Federal Funding for Abortion in the Pelosi Health Bill

Federal Funding for Abortion in the Pelosi Health Bill

NOVEMBER 3, 2009

On October 29, 2009, Speaker Pelosi and House Democrats introduced H.R. 3962, the Affordable Health Care for America Act.  The legislation combines provisions approved by the Committees on Education and Labor, Energy and Commerce, and Ways and Means, including the so-called Capps amendment.  The bill is expected on the floor later this week.  The following are the abortion funding concerns with the Pelosi Health Bill. 

Access to Insurance Policies Covering Abortion:  H.R. 3962 would require at least one insurance plan offered in the Exchange to cover abortions.  This mandate would be a significant expansion from current federal regulations on insurance coverage, which state that, "Health insurance benefits for abortion, except where the life of the mother would be endangered if the fetus were carried to term or where medical complications have arisen from an abortion, are not required to be paid by an employer."  While the bill would also require one plan that does not cover abortions to be offered in the Exchange, this mandate to cover abortion could in turn lead to federal actions to "protect" access to abortions-such as mandates for abortion clinics, drugs, etc.

Federal Subsidies and Abortion Coverage:  H.R. 3962 specifically permits taxpayer subsidies to flow to private health plans that include abortion, but creates an accounting scheme designed to designate private dollars as abortion dollars and public dollars as non-abortion dollars.  Specifically, the provisions claim to segregate public funds from abortion coverage, allegedly preventing public funds from being used to cover abortions.

Given that money is fungible, the accounting scheme has been rejected by pro-life organizations, which recognize it as a clear departure from long-standing federal policy against funding plans covering abortion (e.g., Federal Employee Health Benefits Program, Medicaid, SCHIP, etc.). 

Funds provided to a third-party insurance company to subsidize an individual's coverage would by definition make that individual's "supplemental" abortion coverage more affordable.  Therefore the only way to prevent federal funds from subsidizing abortion coverage is to prevent plans whose beneficiaries receive federal subsidies from covering abortions.  To that end, many may note that insurance plans within the Federal Employees Health Benefits Program (FEHBP) have been prohibited from offering abortion coverage since 1995, and federal employees have expressed strong satisfaction with their choice of plan options.

Government-Run Plan:  H.R. 3962 explicitly permits the Secretary to include abortion in the services offered by a government-run plan, and requires that the government-run plan cover abortions unless the "Hyde amendment" restrictions on federal funding for abortion coverage are renewed every year in the Labor-HHS appropriations bill.  

While some Democrats have claimed that the government-run plan will self-sustain on premium revenue, meaning abortion coverage should be permitted, several facts undermine that rhetoric.  First, any outlay by a government-run plan would by definition spend federal funds.  H.R. 3962 spends $2 billion-as well as 90 days of claims reserves based on projected enrollment-in federal taxpayer dollars in start-up funds-and these taxpayer dollars would fund a plan that covers abortion.  Third, taxpayer subsidies would be provided to low-income individuals to purchase coverage in the government-run plan, leading to the same potential difficulties and objections as those discussed above.  Fourth, future taxpayers could be asked to provide bailout funds to the government-run health plan-requiring a further unprecedented amount of federal taxpayer funding for abortion coverage.

Network Adequacy Provisions:  H.R. 3962 gives the Health Choices Commissioner the power to regulate provider networks of qualified health benefits plans. When coupled with language requiring a plan that includes abortion be made available in every region, this could lead to mandates to "protect" access to abortion services (such as the establishment of abortion clinics)-or that all private employers include abortion clinics in their networks for them to be considered "adequate."

Indian Health Service Reauthorization:  H.R. 3962 includes the text of the Indian Health Service Reauthorization, a bill that Democrats have been unsuccessful at passing for years largely due to pro-life concerns.  Attaching this reauthorization to health care reform is an attempt to circumvent a pro-life vote.  The Indian Health Service (IHS) provides health care for eligible American Indians.  While it is funded through Interior Appropriations, the IHS is an agency within the Department of Health and Human Services.  Language exists in current law, as well as in the Pelosi bill, that requires IHS to adhere to all policy provisions (also known as "riders") included in the Department of Labor, Health and Human Services (LHHS) Appropriations acts.  Among those provisions is the Hyde Amendment, however, due to the year-to-year vulnerability of the Hyde Amendment, a permanent ban on abortion is necessary.  H.R. 3962 does not include this permanent application of the Hyde Amendment to the IHS reauthorization. 

For more information on this issue, see documents from the National Right to Life and the Family Research Council.

Staff Contact:  Sarah Makin, sarah.makin@mail.house.gov, (202) 226-2302