How Stupak's amendment could change the whole insurance market.

How Stupak's amendment could change the whole insurance market
Brian Beutler has a good post assessing the Stupak amendment's likely impact on the exchanges. "It is safe to say," he concludes, "that the vast majority of, if not all, women in the exchanges will not be allowed to have abortion coverage in their benefits packages."

But the bigger danger is the eventual growth of the exchanges. If health-care reform began with huge exchanges, in which only a small portion of the participants were on subsidies and the Stupak amendment only applied to a fraction of the market, insurers would probably offer mostly policies that included abortion coverage. In reality, almost 90 percent of the population on the exchanges will be subsidized, so there is no real market for insurers to present a policy that covers abortion. That presents a much bigger problem.

The exchanges are not likely to stay small. They will gradually add larger and larger employers. But it won't happen all at once, and so there's no reason to believe that that the insurers will change their offerings all at once. And maybe they never do. After all, very few insurance customers call insurance companies to ask whether their policy covers abortion. Virtually no one calls their HR department to ask that question. There's a real chance that insurers might never switch back over, as they've already got products in the exchange, and they don't want to have to go through the trouble of offering one package to people with subsidies and one package to people without subsidies.

Over time, that could mean that the norm becomes an insurance market that doesn't cover abortion as opposed to an insurance market that does. Stupak's amendment is a limited, though bad, policy in its current form. But it could grow into something much larger. If it sets the standards for the exchanges and the exchanges eventually become the standard for the whole insurance market, then the Stupak amendment could transform coverage for not just poor women, but all women.

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