Let’s nail this one down. This time, I won’t point out past hypocrisies by those who oppose this healthcare bill because of abortion and yet supported far more lenient language in the past (I’m looking at you, NRLC…). This time, let’s look at what’s actually in the bill. And to do this, I will lean heavily on a detailed analysis by leading health lawyer Timothy Jost, courtesy of our friends at Faith in Public Life – I’m going to take the easy road and pretty much reproduce his post, as it covers everything in a succinct manner. The bottom line is that there is hardly any difference between the two bills, and in some respects, the Senate bill is actually stronger.
What the House and Senate bills have in common:
• Prohibit the use of premium affordability tax credits or cost-sharing reduction payments to pay for abortions that are not covered by Medicaid.
• Prohibit qualified health plans from discriminating against providers or facilities because of their unwillingness to
provide to pay, provide coverage, or refer for abortion. Senate also requires the Office of Personnel Management to assure that at least one of the multi-state plans does not cover non-federally-covered abortions.
• Explicitly do not preempt any state laws regulating abortion.
• Explicitly do not change federal law regarding conscience protection or willingness to provide abortion.
• Provide that qualified health plans may not be required to provide abortion as an essential service.
• Leave federal funding for other programs, such as the Medicaid, Medicare, and Federally Qualified Community Health Centers subject to the Hyde amendment. Provide no funding for new programs that cover abortions — Senate bill specifically states that funds authorized for the new school-based health center program cannot pay for abortions.
• Prohibit federal agencies and programs, and state and local governments that receive federal funding, from discriminating against health care providers or professionals on the basis of their unwillingness to provide, pay, provide coverage or refer for abortion (House explicitly, Senate by incorporating Hyde Amendment provisions).
The issue of community health centers
The Senate bill creates a Community Health Center Fund, and funds it with $7 billion. Community health centers are critical – last year, they provided prenatal, perinatal, and post-natal care to one in eight children. It is an initiative that pro-lifers should applaud. But the noise machine is saying that this money will be used to turn community health centers into abortion factories. No chance. Here’s Professor Jost:
“Because this funding is not just authorized but also appropriated by the bill, it has been argued that it is not subject to the Hyde amendment provisions of the annual HHS appropriations act. The Senate bill, however, provides that this funding is to be transferred to HHS accounts to increase funding for community health centers and does not provide for segregating these funds. Since all other HHS funding, including expenditures from trust funds, is subject to the Hyde Amendment, these funds cannot be used to pay for abortions.”
Where the House and Senate bills differ
o House – if a health plan is purchased using federal support, abortion coverage must be purchased with private funds under a separate supplemental policy. Senate – if federal premium credits or cost-sharing reduction payments are used to purchase a health plan, the plan must collect a separate privately-paid premium to cover the abortion coverage from the enrollee or enrollee’s employer. The amount of the premium must fully cover the cost of the abortion coverage and may not take into account savings from not having to pay for prenatal care, delivery, or postnatal care when abortions take place. The funds must be kept in a separate account used solely for abortion coverage. State insurance commissioners must ensure that health plans comply with the segregation requirements in accordance with generally acceptable accounting principles and circulars on funds management from the OMB and GAO. Concern has been expressed that plans might use accounting practices that, despite this oversight, allow them to subsidize abortion coverage from federal funds, but if they want to do this for some reason, they could also do it under the House bill. Requiring a separate abortion policy rather than a separate premium is an administrative technicality. It merely requires one more piece of paper. It has also been argued that employees of small businesses will be forced by their employers to pay for abortion coverage through the exchange, but under section 1312 of the Senate bill, an employer cannot choose a health plan for an employee, employees are free to choose their own plan within a tier of coverage specified by the employer. No one will have to purchase abortion coverage under the Senate bill who does not want it, just as under the House bill.
o Second, the Senate bill goes beyond the House bill in permitting the states to absolutely prohibit the sale of plans through the exchanges that cover abortion. That is, under the Senate bill, a state may prohibit not only plans that receive a public subsidy from covering abortion, they may also prohibit plans that do not receive a public subsidy but are sold through the exchange from covering abortion. The CBO estimates that 6 million Americans will purchase unsubsidized plans through the exchanges. The House bill does not explicitly allow the states to do this.
o Third, the Senate bill, but not the House bill, prohibits plans from advertising the separate cost of their abortion coverage. This provision is presumably intended to keep plans from competing with each other by making abortion coverage attractive.
o Fourth, the Senate bill, but not the House bill, provides for $25 million a year in grants to the states for assisting pregnant and parenting teens and women. These grants would go to institutions of higher learning, high schools, and community centers that offer pregnant and parenting teens and women the support that they need to get an education and to function.
Conclusion
These two bills differ, but not because of abortion. Both bills prohibit federal funds from being used to purchase abortion, albeit with different approaches. With The House bill, you can still purchase abortion on the exchange with a supplemental policy. With the Senate bill, you use a separate premium. It’s different only in an accounting sense, and the issue of money being fungible applies to both cases.
While the House (Stupak) approach is easier to understand and possibly cleaner, it is not necessarily much better. The Senate bill allows states to ban all insurance plans that offer abortion – there is no such language in the House bill, which always allows people to use their own money to buy a supplemental policy. The Senate bill requires all who purchase a plan with abortion to make a supplemental payment – even those that get no subsidies at all. This is arguably stronger. So let’s not be bamboozled by those who seek to use the unborn to kill vital healthcare reform.
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