George Washington University’s School of Public Health released a crucial study last month showing how the Stupak amendment would lead to the end of all insurance coverage of abortion services within a certain amount of time. Now, GWU’s Sara Rosenbaum has released her assessment of the compromise forged by Ben Nelson in the Senate manager’s amendment – and she sees many similarities in the consequences for women and abortion services coverage.

In a two-page letter, which you can read here, Rosenbaum says that the Nelson compromise “can be expected to have a significant impact” on insurers offering abortion services coverage in the exchange. Therefore, by the same logic of the GWU study of the Stupak amendment, insurer products outside the exchange may be altered as well:

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.

Rosenbaum believes that the state opt-out for providing abortion services coverage in the exchange would reach virtually all markets where insurance coverage is sold, impacting almost all residents of a state, other than the self-insured. This would go beyond the Hyde Amendment because it would affect insurance coverage where federal dollars are not involved.

Rosenbaum finds the segregation of funds problematic as well, saying that it would “chill” the willingness of insurers to provide abortion services coverage:

They would have to comply with complex audit standards and more importantly, they would have to collect an additional fee from each member of their plan, a step that could be expected to encounter broad resistance. (It is also not clear what the consequences would be for plan members who do not make the payment or whether non-payment would place them in arrears). The more logical response would be not to sell products that cover abortion services.

This assessment is damaging to hopes that the Nelson compromise would be acceptable to pro-choice Democrats in the House. The leaders of the Pro-Choice Caucus have already condemned the compromise language and vowed to engage in a close study of its impact. This preliminary study shows it to be quite destructive.

Mike Lillis has more.

David Dayen

David Dayen