Massachusetts Goes Purple....Now What?

Congratulations are in order for Scott Brown, who won the special election in Massachusetts and really upset the health reform apple cart. It's ironic, because Brown opposes the national health reform efforts that practically mirror the state health reform in Massachusetts that he voted for and continues to support. There is commentary aplenty about what exactly it means that a Republican was able to claim a seat held by Ted Kennedy for nearly half a century, in America's bluest state. Said state is now, I think it's fair to say, purple. Does this mean the "people have spoken" or that this was "a referendum on health reform" or that "Democrats are out of touch with the American people?" Maybe. Of course, for any of those sweeping statements to be true, we'd have to agree that the people of Massachusetts adequately represent a cross-section of America and that Martha Coakley did everything right in her campaign. I don't think either of those things is true. And I don't really care.

The media's gone on the offensive, hyping Brown's victory as the death of health reform and searching in Nancy Pelosi's public comments for what could be evidence of the coffin's final nail. I and others think it's all incredibly overblown. The better question is what do the Democrats do now? And as is being widely reported, there are several options.

First, as I previously wrote, the House could vote for the bill the Senate passed on Christmas Eve. This is probably the best option left, substantively, and it's happened before. The problem with that is, the House bill is much more progressive than the Senate bill, and despite what some people might accuse the party of, there are some Democrats who refuse to compromise any further. So, it doesn't look like this is going to happen, and Pelosi's comments seem to be bearing that out.

There's also the idea of doing things through the reconciliation process, which looks like a possibility. Congressional Democrats might even decide to break the bill up into smaller pieces and pass some of the key reforms that are easily communicated to--and strongly supported by--the public. Then they could build on that. Hooray for incrementalism. (Although some people think such a strategy will never work.)

If you need to buy some time to figure out a strategy, maybe you bring up banking reform to divert people's attention from health care reform for the moment by focusing on something that all people (save bankers) should--theoretically--support. Or maybe the process should just go forward, forcing the Republicans, who will inevitably vote against the bill, spending all their time explaining why the country doesn't need insurance reform. If they can pick up a lot of seats in 2010 with that platform, perhaps they deserve to win.

But not so fast. Health reform has suffered a setback, but it is not yet dead. Now is the time for politicians to find creative solutions to the problem. Plenty of people will complain about more compromising--as it has been so one-sided until now--but just letting health reform die is no better. The Democrats have a real chance to lead here and they must. In fact, that's just what a group of nationally-known health policy experts (including my dissertation committee chair) had to say in a recent letter to Congressional leadership. They urge the House to pass the Senate bill and make subsequent compromises through the reconciliation process. I like their approach and would have signed-on, too, if I were considered enough of an expert to be asked. Here's what they wrote:

Congresswoman Nancy Pelosi
Speaker of the House of Representatives
235 Cannon House Office Building
Washington, DC 20515

Congressman Charles Rangel
Committee on Ways & Means
U.S. House of Representatives
1102 Longworth House Office Building
Washington D.C. 20515

Congressman Henry A. Waxman
Committee on Energy and Commerce
2204 Rayburn House Office Building
Washington, D.C. 20515

Congressman George Miller
Committee on Education and Labor
2205 Rayburn House Office Building
Washington, DC 20515

Dear Speaker Pelosi and Chairmen Rangel, Waxman, and Miller:

For nearly three-quarters of a century, Presidents and Congressional
leaders have tried to enact legislation that would make health care
accessible to Americans. Although pieces of this dream have been
realized—health care for the elderly, the disabled, and children in
low-income families—universal coverage itself has proved beyond
reach.

We are now on the cusp of realizing this goal. Both houses of Congress
have adopted legislation that would provide health coverage to tens of
millions of Americans, begin to control health care costs that
seriously threaten our economy, and improve the quality of health care
for every American. These bills are imperfect. Yet they represent a
huge step forward in creating a more humane, effective, and
sustainable health care system for every American.

We have come further than we have ever come before. Only two steps
remain. The House must adopt the Senate bill, and the President must
sign it.

