Thursday, March 25, 2010

Footnote to the preceding

Updated I need to mention two other areas where the health bills fall short which I could (and perhaps should) have included but also stand on their own apart from the bill, so I'm doing it here.

The first is reproductive health care; more bluntly, the right to abortion. Start from the fact that the Hyde amendment has for years required that there be no federal funding for abortion.

The issue came up with regard to the health bill because of the Stupid - the Stup - the Stupak amendment, which would essentially make it impossible for any woman who could not pay for an abortion out of pocket to get one. It remained in the version of the bill passed by the House, apparently because the leadership concluded either through a good deal of vote-counting or a simple failure of nerve that they couldn't pass the bill without him and his Gang of 12 or however many it was.

That language was "softened" in the Senate to the Nelson amendment, which required a very strict separation of funds and accounting such that, for practical purposes, for a woman to get abortion coverage in her health insurance she'd have to send two checks, one for the policy and another for what would amount to an abortion rider. After some more bluster from Stupak, he was bought off with a presidential proclamation affirming that the Nelson amendment would be enforced. (And, let it be said, got called "baby killer" and received a fax of a noose and gallows for his trouble.) So the Nelson language is now law.

Legally, the language of the Nelson amendment is no more restrictive than that of the Hyde amendment. So did the anti-choice crowd get nothing for their efforts?

Not exactly. While legally there is no meaningful change, practically is a different matter. By putting extra accounting burdens on insurers who will now be required to segregate funds in a way familiar to nonprofits but alien to them, the bill creates an incentive for those insurers to simply drop abortion coverage since they may well decide the market isn't big enough to justify the hassle - especially because it's possible that a significant number of women, faced with the need to make an additional payment for coverage, will simply forgo it because who plans to need an abortion?

The result could easily be to have fewer companies offering the coverage with those that do charging higher prices, limiting access to the ability to pay for an abortion in two ways. So again, while as a legal matter nothing has really changed, as a practical matter it is possible that access to abortion could soon become available only to those women who can pay for one out of pocket.

The other issue is immigration. As an overall issue that quite frankly is too big for me to get into on the fly here but with regard to the immediate issue, I say it is unconscionable that the bill bans undocumented immigrants from being able to buy insurance on the so-called exchanges, even if they pay the full cost with their own money.

As Jon Walker at FDL pointed out on Monday, this is fiscally irresponsible because taxpayers wind up picking up the tab for any uncompensated care at emergency rooms that people without insurance may require. But beyond that, it is absurd, it is inane, it is I say again unconscionable, to go even beyond denying people access to the protections of health insurance to actively preventing them from having such access based solely, solely, on an accident of birth and a desire for a better life.

And for what? For election year posturing? To look "tough" on "illegal immigration" lest there be some attack ad about being what, a "foreigner-lover?" (With the appropriate whispered substitute for "foreigner.") What price conscience?

Updated with this personal addendum, required because I've been getting some grief in comment threads other places in talking about this:

Making the factual statement that "the Hyde amendment has for years required that there be no federal funding for abortion" does not mean I endorse the Hyde amendment! I do not! So stop being so god damn stupid! I was addressing my dismay at how the health care bill effectively further limits access to abortion.

I've had occasion many times in the past to warn people that I strive to say what I mean and only what I mean. I do not always succeed, of course, but the result is that presuming what I think about something I haven't addressed is often a fool's errand. And I've seen several fools of late.

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