Pay no attention to our chart
This afternoon I received an email from Americans United for Life. “TAXPAYERS FORCED TO PAY FOR ABORTION UNDER PRESIDENT’S PLAN” it warned in a headline, which was followed by a “Statement of Dr. Charmaine Yoest”:
This announcement marks the President’s latest attempt to mislead the public on abortion. Last September, he promised taxpayers that no public funds would go to pay for abortion. He has since pushed strongly for the pro-abortion Senate health care bill, released his own health care proposal, and announced today’s revised proposal – all three plans are a radical move to establish taxpayer-funded abortion. In the confusion of the health care debate, one thing is clear – the President is firmly committed to advancing taxpayer-funded abortion while continuing to claim otherwise.
I replied to the email with a curt request that the organization provide some evidence for Dr. Yoest’s claims. I did not expect an answer. To his credit, a representative from Americans United for Life wrote me back, thanking me graciously for my not-very-gracious note and forwarding several links to documents put together by the organization’s legal team. Among these was the following chart:
The chart could not be clearer, and it accords well with what I know of the Senate Bill (which, as Americans United for Life tells us, is very close to the president’s final proposal for reconciliation). Fortunately for the country, and unfortunately for Americans United for Life, the chart does not accord well with its own title: “Taxpayer Funding of Abortion Under the Senate Health Care Bill.” Anyone who follows the arrows can see that no tax money is used to pay for abortions. Nor is anyone forced by the Senate Bill to enroll in a plan that covers abortion. Those who do enroll in such a plan will have to pay a separate premium that goes into a segregated fund for abortion payments. The chart calls this a “surcharge.” That’s not the term the Senate Bill uses, but never mind; it will do. According to the chart, enrollees would be required to pay the surcharge “even if [they] object or never plan to have an abortion.” This is true, just as it’s true that many who object to abortion and/or never plan to have an abortion (who does?) already pay for abortions through their health-insurance premiums. If people now want to avoid this, they can — but then, so could anyone under the system illustrated by the chart: see the big gray box that says, “Enroll in exchange plan that does not cover abortion.”
But what about that asterisk? It sends us to the bottom of the chart, where we read that “under various mandate authorities in the bill, all private insurance plans could be required to cover abortions.” That “could” is a tell. At this level of detail, the bold declarative rhetoric slips quietly into conditionals. In this case, though, the claim is not even conditionally correct: the Senate Bill would not allow insurance exchanges to offer only plans that cover abortion. The double asterisks tell us that “if the Hyde Amendment is removed from LHHS approps, affordability credits could be used to directly pay for abortions,” but there is no reason to suppose that the Hyde Amendment will be removed from LHHS appropriations, apart from the presumption that prochoice politicians are all necessarily sneaks and liars.
Finally, the triple asterisks inform us that “federal funding of insurance plans that cover abortions is a radical change from existing law.” Notice the shift that has taken place between the top line of the chart, which announces taxpayer funding of abortion, and the last footnote, which more modestly predicts funding of insurance plans that cover abortions. The distinction is important. One reason the federal government has never before funded insurance plans that cover elective abortion is that it has never had to fund insurance for as many people as would receive affordability credits under the Senate Bill. You cannot just extend the Hyde Amendment to the new private-insurance exchanges without also translating it into a new legal structure. The Stupak Amendment does this rather nicely. But the nonnegotiable principle behind the Hyde Amendment is that the federal government should not be funding elective abortion. If the Senate can figure out a way to subsidize policies that cover abortion without actually paying for any abortions, then we should welcome its principled ingenuity and not carry on as if the Hyde Amendment were the first and last word in prolife policy. (People forget that the Hyde Amendment is itself a political compromise: it prevents the federal government from funding “elective” abortion while allowing it to fund abortions that many prolifers and the Catholic Church oppose.)
The lawyers at Americans United for Life also speculate that the Senate Bill’s provision of more federal funding for community health clinics will mean funding for abortion. This is a legitimate concern. Prolife Democrats should try to fix the final legislation so that it explicitly prohibits the use of this funding for abortion. But here again we are in the realm of speculation. Groups like Americans United for Life scare us with claims about what the Democrats’ health-insurance reform will do, and then, when asked for an explanation, fall back on hedged predictions about what it could do if this or that also happened – even when this and that seem quite unlikely. Such obviously unscrupulous rhetoric will probably not have much effect on the prolife Democrats in the House and Senate who may decide the fate of health-care reform (presumably they know what’s actually in the bill). But whatever its immediate effect on them, the rhetoric has seriously undermined the credibility of people who are supposed to represent and inform prolife voters.
on March 3rd, 2010 at 9:13 pm
Perhaps I would have believed, that “this” and “that” were” pretty unlikely” had the Stupak Language existed in the Health Care Bill to begin with.
on March 3rd, 2010 at 11:48 pm
I’m pretty much in agreement with you on your analysis of the indurance provisions of the bill (not to mention your assessment of the credibility of some pro-life organizations). However, the community health center (CHC) funding that you mention at the end is a MAJOR loophole that I think is pretty likely to be exploited for purposes of funding abortion if not corrected. The president’s plan calls for $11 billion in direct appropriations to go to these CHC’s. Because these are direct appropriations from Congress and are not channeled through the HHS budget, they are not subject to the Hyde Amendment. Any CHC that performs abortions could use this money to pay for them.