While the House and Senate bills differ on specific points, they are
built on the same framework and common elements—eliminating health
status underwriting and insurance abuses, creating functioning
insurance markets, offering affordability credits to those who cannot
afford health insurance, requiring that all Americans act responsibly
and purchase health insurance if they are able to do so, expanding
Medicaid to cover all poor Americans, reforming Medicare payment to
encourage quality and control costs, strengthening the primary care
workforce, and encouraging prevention and wellness.

Some differences between the bills, such as the scope of the tax on
high-cost plans and the allocation of premium subsidies, should be
repaired through the reconciliation process. Key elements of this
repair enjoy broad support in both houses. Other limitations of the
Senate bill can be addressed through other means.

The Senate bill accomplishes most of what both houses of Congress set
out to do; it would largely realize the goals many Americans across
the political spectrum espouse in achieving near universal coverage
and real delivery reform.

With the loss of Edward Kennedy’s Senate seat, Democrats no longer
enjoy a filibuster-proof Senate majority, though they still enjoy the
largest Senate majority any party has achieved in the past
generation. The loss of this one vote does not require Congress or
the President to abandon Senator Kennedy’s life work of health care
reform. A year of political infighting, misleading debates about death
panels and socialized medicine, and sheer inaction has left Americans
exhausted, confused, and disgruntled. Americans are also bearing the
severe consequences of deep recession and unemployment. Still, a
majority of Americans support the elements of the Senate bill.

The House of Representatives faces a stark choice. It can enact the
Senate bill, and realize the century-old dream of health care reform.
By doing so, it can achieve a historic milestone while freeing itself
to address other national problems such as joblessness and mortgage
foreclosure that affect millions of Americans. Differences between
the House and Senate bill can be negotiated through the reconciliation
process.

Alternatively, Congress can abandon this effort at this critical
moment, leaving millions more Americans to become uninsured in the
coming years as health care becomes ever less affordable. Abandoning
health care reform—the signature political issue of this administration
—would send a message that Democrats are incapable of governing and
lead to massive losses in the 2010 election, possibly even in 2012.
Such a retreat would also abandon the chance to achieve reforms that
millions of Americans across the political spectrum desperately need
in these difficult times. Now is the moment for calm and resolute
leadership, pressing on toward the goal now within sight.

Some have proposed dividing the bill or starting anew with
negotiations to produce a less comprehensive bill. From the
perspective of both politics and policy, we do not believe this is a
feasible option. We doubt that the American public would welcome more
months of partisan wrangling and debate. We doubt that the final
product would match what has already been achieved. Indeed we doubt
that any bill would reach the President’s desk should congressional
leaders pursue this misguided course.

We, the signatories of this letter, come from a variety of different
perspectives. Some of us are long-standing advocates of progressive
causes. Some of us are nonpartisan or identify as political
moderates.

From these differing perspectives, we agree on one thing: the current
choice is clear. Pass the Senate bill, and improve it through
reconciliation.

Sincerely,

Henry J. Aaron, The Brookings Institution
Gerard Anderson, Johns Hopkins University
Ronald Anderson, UCLA
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia University
Anna Burger, SEIU
David Cutler, Harvard University
Linda C. Degutis, Yale University
Eric Feldman, University of Pennsylvania
Thomas Fisher, University of Chicago
Brian R. Flay, Oregon State University
David Grande, University of Pennsylvania
Thomas Greaney, St. Louis University
Colleen Grogan, University of Chicago
Jon Gruber, MIT
Mark A. Hall, Wake Forest University
Jacob S. Hacker, Yale University
Jill Horwitz, University of Michigan
James S. House, University of Michigan
Peter Jacobson, University of Michigan
Timothy Jost, Washington and Lee University (organizer)
Theodore Joyce, CUNY
George A. Kaplan, University of Michigan
Jerome Karabel, University of California at Berkeley
Mark A.R.. Kleiman, UCLA
Paula M. Lantz, University of Michigan
Simon Lazarus, NSCLC
Arleen A. Leibowitz, UCLA
Theodore Marmor, Yale University
Lynda Martin-McCormick, NSCLC
Michael L. Millenson, Northwestern University.
James A. Morone, Brown University
Jonathan Oberlander, University of North Carolina at Chapel Hill
Karen Pollitz, Georgetown University
Harold Pollack, University of Chicago (organizer)
Daniel Polsky, University of Pennsylvania
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas
Theda Skocpol, Harvard University
Paul Starr, Princeton University
William Terry, Brigham and Women's Hospital
James A. Tulsky, Duke University
Alexander C. Wagenaar, University of Florida, Temple University
Joseph White, Case Western Reserve University
Celia Wcislo, 1199-United Healthcare Workers East, SEIU

