Questions and Answers on the Nelson Abortion Check Provision
Q: What does the new abortion language in the Senate bill do?
A: The new abortion language in the Senate bill establishes an unworkable system that creates enormous administrative burdens for individuals and health plans for no policy reason and stigmatizes abortion care.
Under the Nelson abortion check provision, individuals who choose a health plan that includes abortion care are required to write two separate premium checks, one for abortion care and one for everything else. This has the same effect as an abortion rider, a policy that requires individuals to purchase a single-service abortion policy separate from their health insurance package.
Health plans are then required to deposit the payments from subsidized individuals 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. But forcing individuals to write two separate checks (which are both private funds) and requiring health plans to administer two different payments of private funds is not necessary to ensure public funds are not used for abortion care.
In fact, this is not about separating funds at all. There is simply no policy reason to force individuals to write two separate checks from their private bank accounts. Health plans themselves can easily establish a firewall separating public funds from private funds and ensure that only private funds are used for abortion care. This provision only serves to stigmatize a woman’s right to comprehensive insurance coverage that includes abortion.
The Nelson abortion check provision creates an unworkable system for health plans, and it is likely health plans will forgo covering abortion care rather than have to abide by this series of cumbersome administrative requirements.
In addition, this provision removes the protection in the underlying Senate bill that required that each exchange have at least one plan that provides abortion coverage and one that does not provide abortion coverage. Under this plan, there would only be a guarantee of a plan that does not provide abortion coverage. It also unnecessarily removes protections for abortion providers — leaving a lopsided protection only for entities that refuse to provide, pay for, provide coverage of, or refer for abortion.
Collectively, the manager’s amendment is a far cry from the status quo or abortion neutrality in health care reform.
Q: How does it differ from the Capps compromise and the current language in the Senate bill?
A: This abortion language completely upends the Capps compromise by adding the restrictive and stigmatizing abortion check provision. Whereas the Capps compromise prohibited federal funds from going toward abortion, but allowed individuals to buy a comprehensive health plan without jumping through any unnecessary hoops, this provision imposes a ridiculous standard on Americans who are just trying to buy health insurance coverage that meets all of their needs.
For no reason except to stigmatize abortion care, the Nelson abortion check provision requires individuals to write two separate premium checks, one for abortion care and one for everything else. This has the same effect as an abortion rider.
In addition, this provision removes the protection in the underlying Senate bill that required that each exchange have at least one plan that provides abortion coverage and one that does not provide abortion coverage, requiring only a plan that does not provide abortion coverage. It also unnecessarily removes protections for abortion providers — leaving a lopsided protection only for entities that refuse to provide, pay for, provide coverage of, or refer for abortion.
Q: How does it differ from the Stupak amendment in the House bill?
A: Like Stupak, this provision creates an enormously cumbersome and unworkable process that could result in abortion not being offered in the exchange. Whereas the Stupak provision would ban abortion coverage altogether in the exchange, the Nelson abortion check provision stops one step before that and requires abortion coverage to be paid for separately, giving it the same effect as a rider.
Q: If the Nelson abortion check provision only applied to subsidized individuals, would that be an improvement over the current proposal?
A: Even if the Nelson abortion check provision applied only to subsidized individuals, it would have the same impact on unsubsidized individuals because distinguishing between those two groups would impose an even harsher burden on health plans that are already working through a maze of red tape just to offer comprehensive care.
In addition, the fact that an individual receives a premium or cost-sharing credit doesn’t make their private funds any less private. Requiring any individual — subsidized or not — to write two separate checks from their private bank accounts is an unnecessary and troublesome requirement.
As under the Stupak provision, insurers are highly unlikely to establish two different systems — one for subsidized and another for unsubsidized individuals — especially since income fluctuates and enrollees are therefore likely to move from one category to another. Therefore it is more likely that this policy, like the Stupak policy, will apply to all enrollees in the exchange, both those that are subsidized and those that are fully paying for their own health coverage.
Furthermore, 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.
Q: Is this an improvement, from the pro-choice community’s perspective, over Stupak?
A: This provision is in line with the Stupak abortion coverage ban in that it stigmatizes women’s health and intentionally creates unnecessary burdens for both individuals that want comprehensive health coverage and health insurance issuers who want to offer it. In fact, health plans are unlikely to do so because of those burdens. The abortion language that was in the underlying Senate bill already represented a significant compromise on the part of women. The new abortion check provision goes too far.
Q: Do you think the new abortion language will be the final compromise on abortion? Will it be able to pass the House? Do you anticipate more changes in conference?
A: Planned Parenthood hopes to work with leaders to eliminate this offensive provision in conference. Speaker Pelosi has said that she believes she can pass a health care bill that does not include Stupak and is abortion neutral. This new provision is not abortion neutral. We believe, like the president and the majority of Congress, that health care reform is not the place to litigate abortion policy. The compromise that was in the underlying Senate bill already applied the long-standing Hyde amendment to health care reform by prohibiting federal funding of abortion. As the president said, Stupak goes too far. The Nelson abortion check provision also goes too far.
Q: Are you upset with longtime supporters who signed off on this proposal?
A: Senators Boxer and Murray did everything they could to stop this from happening. We applaud their efforts and the efforts of Senator Reid to come to a better solution. Unfortunately, we were held hostage by Senator Ben Nelson, who has no interest in health care reform or women’s health. We look forward to working with our leaders in the Senate and the House to improve this language when it gets to conference.