Neither Side Happy With The Nelson Compromise On Abortion, Senate Presses Onward

"You have both sides criticizing it, which means that we did what we had to do, we compromised in a fair way," says Senator Boxer - but can this fragile compromise on the Nelson abortion restrictions hold?

The details on how the amendment compromise will impact the bill are still hazy, but the Washington Post provides an outline of possible scenarios and complications:

The long-standing ban on federal funding for abortion has complicated congressional Democrats' health-care legislation. Medicaid bars federal funding for abortion, but 17 states and the District allow the procedure for female Medicaid enrollees paid out of their own funds. It is harder to reach middle ground in the bill before Congress, which would provide federal subsidies to millions of people to buy private health insurance plans on a new marketplace, or "exchange." The deal reached by Nelson and other Democrats over the weekend would allow those people to purchase insurance plans with abortion coverage. But they would have to write two separate premium checks — one to cover the bulk of their plan and the other to cover the sliver for abortion coverage, probably a dollar or so per month.

States could also decree that no plans including abortion coverage be provided on the exchange in their state. As it stands, five states already have some sort of ban on abortion coverage.

By contrast, an amendment that passed the House would prohibit insurers from selling plans with abortion coverage to anyone buying coverage with the help of subsidies — excluding 85 percent of customers on the exchange. The amendment, sponsored by Reps. Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.), would permit the sale of "riders" for abortion coverage, but abortion rights groups say it is offensive to expect women to buy separate coverage for a procedure that most do not plan on needing.

Neither the House language nor the Senate language would affect women who have employer-provided plans, many of which cover abortion. But it is expected that more people would go into the exchange over time for coverage, broadening the impact of its rules.

While health policy experts believe the additional restrictions may "chill" insurers' willingness to offer abortion services, the Post article reports that there isn't much known about implementation since the bill is not yet finalized. While it appears this deal was done without any consultation with insurance companies, insurance representatives point out that they already comply with state regulations on abortion - adding a federal level of regulations would be something they adapt to.

Despite the optimism of the insurance companies that they can meet the needs of women, Cecile Richards, President of Planned Parenthood, is not pleased with the compromise:

This new "extra" payment for abortion coverage is akin to an abortion rider — as if women would take these extra steps to pay for insurance, with a separate check, that included abortion coverage. Women don't plan an unplanned or problem pregnancy any more than they plan for a heart attack. But they expect that they have coverage nonetheless.

Requiring people to write two separate checks for their health coverage doesn't accomplish anything other than the real goal — making the system unworkable — which is exactly what health care reform opponents want. Like the Stupak abortion ban, the Nelson abortion provision creates such complicated administrative burdens for health plans that it's highly unlikely insurers will offer abortion coverage at all.

How all this will pan out remains to be seen. Remember, the Stupak amendment still exists in the House bill. The Senate vote will happen on Christmas eve, much to the chagrin of Senate aides and workers who have been stranded on Capitol Hill since mid-December. But even in something as universal as griping about working overtime close to Christmas, partisanship still prevails:

Republicans have been quick to cast Democratic leaders as grinches calling for votes so close to Christmas. Of course, the Senate may have already finished its business were it not for GOP delay tactics, such as Sen. Tom Coburn (Okla.) demanding last week that the clerk read aloud a 767-page amendment.

Abortion deal may be hard to keep in health bill [AP]
Both sides question health bill's abortion compromise [Washington Post]
Expert: Nelson Amendment Would ‘Chill' Access to Abortion Coverage [Washington Independent]
Women on the Verge [Huffington Post]
Health-care vote means senators will spend Christmas Eve at the Capitol [Washington Post]