Rep. Bart Stupak (D-MI) is telling reporters that he’s optimistic that he can reach a deal with Democrats on abortion and that “he expects to resume talks with House leaders this week in a quest for wording that would impose no new limits on abortion rights but also would not allow use of federal money for the procedure.” “I’m more optimistic than I was a week ago,” Stupak told the Associated Press. “So is there some language that we can agree on that hits both points, we don’t restrict, we don’t expand abortion rights? I think we can get there.”
If Stupak is serious about strengthening the abortion provisions in the Senate bill — and so far, it’s not clear that he is — Democrats would have to pass a separate bill to change the Senate’s abortion provisions. Below is a comparison of the abortion language in the House and Senate reform bills and some options for how Democrats can persuade pro-life Democrats to vote for reform:
|- If a health plan chooses to cover abortion, the plan must collect a separate privately-paid premium to cover the abortion coverage from the enrollee or the enrollee’s employer. The funds must be kept in a separate account used solely for abortion coverage.
- A state may prohibit all plans in an exchange in the state from covering abortion, regardless of whether they receive a public subsidy.
- Insurers that provide abortion coverage must charge at least $1 a month in private premiums for a reserve fund to cover abortion services.
- Implicitly prohibits federal agencies and programs, and state and local governments that receive federal funding, from discriminating against individuals or institutions that don’t provide, pay for, cover, or refer for abortion by adopting existing federal rules.
|- Plans may not be required to provide abortion as an essential service
- Both amendments prohibit use of premium affordability tax credits or cost-sharing payments to pay for abortions
- Both amendments prohibit insurance plans from discriminating against providers for their unwillingness to cover abortion
1. Nix $1 Fee: Stupak has criticized the Senate bill for requiring Americans enrolled in plans that provide abortion coverage to pay at least $1 into a reserve fund. Negotiators can take this provision out of the bill, and charge insurers with the task of allocating enough funds to cover abortion.
2. Stricter Segregation: Lawmakers can introduce stricter accounting requirements for segregating public and private funds. The legislation can require insurers that cover abortions to demonstrate that they have the capacity to segregate funds.
3. New Rules for Segregation: The bill can layout “clear, strict rules for separating public funds from the premiums of private individuals”
4. Stronger Conscience Protections: Final legislation can adopt the House bill’s broader conscience protection language.
|- If a health plan is purchased using federal support, abortion coverage must be purchased with private funds under a separate supplemental policy.
- Explicitly prohibits federal agencies and programs, and state and local governments that receive federal funding, from discriminating against individuals or institutions that don’t provide, pay for, cover, or refer for abortion.
To be clear, most progressives would rightfully argue that the existing Senate measure already goes further than current law by regulating the abortion coverage of private insurers. As Jessica Arons points out, the Nelson amendment places “unprecedented restrictions on private insurance coverage for abortion care, making it much more cumbersome for insurers to offer coverage and for consumers to obtain it.”