Bart Stupak and his anti-choice partners like to suggest that their amendment merely extends the Hyde Amendment about public funding for abortion to the new health care bill. In actuality, over time this amendment would end reproductive choice insurance coverage entirely.

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. In the House, that exchange could theoretically be opened up fairly rapidly:

In year one, 2013, only individuals without employer provided insurance and the “smallest” employers (25 or fewer employees) would have access to the exchange. In year two, 2014, “smaller” employers (50 or fewer employees) could access the exchange. By year three, 2015, all “small” employers (100 or fewer employees) would gain access to the exchange, and the exchange Commissioner could permit larger employers (greater than 100 employees) to be eligible for the exchange.

In theory, by 2015 all employers, and therefore all Americans not on Medicare or Medicaid, could start using the new health insurance exchange for health care. This would give nearly everyone the ability to choose the public option if they wanted. Of course, that would rely on the Commissioner deciding to throw open the exchange to every business, as well as all large employers choosing to provide coverage through the exchange. . . but, I don’t see that happening nearly as quickly as is theoretically possible.

The Senate has language like that as well, albeit at a slower rate. Sen. Ron Wyden has been trying throughout the debate to open the exchanges more and more, and Max Baucus agreed in the Senate Finance Committee to work toward some version of the opening of exchanges. So we can expect something along those lines going forward.

Only now, with 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.

And then there’s the question of what is considered, in technical medical terms, as an abortion. Hospitals determine a terminated pregnancy where the fetus was not expelled as an abortion, requiring a “D&C” procedure. Under the Stupak amendment, insurance companies would not be allowed to cover this procedure either. It’s possible that this would fall under the “life of the mother” exemption, which is in the bill, but that would only be the case if the life of the mother was directly threatened. There is no “health of the mother” exemption.

Stupak and his anti-choice cadres would counter that women could get a “rider” for abortion services, but asking women to plan for an unplanned event is offensive to the pro-choice community.

Progressives generally support opening the exchanges, which would also open access to the public option. Under the Stupak amendment, that would have the effect of chipping away at abortion access slowly but surely.

UPDATE: McJoan has much more on this.