(Institutional affiliations listed for identification only).

cc. Senator Harry Reid
President Barack Obama

What Does Health Reform Mean For Me?

I ran a piece similar to this one a week ago, but it looks like concrete examples are the new way of communicating health reform to the public in a way that people can--hopefully--understand. So, today, I bring you more of that kind of "stuff" that explains what health reform will mean for you. Provided, of course, that you fall neatly into one of the categories that are used as examples.

As always, the staff of the Kaiser Health News does a great job of presenting non-partisan information. Their write up is a good place to start. Next, there's a look at what families can actually afford as laid out by The New Republic's Jonathan Cohn. And finally, Uwe Reinhardt answers the question that many of you are asking--why should we all pay one premium based on where we live (community rating) rather than individual premiums based upon our health history and personal habits and risk factors (experience rating)?

As an aside, here's a copy of a memo sent to all Democratic Senators from Mark Mellman, head of the Mellman Group--a public opinion research consulting group--explaining who does and who doesn't support health reform and how to get more support. I think I'd like a job like his.

Latest Health Wonk Review Is Up

The latest edition of the Health Wonk Review is now up online. This edition centers around a Pandora theme (if you don't know that reference, you need to get out more) and includes a post from yours truly. You can check it out here.

The Senate Is Broken

When I was much younger, I liked to play card games with my Granny. I also liked to change the rules to my advantage as the game rolled along. For example, during a game of "Go Fish":

Brad: "Got any nines?"
Granny: "No. Go Fish."
Brad: "Got any sixes?"
Granny: "You already asked if I had any nines and I told you no. Now you have to reach into the pile and see if you can draw one."
Brad: "Nah uh. You get to ask three times before you have to go fish."

You get the point. What does any of this have to do with the Senate? Well, it all comes down to one word: rules. In my card games, I understood that changing the rules had the potential to change the outcome of the game. The same thing is true in the Senate, where rules like the filibuster stand as a major impediment to passing not only poor legislation, but almost any legislation at all. Now, my changing the rules mid-game is more accurately labeled cheating, and make no mistake about it, the accusations would fly fast and furious if the Senate were to change the rules when a bill with the magnitude of health care reform is under consideration. But in between games--at the start of a new session of Congress, say--changing the rules should be completely acceptable. After all, both parties will be equally constrained to operating in accordance with the changes.

And so, after health care reform has passed, the Senate needs to reform itself by doing away with the filibuster. No one elected official should be given the power to prevent a vote in the Senate, as is now the case. I am joined in thinking this by a large number of others--some of whom even have their own outlets in the media. I share with you their contributions to this issue now.

Norman Ornstein writes about Our Broken Senate in The American, and Ezra Klein really tees off on the subject here, along with interviews with Sen. Tom Harkin, Prof. Barbara Sinclair, Sen. Jeff Merkley, and Service Employees International Union President Andy Stern. Of course, all of this just begins to scratch the surface. The bottom line: The filibuster needs to be laid atop a funeral pyre, set ablaze, and pushed out to sea.

Conference Committee: A Quick Guide

With the House and Senate both having passed their respective health care bills, the next step in the legislative process is the conference committee, wherein a handful of members from the House and Senate will convene to negotiate a compromise that merges the two bills into one. This conference report then returns to both chambers to be voted on for final passage.

