Scholar: Nelson Abortion Compromise No Better Than Stupak

Baloney. How is this different from needing pre-approval from your insurance company for any other medical procedure or prescription? The provider's interests/costs/convenience have never been a primary concern of insurance policy writers. Also, the market now handles multiple layers of insurance coverage (primary/secondary/tertiary), plus patient copay, without breaking a sweat.

I don't like dragging the abortion debate into this particular legislation either, but we don't need to be inventing problems that can be handled.

I just don't think I can follow this.

Their part about the state opt-out would make a good point if it weren't that, again, states already have the ability to, and five do, ban abortion coverage in private insurance altogether, and this ability is essentially unchallenged (attempts to legally challenge these laws were successful in RI and unsuccessful in MO). This seems among other things to make the threat somewhat redundant that a state could wind up losing abortion coverage altogether-- since the state could also just do that if they wanted to. Something else that has not been explained to me is how things would work in the absence of this bill provision in a state which already has an abortion coverage ban. In a world without the Senate provision either abortion coverage through the exchange would be banned anyway because exchange participants follow state insurance laws, or else somehow the creation of the exchange would allow exchange members to buy abortion coverage despite the state ban-- which would be pretty neat, but not something I'm sure we have grounds to ask for right now.

The second paragraph just seems really unconvincing. I can see the argument for how Stupak would have created real practical disincentives to offering abortion coverage. But the Senate bill just seems to create what looks like extra paperwork. "Collecting a separate fee" for those people receiving subsidies doesn't seem to obviously dissuade customers since those customers would be paying the exact same amount overall as a non-subsidy customer (who would not have to pay a separate fee) and one assumes be aware of this. The separate accounting standards seem silly, unnecessary and obnoxious but it's yet to be explained to me how they would actually stop an insurance company from doing anything that there was any amount of market demand for. Accepting government money is always complicated for any business, and the business of health care already comes with a lot of complex accounting requirements. GWU is correct that following the abortion provisions require the insurance companies to "comply with complex audit standards". But surely so do many of the health care bill's other provisions? It seems like if any business in America is well equipped to handle the slightly unusual accounting and auditing standards of the senate abortion law it's the health insurance business, since they do many things with moving around money which are much more complicated already.

I've yet to see anything to give me a reason to believe that this fails to meet Barbara Boxer's standard for abortion compromise acceptability: that no compromise should change the status quo on abortion. Probably the bigger risk is that the House blue dogs will realize how toothless the Senate abortion language is and somehow get it changed in conference.