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Video: Abortion restriction 'make or break' for health bill

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    >> texas. mark, thanks for that.

    >>> and now to washington and the battle over health care reform . after a dramatic late-night vote in the house this weekend, it's onto the senate, where the prospects are much less clear. our own kelly o'donnell with us tonight from capitol hill , scene of so much activity this weekend. hey, kelly , good evening.

    >> good evening, brian. you're right, the senate does not have the needed votes now but for the house , this was a major milestone. democrats like to use the word history because it's been four decades since the last sweeping change to health care . that was medicare. for speaker nancy pelosi , it was a win with just two votes to spare.

    >> the yeas are 220. the nays are 215. the bill is passed.

    >> reporter: a huge but narrow victory for house democrats late saturday night after a marathon debate.

    >> he says, don't tax me to pay for health care that you guys want. if you want health care , pay for it yourselves.

    >> on this day at this moment answer the calm of history and pass health care reform !

    >> reporter: democrats' euphoria is tempered by the next critical test for health care reform , an uncertain outcome in the senate.

    >> if you thought it was hard in the house , it's going to be harder in the senate.

    >> reporter: house democrats were not united. 39 voted no, most from more conservative districts. and surprisingly republicans were not united in opposition. one republican, first term louisiana congressman joseph cao, voted yes.

    >> my district has a lot of poor people , a lot of people who are uninsured.

    >> reporter: the house plan creates a government-run insurance plan to compete with private insurers, requires individuals to buy health insurance or pay a tax, and most businesses would have to offer health coverage or pay a penalty tax. insurers could not deny coverage for pre-existing conditions. today there is heated fallout over one controversial last-minute change to the bill that would block insurance coverage for abortion in any health plan that's would join the government's list of providers. abortion rights advocate nancy keenan --

    >> women with their own money can no longer purchase that insurance in the new system, and that's outrageous.

    >> reporter: denying insurance payments for abortion would not apply if you get your insurance through work, but it would affect those who might buy insurance down the line. that might be the uninsured or self-employed who might want to buy from this newly created government system, which would have both public and private insurance choices. now democrats say without that restriction on abortion, it would not have passed the house . it was make it or break it. brian?

    >> all right. kelly o'donnell on the hill. we'll continue to follow it as it goes along. kelly , thanks.

    >>> on wall street today, a

By
updated 11/11/2009 12:36:23 PM ET 2009-11-11T17:36:23

The House-passed health bill bars insurers from selling policies that cover abortion to anyone who gets a federal subsidy. But it does allow insurers to offer optional abortion coverage that consumers could purchase with their own money. Based on some states' experiences, it's unlikely insurers would sell such coverage.

The abortion debate rivals the controversy over the public-option — the proposal to offer consumers in the new insurance exchanges a government-run insurance plan. The fight now moves to the Senate, where Majority Leader Harry Reid, D-Nev., is trying to meld two committees' bills.

Laurie Rubiner, vice president for policy at Planned Parenthood, says she is optimistic about blocking a similar amendment in the Senate. "This is a very broad, middle-class abortion ban in the exchange and once people really understand that I just don’t think there’s going to be the support for it.”

The U.S. Conference of Bishops, which led the lobbying fight in the House for the amendment by Reps. Bart Stupak, D-Mich., and Joe Pitts, R-Pa., is just as determined. “The Conference will remain vigilant and involved throughout this entire process to assure that these essential provisions are maintained and included in the final legislation,” the organization's president, Cardinal Francis George of Chicago, said in a written statement.

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Here's basic information about the House amendment and private insurance coverage of abortion:

Q: Do the House restrictions apply to all insurance?
A: No. They apply only to policies sold to people who qualify for federal subsidies to purchase insurance through the exchanges. Most job-based insurance, which is how the majority of insured Americans currently get their coverage, would not be affected.

Q: Who can buy through the health insurance exchanges?
A: Initially, the exchanges will be open to the uninsured, people who buy their own coverage and some small businesses. Two years after the exchanges open, Congress could decide whether to allow larger employers to purchase coverage there.

Q: Could consumers using the exchanges buy policies that offer abortion coverage if they use their own money, rather than federal subsidies?

A: Only if insurers decide to offer two types of policies in the exchange: ones made available to subsidy-eligible people that don’t cover abortion, and another set, sold only to those who don’t get federal subsidies, that would cover it. Insurers may have little incentive to offer both, as the vast majority of the exchange marketplace is expected to be subsidy-eligible people.

Q: Are there other options for people to get abortion coverage?
A: Yes, insurers could opt to create “abortion riders,” separate add-on coverage that consumers could purchase with their own funds.

Q: Do such policies exist?
A: Five states – Idaho, Kentucky, Missouri, North Dakota and Oklahoma – prohibit insurers from covering abortions except to save the life of the mother or in cases of rape or incest, but allow insurers to sell separate abortion riders. Insurance departments in Idaho, Kentucky and Missouri say they don’t track such riders, so it isn’t clear if any are offered. North Dakota and Oklahoma say insurers there don't offer abortion riders to individuals. In Oklahoma, however, one insurer has filed for a rider to offer abortion coverage to small groups. And in Idaho, one of the state’s major insurers offers abortion coverage to small groups if they pay an additional premium charge.

Q: How many people currently have abortion coverage in their health plans?
A: A survey by the Kaiser Family Foundation in 2003 found that 46 percent of workers had insurance that covered abortion. (KHN is part of the foundation.) Experts say most people use their own funds to pay for abortion. According to the Guttmacher Institute, which studies reproductive issues, about 13 percent of abortions are directly billed to insurers.

Q: Are there other restrictions on federal funding of abortion coverage?
A: Yes. The 1976 Hyde Amendment bars the use of federal funds to pay for abortions, except to save the life of the mother or in cases of rape or incest. Thirty-two state Medicaid programs, the joint federal-state programs for low-income people, limit abortion funding to those cases, according to the Guttmacher Institute. One, South Dakota, pays for Medicaid abortions only to save the life of the mother. And 17 use state funds to more widely offer abortions through their Medicaid programs. Restrictions on payment for abortion coverage are also in place for federal employees, women serving overseas in the U.S. military and women in federal prisons.

Q: How much do abortions cost?
A: First-trimester abortions can cost between $300 and $900, according to Planned Parenthood. Later-term abortions or abortions where women may face a higher risk of complications are more expensive, running several thousand dollars if hospital care is required.

© 2012 This information was reprinted with permission from KHN. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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