The abortion "handshake deal" that Patty Murray and Barbara Boxer struck with Ben Nelson was a bad one. Via TWI, Sara Rosenbaum, a health policy expert George Washington University, released her analysis on the Nelson amendment, and concludes that it could lead to insurers dropping :
Taken together, the provisions of the amendment can be expected to have a significant impact on the ability or willingness of insurance issuers to offer Exchange products that cover a full range of medically indicated abortions. Furthermore, as with insurance laws generally, and for the reasons stated in our earlier analysis [blogged here], the amendment could be anticipated to have considerable spillover effects. This is because companies that issue insurance products (or administered products in the case of sales to self-insured plans) obviously desire to sell these products in as many markets as possible. If one purchaser market places significant restrictions on one or more aspects of product design, it is likely that sellers will attempt to design their products to a common denominator, so that the product can be sold across all markets in which the company desires to do business. This is particularly true with modern health insurance coverage products, where the concern is not only the coverage but the provider network through which coverage will be obtained. Negotiating the elements of such a product is extremely difficult, and it is just as difficult to have to explain to providers that some of their patients will be insured for certain medical procedures while others will not....
Payments would have to be strictly segregated, subject to state insurance commissioner oversight and adherence to federal segregation requirements. For several reasons this provision could be expected to chill issuers' willingness to sell products that cover a range of medically indicated abortions. They would have to comply with complex audit standards and more importantly, they would have to collect an additional fee from each member of their plan, a step that could be expected to encounter broad resistance. (It is also not clear what the consequences would be for plan members who do not make the payment or whether non-payment would place them in arrears). The more logical response would be not to sell products that cover abortion services.
Nelson is not a better compromise for women's health than Stupak. It just takes the heat off on the federal level, to a degree, and shifts it to the states. This is still not an acceptable situation, regardless of Barbara Boxer's and Patty Murray's intervention. The House pro-choice caucus has serious reservations about the compromise, they say. They need to lead better than Boxer and Murray did on this one, and not let America's women down.