Stupak has never signed up for federal health benefits because he promised voters in 1992 that he wouldn’t until universal healthcare was enacted.

He also said was denied coverage for a pre-existing injury when he got his insurance from the Michigan Legislature: “I can identify with those people who have been before my committee.”

Despite this, he is opposing the passage of the only health care reform effort he's likely to see in his time in Congress because he claims to think that the bill will help fund abortions. This is the opposite of the truth. The truth is that the current health care bill is a serious threat to abortion coverage in insurance plans not only in the newly created exchanges but in general. Why?

A report from George Washington University explains:

Taken together, the provisions of the [Sen. Ben Nelson (D-NE)] amendment can be expected to have a significant impact on the ability or willingness of insurance issuers to offer Exchange products that cover a full range of medically indicated abortions. Furthermore, as with insurance laws generally, and for the reasons stated in our earlier analysis [ed. note: of the Stupak/Pitts amendment], the amendment could be anticipated to have considerable spillover effects. This is because companies that issue insurance products (or administered products in the case of sales to self-insured plans) obviously desire to sell these products in as many markets as possible. If one purchaser market places significant restrictions on one or more aspects of product design, it is likely that sellers will attempt to design their products to a common denominator, so that the product can be sold across all markets in which the company desires to do business. This is particularly true with modern health insurance coverage products, where the concern is not only the coverage but the provider network through which coverage will be obtained. Negotiating the elements of such a product is extremely difficult, and it is just as difficult to have to explain to providers that some of their patients will be insured for certain medical procedures while others will not.

Under the Nelson abortion provision, individuals who choose a health plan that includes abortion care are required to write two separate premium checks from their private bank accounts, one for abortion care and one for everything else.

Under the Senate bill, states are not obligated to offer plans that provide abortion coverage, and if they do offer such plans, they have to set up a complicated system of segregation overseen by their insurance commissioner. The risk is that insurers will simply avoid offering such plans because of the administrative headache. And, if they don't offer abortion coverage on the exchange, they may not offer it in the employer-based plans either.

There is a further risk. If abortion coverage is dropped from most or all insurance plans, it has the potential to further limit the number of clinics that offer the procedure, thereby exacerbating an already growing problem of lack of access. Rather than Roe v. Wade being overturned, it may wither on the vine because so few people offer to perform abortions.

Now, a typical first trimester abortion costs about $300-$600 dollars, which is about the price of a health insurance premium payment for one month for most families. Anyone who is so cash-strapped that they might not get a wanted or needed abortion because of the cost is actually going to be in a better financial condition after health care reform is passed than they are now. People living at the poverty line will only have to pay 2% of their income for insurance premiums. The poverty line for a family of five is $25,000, so that family would pay slightly less than $600 a year for insurance under the new law. And, once insured, they would save a lot of money on prescriptions and doctor's visits, making them healthier, more productive, and stronger financially. It's not that people will be priced out of abortions if they can't get insurance coverage that is a great concern, but, again, that it could result in diminished access.

Add to this that the two-check requirement creates a stigma because the decision to purchase separate abortion coverage will be known to employers and husbands alike, and you can see that the Nelson language is very damaging to women's reproductive freedom and choices. You'd think that that would be enough to satisfy Bart Stupak, but it isn't. Responding to a letter supporting the health care bill from "60 leaders of religious orders representing 59,000 Catholic nuns,", Stupak said:

“When I’m drafting right to life language, I don’t call up the nuns.” He says he instead confers with other groups including “leading bishops, Focus on the Family, and The National Right to Life Committee.”

Focus on the Family? That's James Dobson's outfit. They're a Republican front-group and a freak show. It's galling to have to balance the aforementioned risks to women's reproductive choice, not to mention the indignity of enshrining the Hyde Amendment into permanent law, against the provision of insurance to 30 million Americans and the end of insurance industry abuses. But to have Stupak oppose the bill because it isn't anti-choice enough? That's warrants a primary challenge. Stupak says the uproar over his actions has been a 'living hell' for him. I think he deserves that. I think he deserves worse. And, I know that the House of Representatives is anti-choice and we have to deal with that fact, but the Democrats need to keep a very close eye on downfield effects of this health care reform to make sure that it doesn't do harm to women's reproductive health.