I've said for quite some time now that the conference report will look more like the Senate bill than the House bill, because the filibuster rules in the Senate and the willingness of a few conservative Democrats and "Independents" (I'm looking at you, Nelson and Lieberman) makes getting just about anything but a pay raise more difficult in that chamber than in the House. Nelson's hung up on abortion and Lieberman is the face of killing the public option from the left, but there are many more issues than just those two that will need to be reconciled.

To help you understand what is on the table, and how negotiations are likely to proceed, I've compiled a list of resources for you. Again--other people have put in a lot of work on this--who am I to ignore their efforts and reinvent the wheel?

First of all, you need to understand the key differences between the House and Senate bills. For that, I refer you to:

Politico's Side-by-Side Table by Carrie Brown

Comparison of the House and Senate Bills from the Commonwealth Fund

Ten Things to Watch in the Health Care Reform Conference by Paul Waldman

There's also an increasing likelihood--near certainty in fact--that no formal conference committee will actually be convened, and that the negotiations will simply happen informally as versions of the bill are "ping-ponged" back and forth between the House and Senate until a consensus is reached. This according to:

Dems 'Almost Certain' to Bypass Conference by Jonathan Cohn

What does House-Senate "ping-pong" look like? For that, see:

Understanding Conference and Ping-Pong by Keith Hennessey

It promises to be exciting as things get hammered out and we continue to move closer to a reformed health care system.

The Special Election in Massachusetts

It's not all too often that people all across the country find themselves concerned with the outcome of a special election in Massachusetts, but that's precisely what's happening today. When Senator Ted Kennedy passed away months ago, he vacated a seat he had held for nearly 50 years. During his tenure, he championed some of the greatest advances in health care policy this country has been able to accomplish. As I, and many others have noted, if Kennedy's death leads to yet another defeat of health care reform, the irony would be almost too much to bear. And yet, that's exactly what's on the line today, as Bay Staters go to the polls to vote for Kennedy's replacement: either democrat Martha Coakley or republican Scott Brown.

Massachusetts is one of the most liberal states in the country, though, so Coakley should win in a landslide. There's just one problem: Brown's beating her in all the polls. It's actually a fairly close race. It's just that when you're expecting there to be no contest, any contest at all, especially one wherein you seem to be trailing slightly, already begins to look like a defeat. We'll know more by tonight.

What are the implications of all of this for health reform? Well, there are basically two outcomes. If Coakley wins, reform moves ahead as it has been, with the House-Senate ping-pong and all of that. If Coakley loses, however, the democrats no longer possess the super-majority (i.e., 60 votes) in the Senate that they need to vote for cloture and pass the conference report. Health care reform dies an ugly death as a result of Ted Kennedy's vacant seat being filled by a Republican from the Bluest State in the Union. I can already feel myself getting a bit clammy....and not in a chowda kind of way.

In the event that Scott Brown wins a Senate seat, health care reform has only one chance left: The House would have to vote on and pass the Senate's health care bill--exactly the same one the Senate passed on Christmas Eve. You see, if there are no changes made to that bill, the Senate doesn't have to vote on it again. Only if a new compromise bill emerges would the Senate have to vote. If they're back to 59 seats, the Dems aren't going to want to go there. Is this a bad thing? Maybe a little. But, remember, the conference report was most likely going to look a lot more like the Senate bill than the House bill anyway. So it's not clear just how much you lose. That's what I'm telling myself anyway. Maybe when the sun comes up on Wednesday morning, the people of New England will have made me proud. I guess we'll see.

The GOP Prescription for Reform

Two Views From the Right

Here's a newsflash for you: People disagree about politics. Sometimes, when emotions are high enough--when there's enough seemingly on the line--things can even get downright ugly. I've been called my share of unpleasant names in "conversations" about health care reform. But that's okay. In fact, I pretty much expect it. That's right. Go ahead. Disagree with me. I welcome you to. Here's the catch: Bring your facts with you, because I absolutely hate opinionated ignorance.

