This article first appeared in the St. Louis Beacon, Nov. 9, 2011 - The anti-abortion provision included in the health-care bill that passed the U.S. House on Saturday is similar to the private insurance restriction that has been in place in Missouri for 26 years.
Still, some leaders on both sides of the state's longstanding battle over abortion rights foresee possible changes if the federal provision becomes law.
The U.S. House provision in question bars any private insurance coverage of abortion services -- except in cases of rape, incest and to save the life of the mother -- in policies that are purchased with federal subsidies that would be available to low- and middle-income women and their families. It also bars any public insurance coverage of abortion.
(The provision, called the Stupak Amendment for its sponsor, Rep. Bart Stupak, D-Mich., is an extension -- some critics assert, expansion -- of the Hyde Amendment, passed in 1976, that bars the use of federal money to pay for abortion.)
An even stricter ban has been in place in Missouri since 1983, when the Legislature approved a bill -- signed into law by then-Gov. Christopher "Kit" Bond, R-Mo. -- that barred private insurance companies from offering coverage for abortion services, except to save the life of the mother, unless a separate rider was purchased.
That ban was upheld by a federal court in 1992. Missouri is among only a handful of states to impose such restrictions on private insurers. (Click here to see the Guttmacher Institute's latest study on some states' limits on private insurers, when it comes to abortions.)
(Illinois has no such ban on private insurers, although the state doesn't offer abortion coverage in its insurance offered to public employees.)
Missouri's ban on private insurers is among the reasons the state's anti-abortion groups and Catholic leaders were lobbying hard for similar language in the U.S. House health care bill.
Pam Fichter, president of Missouri Right to Life, said there was concern that a House bill without such language might override the state's abortion restrictions on private insurers. Anti-abortion lobbyist Sam Lee, head of Campaign Life Missouri, agreed.
But the abortion-rights camp has its own fear that the House anti-abortion restriction on private insurance companies could make Missouri's restrictions even stricter.
Paula Gianino, president and chief executive for Planned Parenthood of the St. Louis Region estimates that about 7-10 percent of the roughly 6,000 abortions provided annually at its St. Louis facility are covered by private insurance because of the decision of some employers to purchase the insurance riders. (Planned Parenthood, via two regional arms, operates both abortion facilities in the state of Missouri. The St. Louis site performs the majority of abortions in the state.)
An even higher percentage of women patients might actually have the insurance coverage, she added, but may choose to pay for their abortion out of pocket because of privacy concerns.
The Missouri Department of Insurance says it keeps no statistics on how many companies or individuals purchase the rider covering abortion services.
Used or not, Gianino is concerned those company-purchased riders might be barred under the U.S. House bill, if their employees qualify for the insurance subsidies.
The upshot, said Gianino, is that "millions of women who get this benefit could possible lose it. ... We will have women paying even more than they do now out of pocket."
"It's a bitter pill for women in America to swallow," she added.
U.S. Sen. Claire McCaskill, D-Mo., said Monday morning on MSNBC's "Morning Joe" show that she didn't see the House's restrictions on insurance as a deal-breaker. She notes that she supports abortion rights.
But she elaborated on her stance later Monday, posting on her Twitter page the following Tweet: "Oppose Stupak.Don't think we should change current law which is no public $ for abortions,but amndmt goes too far limitng private funds too"
Later, the senator added another Tweet to emphasize that she wasn't changing her mind: "Asked this morning my opinion on whether Stupak amndmnt would kill the bill(said prob no) and NOT asked my opinion of the amndmnt.Im opposed"
Even with the U.S. House's anti-abortion provisions, Fichter with Missouri Right to Life said her group still has concerns about the overall health-care bill.
And Lee noted that the U.S. Senate still has to act and may take a different approach toward abortion in its version of the bill.
"This is an initial skirmish that we had to win,'' Lee said. "But it's by no means the full battle."