one way or another would be ineligible.

Posted by: dday212 | November 9, 2009 6:19 PM | Report abuse

"Poor" is pretty loosely defined in this circumstance because the whole thrust of progressive work on this bill has been to make the subsidies more generous. The fact is that Stupak basically perverted the main source of liberal advocacy on this bill.

As I understand it, the subsidy levels in the House go up to four times the federal poverty line. In other words, if you're a single, self-employed woman making $40,000 -- middle class by most definitions -- you could be facing a hard choice between your insurance benefits and your abortion rights. For a family of four, those subsidies go up to incomes of $88,000 -- edging into the upper middle class!

It's bad enough that Democrats are restricting these benefits for poor women. But the fact is that these plans will actually RESTRICT access to such services for women that could afford them now -- at least unless they're willing to take the hit in terms of unsubsidized premiums.

Posted by: NS12345 | November 9, 2009 6:44 PM | Report abuse

The politics of this are also really poisonous. The Hyde Amendment only works because it's a string attached to benefits that are widely perceived as a "handout." In this case you're REQUIRING that people buy coverage, then forcing them to cede Constitutional rights in order to make it affordable.

Posted by: NS12345 | November 9, 2009 6:49 PM | Report abuse

thanks for this post ezra, sometimes i forget for a moment about large employer insurance being subsidized. but that's the reason it's so toxic to our system..

Posted by: schaffermommy | November 9, 2009 6:50 PM | Report abuse

"Athena--My understanding is the excise tax *does* apply to the self-insured."

How? How will the valuation for that coverage be determined? Premiums are a function of the cost of services covered...which are a function of the area and other rating factors. Women across the country pay 30-50% more for the same coverage as a man. Many middle-aged women in high-cost areas are paying more than $8000 for the *same* coverage that costs employers much less. In the individual market, coverage for a 45 year old man is under the threshold but a woman with the same policy is somehow more prone to over consume and drive up costs for everyone else.

Congress moved quickly to protect (largely male) public safety plans but I haven't heard one peep from the faux feminists wringing their hands about the blantant discrimination inherent in the excise tax.

"And the Cadillac tax *is* a backdoor way to end the deductibility of employer benefits."

It's more like a pet door. And unless our representatives grow a spine and step up to enacting real reform, a whole lot of people -- over and under-65 -- are going to be eating pet food twenty years from now,

Posted by: Athena_news | November 9, 2009 6:56 PM | Report abuse

"getting the same insurance"

They won't be the only ones. The health care reform has an endless series of regulations that will change people's coverage and most certainly their premiums.

Also, note what Planned Parenthood, NARAL and their mouthpiece Ezra aren't telling you is that most insurers don't cover abortion any way. Just 46% of private insurers do. The Stupak amendment calls for those in that 46% group that receive federal subsidies to purchase an additional rider to their insurance or pay for elective abortions themselves (which the vast majority do anyways). It extends Hyde Amendment to the new federal health programs created by the bill.

It addresses a huge problem with the bill that would have funded elective abortions through federal funds in a huge bailout to PP and abortion providers. It does not make abortions illegal, it does not unduly harm the poor, it does none of those things. Rather it stopped dangerous concessions being made to abortion providers.

Posted by: cprferry | November 9, 2009 7:01 PM | Report abuse

From a policy standpoint, it is obviously incoherent to put in place an amendment that denies abortion subsidies to poor women, but not the affluent. That doesn’t mean, however, that the Stupak amendment, was “as much about class as about choice,” as Klein asserts. What it means is that abortion foes have resorted to guerrilla war in the absence of any real hope of overturning Roe V. Wade.

For my complete response to the post, please visit The Innocent Smith Journal:

Posted by: InnocentSmith | November 9, 2009 8:02 PM | Report abuse

This is not about class. It's about what's on the table for the bill, which is a limited experiment to determine that it's the providers and the over-consumers, not the insurers, who are ripping us off.

Just another reason we don't want politicians deciding what health insurance we're allowed to buy must or must not cover. On the other side of the fence you have people demanding that I pay for chiropractors and herbalists. Stupak and the rest of these power mad imbeciles should just go home.

Posted by: staticvars | November 9, 2009 9:34 PM | Report abuse

Taxpayers should not be forced to subsidize mothers who want to kill their children. What's so difficult about this?

Beware of phony alternatives. These ersatz bills are full of accounting tricks. We're not that stupid.

Posted by: dturnerc | November 9, 2009 9:37 PM | Report abuse

Why do the Dems continue to want to kill poor black and brown babies. They have supported this genocide for 40 years. They have killed over 40 million babies so far.

Why is that?

And why is that seen as a good thing?

Posted by: bricko | November 9, 2009 10:19 PM | Report abuse

"It's the $250 billion the government spends each year making employer-sponsored health-care insurance tax-free."

Mr. Klein: Speaking as an IRS agent, this statement is extremely irritating. Until the federal government imposes a tax of $250 billion on employee health care benefit compensation, this money belongs to the hard-working taxpayers of this country.

This attitude helps explain your penchant for a top-down, command-and-control, big government solution to health care "re-form." We citizens are supposed to be grateful that you deign to throw us a few crumbs of our own money after you've designed your Rube-Goldberg-on steroids health care delivery system.

Posted by: dturnerc | November 10, 2009 8:55 PM | Report abuse

that religious fundies have made their Religious beliefs America's using the Republican rule is not surprising. that we have become a theocratic empire for the right wing is just the way it is.

the inherent religious attacks on those who disagree is the way the right keeps their message.

only one way to look at abortion is from the religious point of view.
women will have to get over their second class status as breeders until there is separation of religions and state.

don't hold your breath. the right/religious and otherwise
are doing a great job on "controlling" the message.

the 60's didn't sit well with these people and this is the payback.

Posted by: BernardEckholdt | November 10, 2009 9:52 PM | Report abuse

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