The Nelson compromise on abortion, which Bart Stupak is already engineering opposition to among Republicans, shouldn't be so unacceptable to him. It's just transferring his national battleground to a state one.
Here's how abortion would be paid for in the exchanges in states that allow it
According to a senior Senate leadership aide, under the Nelson compromise, "[i]ndividuals receiving subsidies will have one premium that they pay with two distinct transactions."
Put another way: If you're buying insurance with help from the government, and the policy you want to buy covers abortions, you have to write two checks (or authorize two credit card transactions, etc.) for your plan. If the plan costs $1000 a month, and the insurer plans to sequester $50 to put into a pool that covers abortions, you have to make one payment of $950 and a separate payment of $50.
This is essentially an abortion rider, bringing the same issue that arose through Stupak--creating administrative hurdles for insurers in offering these plans and providing strong disincentive for them to do so. It also just pushes the national fight to the state level and among any of the plans that operation across state lines. It's not as far reaching as Stupak in it's language, but could have the same impact in implementation.
While Barbara Boxer and Patty Murry have signed off on it, pro-choice groups have not. Via e-mail, here's Planned Parenthood's statement:
STATEMENT BY CECILE RICHARDS, PRESIDENT OF PLANNED PARENTHOOD FEDERATION OF AMERICA,
ON PROPOSED ABORTION LANGUAGE IN THE SENATE MANAGER'S AMENDMENT:
"Planned Parenthood strongly opposes the new abortion language offered by Senator Ben Nelson in the manager's amendment. Last week, the Senate rejected harsh restrictions on abortion coverage, and it is a sad day when women's health is traded away for one vote.
"The Nelson language is essentially an abortion rider. It creates an unworkable system whereby individuals are required to write two separate checks each month, one for abortion care and one for everything else. There is no sound policy reason to require women to pay separately for their abortion coverage other than to try to shame them and draw attention to the abortion coverage. Moreover, it is highly unlikely that insurance companies will be willing to follow such an administratively cumbersome system, leaving tens of millions of women without abortion coverage.
"After the passage of the Stupak amendment in the House, we heard loud and clear from women across the country that they will not stand for the undermining of their rights and their access to benefits. This Nelson abortion check provision will no doubt create the same outrage, as women learn that they are being made second-class citizens when it comes to health care coverage.
"As many members of Congress and the president believe, Planned Parenthood does not think that health care reform is the forum to litigate abortion policy. Unfortunately, opponents continue to use abortion as a political wedge at every step of the reform process.
"There is no policy reason for this action, it is simply a political maneuver. We understand that leaders in the Senate and the White House want to move the process forward, but given this provision, we have no choice but to oppose the Senate bill. Planned Parenthood will now work with leaders to fix the abortion coverage language in conference."
And here's NOW's member activation message in opposition to the bill:
The provision was drafted to gain the vote of abortion rights opponent Sen. Ben Nelson (D-Neb.) and is a complicated variation of Stupak-Pitts. It allows any state to prohibit abortion coverage in health insurance exchanges. In addition, all funds that would pay for abortion services would have to be segregated from other private funds and federal subsidies. This requirement would apply to the tens of millions of women who would buy their insurance under the new exchanges and, in the opinion of expert health policy analysts, would mean that insurers simply would not provide abortion coverage in the exchange plans. Eventually, insurers would stop offering abortion coverage altogether.
The Senate health care reform bill is highly flawed now, with the leadership having been forced by a lone senator, Joe Lieberman (I-Conn.), to drop the most important components of reform: a public option and the Medicare buy-in for persons ages 55 to 64. While there are remaining aspects of the legislation that are positive, these three factors -- an abortion coverage ban, no public plan and no Medicare buy-in -- make the Senate bill unacceptable, in our view.