Gaming out Stupak

Even if the damned thing becomes law, why won’t insurance companies offer retroactive abortion-coverage riders? Termination is cheaper than carrying to term.

It appears that the Senate version of the health-care bill won’t include the Stupak Amendment. But assume for a moment that Pelosi decides the votes aren’t there in the House to pass a Stupak-less bill. How bad is that?

As I try to game the situation out, it seems to me that the answer is “Maybe not bad at all.”

Imagine that you’re running a health insurance company that offers individual policies through the exchanges. (Recall that group policies aren’t covered by Stupak.) You’re not allowed to cover abortion under your regular plan, but you’re allowed to offer a supplementary policy – a “rider” – to cover abortion services.

At first blush, this seems stupid; since no one plans to need an abortion, very few people will buy the rider.

But what happens when some of the women you insure get pregnant and wants to terminate? Since perinatal care plus delivery would probably cost you $2500, while a first-trimester abortion costs about $200, you’d be happy to provide the abortion coverage gratis if you thought that otherwise even as many as one in twelve of those women would choose to carry to term. You can’t provide it gratis; that’s what Stupak provides. But you could provide it cheap, even to someone who’s already pregnant. Charge $50 for the abortion-coverage rider, effective immediately.

Now I don’t know that the companies would do this, but it seems to me that doing it would be very much in their best interests. That makes the idea of threatening to scuttle the whole bill if Stupak stays in even more far-fetched than it would otherwise be.

Whether Stupak passes or not, the pro-choice forces ought to make a concerted move to challenge the Hyde Amendment status quo. Restoring Medicaid coverage may be a bridge too far, but it seems to me that getting rid of the ban on abortion coverage for women in the armed services and the female family members of those in uniform ought to be a fairly easy sell, with the Secretary of Defense and the service secretaries testifying that the current policy is bad for recruitment and morale and the brass hats testifying that it’s bad for readiness.

The terrorists win one

George Tiller’s clinic will remain closed permanently. The closest abortion services to Wichita are now three hours away: not late-term abortion services, *any* abortion services.
What are we going to do about it?

Dr. Tiller’s clinic will remain closed permanently. Closest abortion capacity to Wichita &#8212 not late-term abortion, any abortion &#8212is now a three-hour drive away. Legal abortion is increasingly unavailable to women in rural areas and in the South, Midwest, and Mountain West.

And what are you going to do about it? Megan McArdle thinks that passing additional protective legislation would just further enrage abortion opponents. On the other hand, letting them taste blood will just encourage more of them to murder more doctors. Rewarding bad behavior is generally a bad plan. In this case, inaction = reward.

Update A reader answers the “What are you going to do?” challenge:

Require every hospital accepting federal funds to provide abortion services, either directly or under agreements with clinics in the same cities. (Just as transit systems must provide handicapped-accessible services directly or through contract with another operator.)

Department of “Huh?”

Contraception and adoption have roughly nothing to offer in reducing the number of late-term abortions.

Andrew Sullivan:

I want to reiterate my personal moral opposition to legal late term abortions. I understand the awful tragedies and complexities involved. I know too that most of these children would die soon anyway – or be subject to grueling operations with many risks. I just find the ending of human life to be something we avoid as much as we possibly can. And we need to find many more ways to facilitate contraception, the morning-after pill, and adoption to make these tragedies much rarer than they are.

Sorry, I can’t make sense of this. “Contraception, the morning-after pill, and adoption” are relevant to the problem of fourteen-year-old girls who conceal their pregnancies until they start to “show.” (Even then, it takes a colder heart than I can master to say to a middle-school girl who is carrying her father’s child that she has to go through the pain &#8212and, at that age, danger&#8212 of childbirth to bear her half-brother.)

But the whole “safe, legal, and rare” formula offers nothing to women who are carrying fetusus which, if carried to term, would face short, agonizing lives, or women whose pregnancies will kill them if not terminated, or women whose fetuses die inside them. (Yes, doctors are afraid to do dilation and extraction &#8212 the famous “partial-birth abortion” &#8212 even when the fetus is already dead.) Making late-term abortion illegal condemns them to horrors no one should have to face, and I for one don’t have much patience with those willing to impose those horrors on others in order to salve their own consciences.

What Dr. George Tiller was doing (as one of only three physicians in the country) desperately needed, and needs, to be done. An appropriate memorial to him, and rebuke to his killer and those who egged his killer on, would be to enact policies to make certain that the services he had the courage to provide will be provided by others.