By Fredrick Kunkle
The Washington Post
RICHMOND, Va. — The Virginia General Assembly's decision Wednesday to prohibit insurers from offering abortion coverage in federally managed health-insurance exchanges under the federal Affordable Care Act has reopened an emotional debate along familiar partisan divides.
But members of both parties agree that the measure's biggest impact will likely fall along class lines, landing hardest on some of the people the federal health-care overhaul was designed to help: working women who barely get by on their incomes.
"Those people that can afford insurance outside of the exchanges will be able to buy whatever they want. People that can't afford to buy outside of the exchange will have to buy policies that don't cover these procedures," said state Sen. John Watkins, R-Powhatan, who sponsored the bill but opposed the amendment by Republican Gov. Robert McDonnell. "It just sets up a class situation, in my mind."
Lawmakers convened in a one-day session Wednesday to consider legislation vetoed or amended by McDonnell, including an overhaul of transportation funding, possible reform and expansion of Medicaid under the Affordable Care Act, adjustments to the state's two-year, $84.4 billion budget and other legislation, such as a qualified two-year moratorium on law enforcement's use of drones.
The governor also sought to obtain an additional $450,000 for the Opportunity Educational Institution, a new statewide division empowered to take over failing schools. But the legislature maintained funding at the $150,000 agreed to during the regular 46-day session this year and concluded the one-day session shortly before 1 a.m. Thursday after reaching agreement on the appointment of judges.
Nothing raised voices more than the debate over abortion as the legislators voted to accept the governor's abortion-related amendments to two identical bills — sponsored by Watkins and state Del. Thomas Rust, R-Fairfax — whose intent was to prepare the state for the implementation of the Affordable Care Act. Like 25 other states, Virginia has opted to let the federal government manage the exchanges that will offer health-care policies for people who might not be able to afford insurance. The exchanges are to begin enrolling people in October for coverage that would start on Jan. 1.
McDonnell's amendments forbid the sale of any insurance policy or optional rider that would cover most abortions except in cases of rape, incest or when the mother's life is endangered. The Republican-controlled House of Delegates voted 55 to 37 for the measure; the evenly split Senate approved it by a single vote, 20 to 19. The governor said the amendments were necessary to conform with a law enacted in 2011 that is set to expire in 2014.
Groups that oppose abortion, including the Virginia Catholic Conference, the Susan Anthony List and the Family Foundation of Virginia, hailed McDonnell's amendments.
"What we're really talking about here is: Do we really require Virginians, or Americans for that matter, to supply the money to end the life of a unborn child whose heart is already beating?" said Olivia Gans Turner, president of the Virginia Society for Human Life. "Without this amendment, starting on July 1, 2014, Virginians would be paying for all abortion on demand. This is a very positive move. And it's very respectful of where most Americans are on the subject of taxpayer-subsidized abortion."
Virginia Podboy, associate director of the Virginia Catholic Conference, said the Affordable Care Act does not incorporate the Hyde amendment — a federal provision that has blocked taxpayer-subsidized abortions since 1977 — and leaves the decision up to each state.
"Roe v. Wade allowed access to abortion, but access doesn't mean taxpayers need to subsidize those services," Podboy said. "We don't see abortion as health care because it takes away life instead of giving life."
Abortion-rights supporters, including Planned Parenthood Advocates of Virginia and NARAL Pro-Choice Virginia, disputed the notion that federal money would flow through the exchanges to insurance plans covering abortion.
Abortion-rights advocates said the measure goes farther than existing law and federal bans on taxpayer-subsidized abortions, because the amendment would forbid insurers on the exchange from paying for an abortion in cases of severe fetal abnormalities, as Medicaid allows. Others said the ban would prevent women who will buy insurance in the exchanges without using a subsidy from purchasing a policy that would cover abortions.
Cianti Stewart-Reid, executive director of Planned Parenthood Advocates of Virginia, said that the only real effect of the amendment would be to limit access for women who make too much money to qualify for Medicaid but not enough to purchase their insurance on the private market.
"What it means is that women — by and large low-income but working women in Virginia — won't have access to abortion," Stewart-Reid said.
Elizabeth Nash, state issues manager at the Guttmacher Institute, said the ban also would prevent women from buying coverage in the exchanges that would cover abortions when the fetus is impaired or a woman faces health risks that do not rise to life threats, and those types of abortion procedures are the costliest. An early abortion, without complications, might cost about $450. But later-term abortions involving serious health problems could run to $1,500.
"That's quite a chunk of change to pull together. And that's what health insurance is about," Nash said.
The Virginia Department of Health reported 23,635 abortions in 2011, of which 18,914 involved unmarried women. The Kaiser Family Foundation, in reviewing the impact of the Affordable Care Act on women's health, has estimated that 43 percent of Virginia's nearly 400,000 uninsured women would be eligible for subsidies in the exchanges.