I think the pro-life movement should be expending its political effort on passing an amendment that would clearly bar use of these funds for abortion rather than using their political muscle to try to kill the bill. My question though is whether such an amendment could be passed using budget reconciliation. I’m not familiar with all the details of the rules governing reconciliation. Does anyone with expertise in this area know the answer to this question?
on March 3rd, 2010 at 11:49 pm
sorry, should say “insurance”, not “indurance”
on March 4th, 2010 at 12:23 am
So, just to be clear — the Senate bill DOES cover abortion. Never mind who pays for it — it legislates the availability of abortion coverage.
And you support that.
And that is consistent with pro-life principles and Catholic teaching how?
on March 4th, 2010 at 12:32 am
Prolife Democrats should try to fix the final legislation so that it explicitly prohibits the use of this funding for abortion.
Under the current ram-it-through plan, the Senate bill is the final legislation. That plan calls for the House passing the Senate bill as is, but then passing a new and separate bill to “correct” it, so as to game the system and not have to have a cloture vote in the Senate.
But you support prolife Democrats in the House nevertheless voting to pass the Senate bill which you admit needs fixing to explicitly prohibit abortion funding.
How about instead of these games, they just send the bill to a conference committee — like any other bill — and put the Stupak language back in it?
on March 4th, 2010 at 7:39 am
Bender,
Facilitating a system in which people are able to use their own money to purchase abortion coverage is substantively different from “funding abortion coverage” which has been the constant charge of the major pro-life groups. Now, facilitating such a system is not ideal from a Catholic standpoint, but it is a legitimate political compromise if it does not expand the legal right to abortion and it does provide health coverage for tens of millions of the currently uninsured. In our present system lots of people are trapped into paying for abortion coverage through their private employer-based plans. The proposed bill would give everyone access to an affordable plan that does not cover abortion. That’s a step up from what we’ve currently got.
As for why reconciliation and not conference committee? Because the Republicans have shown that they are dead set on preventing any health reform legislation from passing at this point. They are more interested in seeing Obama and the Democrats fail politically thathey are in addressing the health care crisis in this country. I wish that there were enough pro-life politicians who would actually switch their votes and support this bill if the abortion language was corrected, but there are not. Too many of those congressmen are opposed to the bill on ideological grounds and wouldn’t vote for it even with Stupak type language.
I say amend the bill as much as is allowed under reconciliation and pass it. Then we can focus on amending it further and passing Stupak language as soon as politically feasible.
on March 4th, 2010 at 8:49 am
“Reform” is not being passed through reconciliation. “Reform” has already passed both houses of Congress, including a supermajority in the Senate. “Majority” rule, to the extent that it should be considered scandalous in a sane society, will be used in the Senate for funding tweaks.
Since most peole having abortions pay taxes, I guess you could say that a high percentage of abortions are taxpayer funded. That’s about the level of honesty on display here from the AUL.
on March 4th, 2010 at 9:24 am
Yet again, the forces of the right are using the unborn as a tool to oppose a healthcare reform they oppose on lasssez-faire, almost Calvinist, grounds. Here’s the kicker – when the Bush-era Medicare Advantage legislation, which allowed the federal government to pay private insurance companies to cover patients, has an incredibly weak protection against this money being used for abortion. And Medicare Advantage plans today offer “voluntary abortion” while traditional Medicare of course does not. But the NRLC and their fellow-travelers not only had no problem with this, but actively supported it. And now, for the first time in history, the federal government is putting limits on what private insurance companies can do in terms of abortion coverage, and its suddenly a huge abortion mandate from federal funds. Absolutely incredible and despicable hypocrisy.
I blogged about the Medicare Advantage story recently: http://vox-nova.com/2010/03/01/abortion-and-republican-ideas-on-reforming-healthcare/#more-12000
on March 4th, 2010 at 10:01 am
Money is fungible
Money launderers get it – Ben Franklin got it “a penny saved is a penny earned” – but liberals don’t
You can’t use accounting methods to get around this reality. There is nothing in the law that would require the “abortion surcharge” to be sufficient to cover the actual costs of abortions, just that the insurance company have one. If an abortion insurance plan could pay for itself, then you wouldn’t need to have it tacked on to “health coverage.” In other words, if the subsidy to individuals didn’t pay for part of, or at least leverage the purchase of, abortion services then why include them in the plan? Moreover, will the needs test for geting the credits account for the money that a person would spend on the the abortion coverage? Of course not.
