Abortion in the Senate Health-Care Bill: What the Nelson Compromise Will Cost Women

The weeks-long soap opera of finding 60 votes for the Senate health reform bill came to an end yesterday when Democrats "compromised" with Senator Ben Nelson, D-Neb., on language regarding abortion coverage.  After catering first to Senator Joe Lieberman, I-Conn., by removing both the public option and the Medicaid buy-in, Majority Leader Harry Reid, D-Neb., then introduced a manager's amendment that includes new language on abortion care -- and a huge barrel of pork for Nebraska -- in an effort to bring Nelson on board and get the 60 votes needed to end a Republican filibuster.

In doing so, the Senate aided the anti-choice community in achieving one of its primary goals: further stigmatizing reproductive and sexual health care, including but not limited to abortion, and making such care ever-harder for women to secure. This is and was unquestionably a major goal of Nelson's hold-out strategy.  Nelson has consistently voted against expanded contraceptive services, voting no, for example, in 2005 on a program to invest $100 million to reduce teen pregnancy through increased access to sexual and reproductive health education and contraceptive services.  Over the past month, he has several times made a point of "waiting for the approval" of the U.S. Conference of Catholic Bishops and anti-choice organizations on language for the Senate bill.

Meanwhile, the drama over Lieberman and Nelson also aided the Republicans in one of their primary goals: first to kill, and barring that, to severely weaken any attempt to reform health care in this country.

What does the "Nelson" language say?

Pro-choice advocates are still examining the implications of the Nelson language.  But conversations with several analysts over the past 24 hours suggest that if passed into law in the final health care bill, this langauge, at a minimum, does the following:

 

• Requires every enrollee -- female or male -- in a health plan that offers abortion coverage to write two separate checks for insurance coverage.  One of these checks would go to pay the bulk of their premium, the other would go to pay the share of that premium that would ostensibly cover abortion care.  Such a check would have to be written separately whether the share of the premium allocated for abortion care is 25 cents, $1.00, or $3.00 of the total premium on a monthly, semi-annual or annual basis.  Employers that deduct employee contributions to health care plans from paychecks will also have to do two separate payments to the same company, again no matter how small the payment.

 

 

• Eliminates the provision in earlier versions of the Senate bill and in the original Capps language in the House bill to ensure that there is at least one insurance plan in each exchange that offers and one that does not offer abortion coverage.

 

 

• Prohibits insurance companies by law from taking into account cost savings when estimating the costs of abortion care and therefore the costs of premiums for abortion care.

 

 

• Includes "conscience clause" language that protects only individuals or entities that refuse to provide, pay for, provide coverage for, or refer for abortion, removing earlier language that provided balanced non-discrimination language for those who provide a full range of choices to women in need.

 

What are the implications of the Nelson deal?

Separate checks, please

Analysts note that requiring enrollees to pay separately for their "base premium" and their "abortion care" premium will have several negative effects, some very similar to or the same as the Stupak Amendment.

First, the separate checks/separate payments policy will have the same effect as would so-called abortion riders that, under Stupak, would in theory require women to purchase a single-service abortion policy separate from their health insurance package.  Under the Nelson scenario, health plans are required to deposit the payments into two separate accounts -- one for the abortion payments and one for everything else, presumably as a way of ensuring only private funds are used for abortion care.