Pro-Choice Health Policy Expert Says Nelson Just as “Bad” as Stupak

From Sara Rosenbaum, Chair of the Department of Health Policy at GWU:

“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, 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.”

How ironic this is – if this bill passes, we will see the first attempt to regulate the ability of private insurance companies to fund abortion from peoples’ premiums.

And by the way, this is at least as morally serious as the indirect transfer of money to abortion-funding insurance companies through the tax system. But while all eyes are on the latter, nobody has ever seemed to care much about the former. And even here, some “pro-life” groups have carved out even finer distinctions, arguing that it is fine for Medicaid to fund abortions from tax revenue collected by the state, but not by the federal government.

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  • Kurt

    Nelson might almost be better than Stupak. Nelson requires a separate premium for abortion if the insurer wishes to offer it and the state allows it. Stupak allows a rider policy outside the exchange that covers abortion. But because Stupak pushes the abortion rider outside the regualted exchange, insurers could offer a broad rider including all sorts of services not offered in the basic policy. This supplimental plans could be a greater inducement to abortion coverage than the more strictly regulated Senate option.

  • Mark Gordon

    “A review of the Senate language indicates a dramatic shift in federal policy that would allow the federal government to subsidize insurance policies with abortion coverage” -Rep. Bart Stupak (D-Mich)

    But what does he know?

  • ron chandonia

    I think the Secretary of Health and Human Services (like MM, an Obama Catholic) has pretty well explained away any supposedly pro-life silver lining in the cloudy compromise to which Senator Nelson agreed:

  • Bob

    Whatever language comes out of Congress, you can bet that the Supreme Court eventually will be asked to figure out if Stupak or Nelson is constitutional, given that the bill will affect almost every American, and involves a medical procedure that the court has approved with limits. While I’m no legal scholar, sure seems that the equal protection clause of the Constitution could be a basis for argument.

  • David Nickol

    federal government to subsidize insurance policies with abortion coverage

    This seems to me very carefully worded to obscure the fact that the Nelson compromise does indeed prevent federal fund from financing abortions. But here’s a question. Why is it acceptable to have federal subsidies going to insurance companies that cover abortion on demand? Suppose United Health Care or Cigna are the major providers of abortion insurance in the country (and they may be). Why should government money go toward buying insurance policies from them even if the policies don’t cover abortion? It all goes into the same pot.

  • John Hayes

    Mark quotes:

    “A review of the Senate language indicates a dramatic shift in federal policy that would allow the federal government to subsidize insurance policies with abortion coverage” -Rep. Bart Stupak (D-Mich)”

    Both the House and Senate versions allow the government to provide a subsidy to people who buy health insurance that pays for elective abortions. The amount of the subsidy is the same whether or not elective abortion coverage is provided.

    The House bill, requires buying two different policies. The Senate bill requires making two different payments.

    Is that difference enough to justify rejecting a bill that will provide health insurance to 31 million poor people who have no health insurance now? I don’t believe so.

    Please note that both plans provide that there will always be a plan available that does not include elective abortion coverage

  • JohnMcG

    I’m willing to accept the Nelson compromise. But the more you seem to want to change the subject to how nobody cared about regulating private insurance, or putting “pro-life” in scare quotes, the more suspicious I get that you’re hiding something.

    The government acts in all of our names. Insurance companies act in the name of their shareholders. So, people care more about what the government does than what insurance companies do. Just like I care more about the US government torturing prisoners versus what a lone serial killer does.

    This is a burden activists should embrace.

    And yes, the government buying the insurance crosses a threshold from providing tax breaks when individuals buy it.

    That health care reform enables us to regulate covering of abortion is a positive feature of health care reform, not a negative. Because we are doing health care reform, we are shining sunlight on what was darkened, and taking steps to clean it up. This is a good thing, and I wish you would focus on that rather than calling people hypocrites.

  • Matt Bowman

    The bill regulates private coverage of abortion, by facilitating it and imposing an abortion tax that according to Sebelius everyone in the exchange must pay. So where before some pro-life employees had abortion coverage from their employers, now it is the federal government mandating that exchange members pay the abortion tax, and for the first time the federal government is paying cash into the plans that cover abortion. You continue to falsely equate a tax break available to all plans, with a federal expenditure in a federally run regime. And you falsely state that prolifers think it’s OK that states cover abortion, when it is pro-lifers who worked to get those 33 states not to do so (did you work on that? when?), but because of this bill all 33 will default to having government funded abortion insurance. It is bizarre logic to say because pro-lifers were successful at keeping federal funding out and 33 states’ funding out, they shouldn’t complain if all that is chucked in the garbage.

