Senate Abortion Provision Wins Support Of Key Pro-Choice Democrats

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November 19, 2009 8:54 a.m.

We now have much more clarity on how the abortion provision in the Senate health care bill will work, and it’s won the support of both senior administration officials, pro-choice Senators, and the co-chair of the House pro-choice caucus.

“I am pleased that the U.S. Senate has maintained current law when addressing the abortion issue,” says Rep. Diana DeGette (D-CO) in a statement to reporters. “By adopting a common-sense abortion provision, the U.S. Senate ensures that no federal funds will be spent on abortion coverage while not further restricting a woman’s right to choose. The health care bill is about providing access to quality health care to over 36 million Americans. I encourage the U.S. Senate to work towards producing a bill that works for everyone.”

DeGette included a breakdown of the Senate’s abortion provision, which I’ve included below the fold. One of the key sections reads, “Issuers of health insurance plans that offer coverage for abortion beyond those permitted by the Hyde amendment must segregate from any premium and cost-sharing credits an amount of each enrollee’s private premium dollars that is determined by the Secretary to be sufficient to cover the provision of those services.”

Which is a fancy way of saying insurers will have to set up an accounting system to keep private money separate from federal money, and only draw upon the private money when paying providers for abortion. Compare that to the Stupak amendment to the House bill, which both requires separation of funds, but also prevents women who receive federal premium assistance from purchasing policies that cover abortion, and it’s no wonder Harry Reid’s compromise is being met with praise by pro-choice members.

Key Provisions:

1. Voluntary Choice of Coverage of Abortion Services

* Abortion cannot be a mandated benefit as part of a minimum benefits package.
* A qualified health plan would determine whether it will cover:
o no abortions
o only those abortions allowed under Hyde (rape, incest and life endangerment)
o or abortions beyond those allowed by Hyde

2. No Federal Funds for Abortion Coverage in the Community Health Insurance Option

* If the Secretary chooses to cover abortion services in the public plan beyond those allowed by Hyde, he/she must:

1) Guarantee compliance with the provision prohibiting the use of Federal funds to pay for abortions (beyond those allowed by Hyde)

2) Guarantee that, according to three different accounting standards, no Federal funds will be used; and

3) Take all necessary steps to ensure that the United States does not bear the insurance risk for abortions that do not meet the Hyde exceptions in the public plan.

3. State Flexibility and the Community Health Insurance Option

* States may require the coverage of additional benefits in the Community Health Insurance Option, but must assume costs associated with covering these benefits.
* A State may elect to require coverage of abortions beyond those allowed by Hyde only if no Federal funds are used for this coverage.
* The U.S. Government may not bear the insurance risk for a State’s required coverage of abortions beyond those allowed by Hyde.

4. Hyde Amendment Exceptions and the Community Health Insurance Option:

* Abortions currently permitted by Hyde shall be covered in the Community Health Insurance Option to the same extent as they are under Medicaid (only cases of rape, incest and life endangerment).

5. Consumer Choice Assured Among a Variety of Plans in the Exchanges

* The Secretary would ensure that in each State Exchange, at least one plan provides coverage of abortions beyond those permitted by Hyde and at least one plan does not provide coverage of abortions beyond those permitted by Hyde.

6. Strict Prohibition on the Use of Federal Funds to Pay for Abortion Services

* No tax credit or cost-sharing credits may be used to pay for abortions beyond those permitted by the Hyde Amendment (only cases of rape, incest and life endangerment).

7. Segregation of Funds

* Issuers of health insurance plans that offer coverage for abortion beyond those permitted by the Hyde amendment must segregate from any premium and cost-sharing credits an amount of each enrollee’s private premium dollars that is determined by the Secretary to be sufficient to cover the provision of those services.

8. Actuarial Value of Optional Service Coverage

* The HHS Secretary would be required to estimate, on an average actuarial basis, the basic per enrollee, per month cost of including coverage of abortions beyond those permitted by the Hyde Amendment.
* In making such estimates, the Secretary may take into account the impact of including such coverage on overall costs, but may not consider any cost reduction estimated to result from providing such abortions, such as prenatal care.
* In making the estimate, the Secretary would also be required to estimate the costs as if coverage were included for the entire covered population, but the costs could not be estimated at less than $1 per enrollee, per month.

9. Provider Conscience Protections

* No individual health care provider or health care facility may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions.

10. Application of State and Federal Laws

* No pre-emption or interference with State laws. State laws regarding the prohibition of or requirement of coverage or funding for abortions and State laws involving abortion-related procedural requirements are not preempted.
* The provision similarly provides that Federal conscience protections and abortion-related antidiscrimination laws would not be affected by the bill.
* The rights and obligations of employees and employers under Title VII of the Civil Rights Act of 1964 would also not be affected by the bill.

* In addition, this bill does not affect State or Federal laws, including section 1867 of the Social Security Act (EMTALA), requiring health care providers to provide emergency services.

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