Now, some of my more philosophical friends will be quick to ask "Well, what do you mean by facts?" and "How are we to define that?" and "Are all facts created equal?" and on and on and on. To them and you I say that there is some "wiggle room" in what we should be willing to admit as fact. Merely disagreeing with someone's position does not in and of itself negate the value of their assertions. Likewise, just because someone shares your position does not in and of itself necessitate that whatever drivel may spew forth from their lips is, in fact, the Gospel.

For example, if a piece of legislation--a health care reform bill, say--contains the language "nothing herein shall be construed as extending the provisions of this legislation to persons who are not legal citizens of the United States of America"--it should be relatively straightforward for all persons, regardless of whether or not they support health reform, to agree that the legislation does not cover illegal immigrants or even resident aliens. Again, the lawyers among my friends will raise the meaning of each term in turn, asking what the law means by "construed" for instance. I'm not dealing with legalese here. My point is that everyone should be able to agree--when confronted with the specific text of the legislation--what is or isn't being proposed. To say "The Congress wants to tax me more so they can pay for all the damned illegals to get health care!" is just point blank wrong.

The above scenario is not, in fact, the exact point of this post. Rather, I'm trying to appeal to people to dig past the deep piles of cow-processed grass to get to the facts. There are facts that opponents of health reform can cite without resorting to blatant and nearly nonsensical propaganda. If you oppose health reform, it would behoove you to arm yourself with such information. I wanted to demonstrate the differences between two conservative commentators for you in pictures. (Note: You'll need to click on the images to see full-size versions.)

First, we have the following image of the top 100 words (ignoring commonly occurring English words such as "of" and "the") that come from a transcript of Rush Limbaugh's radio show. I got the transcript from his website, where the title read "Don't Be Polite or Non-Ideological: Fight This Un-American Legislation!" Now, I can spend a good deal of time questioning how any legislation passed by the United States Congress could be "un-American" but that's a topic for another day.
What do we see? Rush is talking a lot about "people, money, Democrats, Republicans, and the Senate." There's almost nothing, save "health" and "insurance," that is actually connected to the substance of health reform. Instead, we see a lot of emotionally charged words like "outrage," "anger," and "upset." In fact, the whole thing looks pretty alarmist at a glance. Limbaugh's selling feelings not information, and he's not even explaining the basis for the feelings he's selling. They could be rooted in certain information, or they could just be politically motivated. But if you don't have the information, and if he doesn't supply it, it's pretty easy to believe that you should be angry, upset, and outraged, though you haven't the foggiest idea why.

Now, let's take a look at the top 100 words in a blog post appearing on the website for Health Affairs. The post's author is Stuart Butler, a health policy expert at the highly conservative think-tank the Heritage Foundation. It wouldn't be a surprise if Butler's words resembled Limbaugh's. But take a look:
See anything different? Well, for starters, Butler talks about the Republicans quite a bit, but doesn't say nearly as much about the Democrats. Maybe he's learned the rule "If you don't have something nice to say, don't say anything at all." But wait a minute, he even uses the word "bipartisanship" and "compromise" a good deal. Isn't that borderline party sacrilege?

All kidding aside, here's the big difference I'm hoping you'll see: Stuart Butler's talking about the substance of the reforms rather than playing to the emotions of a largely ignorant populace. Go ahead and look for emotionally charged words like Rush used. You won't find any. What you'll see instead are things like "design," "decisions," and "provisions." Whereas as Limbaugh deals in getting a knee-jerk reaction out of uninformed people, Butler deals in information. He doesn't have to scare you or make you angry, because he trusts that once you are informed, you'll make the right decision for yourself.

I'm hoping that seeing how two very conservative commentators can approach the same issue in quite different manners will convince you that ranting--epitomized by the Tea Party Patriots--is more often than not the response of someone who doesn't know what they're talking about and who hopes to divert everyone's attention from that fact. I'm hoping that you'll begin to see that there are level-headed, rational thinkers of a high caliber who support conservative ideals. With a little work, you could become one of them. Then, even though we still won't entirely agree on health care, I'll certainly respect you more, and we just might find a workable way forward.

