Saturday, when the House voted to pass the Stupak anti-abortion amendment, it was a massive defeat for women's reproductive rights. It should be a huge blow to organizations that claim to defend a woman's right to choose. These organizations were beaten on several levels. They lost to an opposition that did a better job of framing, organization, rallying, whipping, and legislating.
Due to my disgust about how terribly these women's organizations failed in legislative and media battle on the issue, I spend three hours on Saturday craft which should have been their counter proposal.
Original Proposal
The exchange would allow insurance companies to sell plans at four coverage/cost sharing levels. They are basic, standard, premium and premium plus. The original abortion language would have let someone who is using tax credits to help afford insurance select any plan at any level they wanted. If the plan covered abortion, it would need to set aside some money that came only from direct consumer premium payments into a special fund. Abortion providers could only be reimbursed from this special tax payer money-free fund.
With Stupak Amendment
Individuals can still use their tax credits to help them afford any plan at any benefit level on the exchange. But if a plan had even one customer that uses even one dollar of tax credits, the plan could not cover elective abortion. Effectively no plan on the exchange could cover abortion. (Or, in theory, the Stupak amendment could be used to discriminate against low income Americans.)
The Stupak amendment would allow individuals who bought an insurance plan with tax credits to buy a stand-alone rider that covers only abortion with their own money. For economic reasons, no insurance companies would sell these abortion riders. But this provision is important for a strategic counter proposal. The anti-abortion Democrats have admitted that it is not the government funding abortion if some get help buying insurance plans but buy supplemental insurance on their own that covers abortion.
Strategic Counter Proposal
Change the way the exchange works slightly. Insurance companies would only be allowed to sell basic level coverage and people could only use tax credits to buy basic level coverage. Basic level coverage plans can't cover elective abortion. But insurance companies can sell three levels of supplemental coverage to any of their customers that bought their basic plan. The supplemental coverage would bring the total coverage to where it would have been if they were selling standard, premium, or premium plus plans like originally proposed. Supplemental coverage packages could only be bought with private money, and therefore could cover abortion.
The way tax credits are calculated would need to be slightly tweaked, but the net effect on cost, coverage, and cost sharing would be basically zero. Instead of getting tax credits equal to 80% the cost of a standard plan, the individual would get tax credits equal to 100% of a basic level plan and could pay an additional 20% to get supplemental insurance to make it equal to what would have been a standard level plan. Their out-of-pocket cost for premiums would be the same.
We know this system would work because this is how insurance is sold in Switzerland. There is a basic plans and supplemental insurance packages for people who bought a company's basic plan. It is true the basic plans would not be allowed to cover abortion in this counter proposal. The implications should be minor since basic plans are meant to be the absolute cheapest plans competing on the lowest price, it is very unlikely that they would have ever covered anything like abortion that was not directly mandated. With my counter proposal, it is still likely that many insurance companies on the exchange would sell supplemental packages that included abortion coverage and most people would not buy only basic plans. The critical thing is the strategic counter proposal would have technically the same funding firewall that the Stupak amendment uses.
Would this counter proposal I quickly thought up have been able to win over the whole regressive caucus of anti-abortion Democrats? Probably not, but most of the regressive caucus who supported the Stupak amendment ended up voting against the final bill even after it was added. I also think at least some of them were not really concerned about the federal funding of abortion. I believe some were happy to hold reform hostage because they saw this as an opportunity to restrict a woman's right to choose as much as possible.
If the counter proposal had been able to peel away enough votes, it would have been a success. Even if it had been publicly rejected, it would have also been a success. It would have publicly exposed their lies and true intentions. The counter proposal could then be used to win the media and messaging war, and show how radical the Stupak amendment really is.
I can't fault the huge women's reproductive rights lobbying orginizations for not coming up with a similar strategic counter-proposal or attack to undercut Stupak. After all, they are multi-million dollar activist orginizations dedicated to this issue and only had about six months to prepare for this showdown. How can that ever compete with one guy who had three hours to kill over the weekend?
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