Confused news service.
As I’ve noted before, Catholic News Service has a distinctive approach to covering the Affordable Care Act: it freely presents worst-case interpretation as fact. Last February, CNS published a piece of agitprop dressed up as a news story on the alleged threats of “government-run health care.” And two weeks later, CNS ran another misleading article, this time purporting to bust White House myths about the contraception mandate — with a series of non-facts spun to serve a single point of view. And now CNS is at it again, with a confused story about Gov. Tom Corbett’s decision to allow the federal government to set up Pennsylvania’s health-coverage exchange, rather than have the state handle it. Here’s the lede:
Pennsylvania Gov. Tom Corbett announced Dec. 12 that the state would not set up its own health insurance exchange and instead join the federal exchange, which will cover elective abortions.
Just how the decision will impact such issues as abortion was not totally clear.
Both sentences contain misleading claims. Let’s start with the article’s false premise. There is no such thing as “the federal exchange.” The Affordable Care Act requires every state to have a health-insurance exchange by late 2013, where residents can compare and purchase coverage from a variety of companies. Congress intended these exchanges to be created and managed by states — because state regulators know more about local insurers and health-care needs than Washington administrators (subsidiarity!). But, according to the law, if a state opts out, the federal government will step in and create the exchange instead. Each state will have its own exchange. There won’t be a national exchange where anyone in any state can buy coverage. Illinois residents and small businesses, for example, will be able to purchase coverage on their state-run exchange. Illinoisans won’t be able to buy plans on Pennsylvania’s federally facilitated exchange next year, any more than they could buy a Blue Cross Blue Shield of Northeastern Pennsylvania plan today.
But the article’s confusion doesn’t end there.
The authors claim that federally established exchanges “will cover elective abortions.” That is simply false. Health-care-law expert Tim Jost has been pointing this out for quite some time. First, the ACA explicitly allows states to pass laws barring elective abortion coverage on health-care exchanges. The CNS piece gets that right, but then it muddies the waters: “A state exchange would have given Pennsylvania the ability to opt out of abortion coverage.” That makes it sound like because the Republican governor of Pennsylvania decided to allow the federal government to facilitate his state’s health-care exchange, there’s no way to keep abortion coverage out of it. Not true. If the legislature wants to pass such a law, it can, and Pennsylvanians won’t be able to get abortion-covering insurance plans on their state’s exchange.
Yet even without such a law, insurance companies are free to offer plans with or without abortion coverage. As Jost writes, “The federal government will make national ‘multistate’ plans available through individual state exchanges. At least one multistate plan that does not cover elective abortions must be available in each state. But no exchange plan is required to cover abortions.”
But even if a state exchange does include a plan with abortion coverage, the ACA puts up rather high hurdles in order to obtain it. A lot of misinformed commentators have erroneously claimed that “subsidized abortions” will be offered in state health-care exchanges. In fact, those who want to purchase plans with abortion coverage must take extra steps in order to obtain it: They have to pay a separate premium for abortion coverage. And if their employer pays any part of their insurance costs, then the employer has to pay a separate premium. And that premium has to be more than one dollar (it will likely cost more) — the law bars insurers from offering abortion coverage for free. And once insurers receives the abortion-coverage premiums, they must segregate the funds from those they receive for general health coverage (this is what states must do with federal Medicaid dollars, because the Hyde Amendment bars federal dollars from funding elective abortions). Those accounts “must be policed by state insurance commissioners,” Jost explains. And finally, federal health-care subsidies cannot be used to pay the separate abortion-coverage premium. Lots of people have abortion coverage right now and don’t know it. How many people are going to go through the trouble of requesting it — especially from their employers? How many insurance companies will want to go through the trouble of setting up and maintaining the separate accounts?
But the ACA goes further. According to the law, insurers offering abortion coverage must determine its actuarial value — that is, its cost over the life of a policy. Obviously, abortions cost insurers much less than maternity and postnatal care. But the ACA doesn’t allow insurers to build those savings into pricing for plans that include abortion coverage. In other words, the law recognizes that insurers could offer cheaper, potentially more popular plans by including abortion — but it won’t let them.
So when the CNS story quotes a Pennsylvania Catholic Conference statement announcing its intent to “explore every option to avoid the federal elective abortion provision” — both authors work for the Archdiocese of Philadelphia’s news outlet — without bothering to find out whether the Pennsylvania bishops have the facts right, they mislead their readers. And once again, CNS has published a story on a complex policy question that advances one point of view. That is, rather than running a news story, they’ve put out a press release.