The Facts on Abortion and Health Reform

Disclaimer: This post is long. Go top off your coffee, make a pit stop, and attend to any other urgent matters before you settle in with this one. That said, if you'll dare to wade through it, I think you'll emerge all the better for it.

Fear is a powerful motivator for people. We dislike change because it generates within us a fear of the unknown. Anger is also a powerful motivator for people. If you can get fear and anger on your side, you can get people to say and do just about anything. Especially if they don't really know what they're afraid of (the unknown) or why they should be angry (other than that you told them to be so).

Consequently, it comes as little surprise that, on his website, Rush Limbaugh goes after the health reform movement by invoking the emotionally-charged, extremely divisive issue of abortion. He actually uses a video clip of an interview with Secretary of Health and Human Services, Kathleen Sebelius, to convince his audience that everyone will be paying--through their taxes--for women to get abortions. Here's the transcript from his site (and my thoughts in italics):

"RUSH: Now, in case there remains any confusion about whether or not your taxpayer dollars will be used to pay for insurance policies that cover abortion, here is Kathleen Sebelius, that wizard of smart (is there really any need to attack the woman's character?) who taught us all how to cough properly during the nonexistent swine flu epidemic (roughly 50 million cases leading to 10,000 U.S. deaths is nonexistent???), basically destroy your sleeve, cough up all the mucus on your sleeve, not in your hand, and she demonstrated how to do it, and she even chastised some idiot reporter (if one idiot chastises another idiot, does that make Rush the genius?) who didn't get it right at a press conference. During an interview on Blogher.com yesterday, Kathleen Sebelius said this.

SEBELIUS: The Senate language, which was negotiated by Senators Barbara Boxer and Patty Murray, who are very strong defenders of women's health services and choices for women, take a big step forward from where the House left it with the Stupak amendment. (Watch the video below and you might wonder where this part of Sebelius' comment went: "And I think it does a good job making sure there are choices for women, making sure there are going to be some plan options, and making sure that, while public funds aren't used, we are not isolating, discriminating against, or invading the privacy rights of women. That would be an accounting procedure, but") Everybody in the exchange would do the same thing, whether you're male or female, whether you're 75 or 25, you would all set aside a portion of your premium that would go into a fund, and it will not be earmarked for anything, it would be a separate account that everyone in the exchange would pay. It's really an accounting measure that would apply across the board and not just to women and certainly not just to women who want to choose abortion coverage.

RUSH: So you are going to forced to make a contribution to the exchange, whether you're 75 or 25, a portion of your premium would go into that fund and it would cover abortions. She's making it very clear. An accounting gimmick -- you can call it an accounting gimmick, it sounds more like a policy to me, but if you had any doubts, okay, you had Nelson all worried about the language in the Senate, you got Stupak all worried about his language over there in the House, and here's Kathleen Sebelius spelling out how it's going to happen regardless what the language in the legislation is. (Right. The very pro-life Stupak and Nelson are both so clueless as to introduce amendments that don't do anything.)"

Here's the version of the video available on Rush Limbaugh's website. Watch it for the parts of Sebelius' quote that Rush doesn't put in print:


Here's the video in its entirety from Blogher and the White House:


If you listen between 3:30 and 6 minutes, you'll hear Sebelius' entire remarks on abortion, which include the following, which Limbaugh conveniently left out:

“I certainly agree that the reproductive rights of women is an important issue and from the outset, again, the President made it clear that this was not an abortion bill, it’s a health care bill and what was very important was to essentially maintain the status quo and the status quo, which I know a lot of women don’t like, but that is the current law is that federal funds are not used to provide abortion coverage except for some rare exceptions. Except for when the life of the woman is in danger, or rape and incest. Those are the only two and that has been the public policy of this country for over a couple of decades. So that’s really the goal of both the House and the Senate. Not all members. Some members would like to take a big step, I would suggest backward to really ban not only coverage with public funds, but to really reach into the private market and make choices.”