  • John Hayes

    Matt quotes:

    “The bill regulates private coverage of abortion, by facilitating it and imposing an abortion tax that according to Sebelius everyone in the exchange must pay. ”

    But, of course, that’s not what the bill says. People who choose a plan that doesn’t cover elective abortion services don’t pay the $1/month (or whatever) premium. And the bill provides that there must always be such a no-elective abortion coverage plan available.

  • David Nickol


    Matt Bowman and I are about as far apart on most issues as two people can be, but he is reporting accurately what Sebelius said. It makes absolutely no sense to me, but she says quite explicitly that everyone would write two checks that would go into separate accounts and would not be earmarked for anything. Whether or not she is correct, I don’t know, but that’s what she said.

  • David Nickol

    More information . . .

    If Newsweek has it correctly, the Sebelius clip is misleading:

    To address Nelson’s concerns over federal funds, Boxer and Murray agreed to a plan requiring insurers to collect separate payments from subscribers to cover abortions. Here’s how the newly proposed segregation system would work: insurers that wanted to cover abortion would be required to collect two payments from every enrollee. One would go into a general fund, one would go into a fund that exclusively covers abortion. Every enrollee in a plan covering abortion—male or female, regardless of whether they wanted abortion coverage—would need to pay into both funds, the idea being the separate payment is not a rider but rather a standard part of the premium that must be paid separately. Insurers would be barred from advertising the breakdown of payments: in promotional materials, one would only see the lump sum premium payment advertised. Enrollees would learn of the breakdown after they signed up “as part the summary of benefits … at the time of enrollment,” according to the amendment.

    It is this so-called “two-check” provision that has greatly frustrated pro-choice groups. They are nervous that consumers (particularly those who are not women of childbearing age) will find the extra fee burdensome while giving them no benefit, and decide to switch to another plan without abortion coverage. If enough consumers made these switches, insurers could begin to drop their abortion coverage altogether. “It unfairly treats abortion as a separate, stigmatized benefit,” says Nancy Keenan, president of NARAL Pro-Choice America. “Requiring these insurance plans to process hundreds of additional transactions, I think that runs the risk of creating a significant disincentive for plans to offer abortion services in their coverage.” An analysis of the language by Sara Rosenbaum, a professor in the George Washington University’s department of health policy, says that it will “have a significant impact on the ability or willingness of insures to offer … medically indicated abortions.”

    Newsweek’s interpretation is that every enrollee in a plan covering abortion would write two checks, whether they wanted abortion coverage or not. Sebelius says everybody in the exchange would write two checks. She does not say those who have plans covering abortion will write two checks, but those who have plans that do not cover abortion will need to write only one check.

    In any case, I believe Matt reported Sebelius’s comments accurately.

  • Matt Bowman

    Sebelius might know a little more about this than you–after all, Catholics United rallied for her appointment. It doesn’t make sense to say that since some evil of a certain kind occurs in the private sector, it’s OK to change federal policy to make the federal government officially require and expand that evil when heretofore it has been neutral but now the weight of the federal behemoth will push the idea that abortion is health care, and in the same bill to promote even worse related evils like immediately providing free access to abortion to the millions of uninsured who don’t get abortions for lack of coverage, and HRSA being able to mandate abortion as “preventive” care in all health plans everywhere, and wiping out 33 states’ laws that currently keep those states out of involvement in abortion coverage, and failing to protect pro-life health providers from government-coerced involvement in abortion, etc., etc.

  • John Hayes


    Newsweek has it right and Sibelius mispoke. See (B) at the top of page 41 of the Manager’s Amendment. The dual-premium applies only to plans that include elective abortion services. Elsewhere, the bill provides that there will always be a plan available that doesn’t include elective abortion services.

  • digbydolben

    The Catholic Hospitals Association breaks with the bishops over support for the health insurance legislation:


  • Kurt

    I am coming to think that the Senate language is better than the House from an anti-abortion standpoint. I have long ago lost interest in the government funding issue. Not one member of Congress (pro-life or pro-choice) would taker an oath that he would use the criteria applied in this case to all future questions of what is government funding. It is not objective and beyond a Talmudic deabte.

    However, with the Senate language, one pays a separate charge solely for abortion. Under the House language, one could purchase an abortion rider outside the regulation of the exchange. In the House but not the Senate method, these riders could become catch-alls for a variety of services not covered in teh basic policy, inticing million to purchase “abortion plus” coverage.

    The Senate language may well kill off abortion coverage in the private insurnace market.