Reading the posts over the last 48 hours, and this Australian, at least, is more familiar with the name Stupak than with most of the persons in Australia's legislature. No doubt, the man has made a big splash. Also, no doubt, lots of people are feeling lots of concern. However, read below the fold for some information from Australia that might shed some light on things. It might even turn out that Stupak's amendment is entirely symbolic, with no practical outcome whatsoever.
Background: Most health care in Australia is paid for by a form of public option, namely Medicare. The same as in Canada, Medicare doesn't provide health care, it reimburses providers (doctors, hospitals etc) who provide the actual care. The core feature of Medicare is the "item number" that is, a barcode number, if you will, which is allocated to every conceivable medical service. For example, Item 23 is a standard consultation with a vocationally registered general practitioner (VRGP).
The key concept that informs the process of differentiating services into different item numbers, and reimbursing different item numbers at different rates, is "relative work value". Item numbers are reimbursed at higher rates if, in the opinion of the "umpire", the Health Insurance Commission, they involve harder work, greater skill or training, or the use of more expensive equipment, than other item numbers reimbursed at a lower rate. So for example, Item 3, which is a brief consultation with a VRGP, is reimbursed a lower rate than Item 23, because it involves less work. Item 53, which is a standard consultation with a general practioner who is not vocationally registered (non VRGP) is reimbursed at a lower rate than Item 23, on grounds that a non VRGP has less skill or training than a VRGP.
However, if different services are judged to involve the same levels of hard work, skill and training, and equipment, they are liable to be allocated an identical Item Number, particularly if they are closely enough related that the same practioner is likely to offer both services.
This is the key to the debate over the Stupak Amendment. Medicare Australia has two item numbers that cover abortion services, Item 35643, which covers first trimester abortions, and Item 16525, which covers second trimester abortions. However, both item number also cover the evacuation of the uterus at similar gestation in cases where the fetus had natually died, because, in the opinion of the umpire the relative work values of the two procedures are identical Bart Stupak is certainly not without soulmates in Australian politics. They have certainly tried to gain publicity by moving parliamentary motions to "defund abortions", but I know of nobody who knows the issue who regards this as anything more than hot air. Nevertheless, the way forward for pro choicers in the Obama administration to get around the Stupak amendment should now be obvious.
I forgot to say, when a provider sends out a bill, they do so using the item number, not a verbal description. The point is, you can't look at an account for Item 35643 and determine that it's for an abortion. This also preserves the woman's privacy.