I find, when there's a disagreement like this, that it helps to look at the actual source material. So let's do that. Here's excerpted text taken directly from the Stupak amendment (in the House):

"No funds authorized or appropriated by this Act...may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of rape or incest....Nothing in this section shall be construed as prohibiting any nonfederal entity...from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section...so long as such coverage or plan is paid for entirely using only funds not authorized or appropriated by this Act; and such coverage or plan is not purchased using individual premium payments required for a Exchange-participating health benefits plan towards which an affordability credit is applied; or other nonfederal funds required to receive a federal payment, including a State's or locality's contribution of Medicaid matching funds."

Now what about the Nelson Amendment in the Senate? Take a look:

“A State may elect to prohibit abortion coverage in qualified health plans offered through an Exchange in such State if such State enacts a law to provide for such prohibition…nothing in this title (or any amendment made by this title), shall be construed to require a qualified health plan to provide coverage of [abortion] services…as part of its essential health benefits for any plan year;…the issuer of a qualified health plan shall determine whether or not the plan provides coverage of [abortion] services…as part of such benefits for the plan year…If a qualified health plan provides coverage of [abortion] services…, the issuer of the plan shall not use any amount attributable to any of the following for purposes of paying for such services: (i) The credit under section 36B of the Internal Revenue Code of 1986 (and the amount (if any) of the advance payment of the credit under section 1412 of the Patient Protection and Affordable Care Act). (ii) Any cost-sharing reduction under section 1402 of the Patient Protection and Affordable Care Act (and the amount (if any) of the advance payment of the reduction under section 1412 of the Patient Protection and Affordable Care Act)…In the case of a plan [funded in part by (i) or (ii), the issuer of the plan shall—(i) collect from each enrollee in the plan (without regard to the enrollee’s age, sex, or family status) a separate payment for each of the following: (I) an amount equal to the portion of the premium to be paid directly by the enrollee for coverage under the plan of services other than [abortion] services…(after reduction for credits and cost-sharing reductions described in subparagraph (A)); and (II) an amount equal to the actuarial value of the coverage of [abortion] services…and (ii) shall deposit all such separate payments into separate allocation accounts….The issuer of [such] a plan shall deposit— ‘‘(I) all payments [for non-abortion services]…into a separate account that consists solely of such payments and that is used exclusively to pay for services other than [abortion] services…and (II) all [“separate”] payments…into a separate account that consists solely of such payments and that is used exclusively to pay for [abortion] services…A qualified health plan that provides for coverage of [abortion] services…shall provide a notice to enrollees, only as part of the summary of benefits and coverage explanation, at the time of enrollment, of such coverage…No qualified health plan offered through an Exchange may discriminate against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.”

If either of those amendments suggest to you that tax revenues will be used to fund abortions, might I suggest you read again more carefully, or perhaps attend law school. (Note: Listening to Rush on the radio is NOT a suitable alternative.) The bottom line is that no tax money is going to be used to fund abortions. In fact, no private insurance plan --participating in the Exchange or not--is required to offer abortion coverage, and no provider can be discriminated against for refusing to provide abortions.

Here's what can happen: Insurance plans can offer supplemental abortion coverage under Stupak that folks buy on their own with money out of their own pocket. Or, under Nelson, insurance plans can include abortion services as a benefit, but they must maintain two separate accounts, and any federal money they receive is kept wholly separate from the account from which abortion services are paid for. Is it an accounting procedure? Yes. Is it somehow different from what exists today? Not at all. Go pull your insurance benefits summary off the shelf (you kept it, right?) and take a look. I'll bet it covers abortion services in at least some capacity. If it does, guess what? A portion of your monthly premium is being used to fund abortions. Rush's abortion argument--most especially his claim that you're going to be forced to contribute to the Exchange--is nothing but a straw man designed to be knocked down with the goal of fostering more animosity among opponents of health reform. It takes a fair bit of digging to prove him wrong, and that's exactly what he's counting on when he--and others--sell you the policy equivalent of Florida swampland.