Dissecting the Stupak Amendment

Selected text of the Stupak Amendment:

No funds authorized or appropriated by this Act . . . may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of rape or incest.

As Booman points out, I don't see coverage for a D&C after a spontaneous but incomplete miscarriage, or for a D&C after an unsuccessful therapeutic abortion, unless the woman's life (not merely her health) is endangered.

How do you police and enforce this rule?

When I was pregnant, I passed a quantity of material that, considering what it looked like and how far along I was in the pregnancy, could have been nothing but a fetus. That is, I'm almost certain that I had been pregnant with twins, and that only one of the twins survived. Under the Affordable Health Care for America Act that the House of Representatives has passed, if I'd progressed to a full complete miscarriage and needed a D&C, my doctor and I would have had to be able and willing to certify to the U.S. government that my life was endangered in order for the procedure to be covered.

Here's another question: If a woman has a D&C to treat fibroids, or treat any of the other conditions that indicate a D&C, will the doctor have to certify to the government that she wasn't pregnant when the procedure was performed? What if the lab's urine or blood test for pregnancy returned a false negative and the doctor unintentionally aborts a fetus? I don't see a state-of-mind requirement in the language of the Stupak Amendment; but maybe it's elsewhere in the bill. As the language stands solely in the amendment, though, it looks like strict liability to me.

This is smaller government? If a woman you know needs a D&C -- your mom, your partner, your daughter, your sister -- do you want her to have to justify her healthcare to the government? The government is going to keep files of American women's pregnancy test results? (I guess I'd better forgo using my credit card and instead use small, unmarked bills next time I buy an E.P.T.) What else about your private medical information are you OK with giving the government?

If this language remains in the final version of the law that President Obama signs, we'll see the following developments from the new restriction:

one million American women every year will still get abortions

doctors will massage the paperwork, and mysteriously the rate of "life-endangering pregnancies" in the U.S. will go up

for larfs, maybe that'll turn into a public health crisis

but seriously: poor women, who can't get their abortions paid for through Medicare anyway, will find it that much harder to raise the funds for their abortions; the ensuing delay will result in riskier abortions, increased healthcare costs, and very likely deaths

government functionaries will decide which pregnancies are life-endangering enough that the abortions ending them should be paid for

For the life of me, I can't figure out how to reconcile that last item with ideals of small government and the protections of the 4th Amendment. But then, abortion restrictions are like that: Government out of my patient files and out of my doctor's office! . . . Unless the patient is a woman and the doctor is providing her with reproductive health care.