Think of it this way -
Father – Son, I have been very disappointed in you. I have discovered that you have been using your allowance for drinking and loose women.
Son – Dad, that’s not true! I don’t use my allowance for drinking and loose women, I use the money from Grandpa’s trust fund and money I take out in loans for drinking and loose women, I use the allowance money for other legitimate purposes, and as collateral for the loans that I use for drinking and loose women.
The best that supporters of this bill can say is that it funds this evil practice just a little, not that “no taxpayer money goes to abortion.”
on March 4th, 2010 at 10:17 am
F.Y.I.:
http://www.ncregister.com/register_exclusives/health_reform_would_now_fund_still_more_abortions
on March 4th, 2010 at 10:50 am
Sean,
By your logic, ANY government assistance program would constitute government funding of abortion. If a student gets a federal Pell grant to help pay for college, that frees up some money they would have spent on college to be used for other purposes, possibly including abortion. Should we protest against federal education assistance on the grounds that money is fungible and there such assistance funds abortion?
The Senate bills requires the purchaser of abortion coverage to write a separate check for that coverage and it requires the insurance company to set up separate accounts to handle that money and reimburse abortion providers. I think that system prevents the undercharging for abortion that you suggest might allow backdoor funding of abortion.
on March 4th, 2010 at 10:56 am
Inded, David, this is the argument that was explicitly rejected by the Supreme Court in the Grove City case, involving the provision of federally guaranteed student loans to students attending a school that did not adhere to various federal commitments regarding non-discrimination. At some point, the subsidy is indirect enough that it cannot be viewed as taxpayer funding of the activity involved. This is the argument that voucher proponents make all the time when it is pointed out that most voucher funds will go to support parochial schools. Somehow, what’s good enough for the gander is never good enough for the goose.
on March 4th, 2010 at 11:16 am
I agree with Matthew’s analysis of the chart, and agree that the chart itself squares with explanations I’ve seen on how the Senate bill handles insurance-exchange abortion funding.
A couple of questions that I’m hoping folks here can answer:
* Regarding that first asterisk at the bottom of the chart: what are those “various mandate authorities”, and how likely are they to be triggered? What comes to mind is that in various earlier versions of these bills, the HHS secretary would have been given a fair amount of discretion to determine whether or not some government funds could be used to pay for abortions. Is that what is referred to here, or is it something else?
* In Visio, it would be the work of a moment to draw another dotted line connecting the “Affordability Credits” box to the “Required: PAY ABORTION SURCHARGE” box. Would the Hyde Amendment prevent that, or could subsequent legislation accomplish that while leaving the Hyde Amendment intact?
on March 4th, 2010 at 12:29 pm
David,
Actually, you are right in an abosolute sense. Whenever the governemnt pays money out to individuals that frees up other money for other uses.
That being said, I am not taking it that far. In this case, the government is directly paying an insurance company that covers abortion by means of a credit. The fig leaf is a supplemental premium or surcharge.
Is there a requirement that the surcharge be sufficient to cover the entire cost of abortions, including the administartive overhead related to that coverage? Answer – no
Will the insurance company have to exclude the tax payer subsidized portion of their premiums when they negotiate coverage for abortions? No.
What is lost in the discussion about this is that it is about a moral principle. I will grant you that the amount of money any individual must contribute to fund elective abortions is small. The objection is to any funding at all.
on March 4th, 2010 at 12:42 pm
David,
Thank you for your helpful comments. I agree that prolife Dems should be “expending their political effort on passing an amendment that would clearly bar use of these [community health clinic] funds for abortion.” And I’m not sure why the White House doesn’t save itself an unnecessary political fight by addressing this question directly. It should.
Sean,
David’s right. According to your own principles, you should be opposed to any government program that funds anything for anyone who could get an abortion. Money is fungible all the way down. So, for example, you should openly oppose Medicaid, since the Hyde Amendment does not keep states from paying for abortion with money they “saved” because of federal funding for other things. On your own view, the Hyde Amendment does nothing important.
And a point of information: You’re just wrong when you say that there’s nothing in the Senate Bill “that would require the ‘abortion surcharge’ to be sufficient to cover the actual costs of abortions, just that the insurance company have one.” In fact, the bill stipulates that all payments to cover elective abortion go into “a separate account that consists solely of such payments and that is used exclusively to pay for” elective abortion. All other payments go into another account used exclusively to pay for everything else (Cf sec. 1303 Special Rules, especially (C) Segregation of funds (ii) Allocation accounts. Please read the bill before you tell us what you think it must say.
on March 4th, 2010 at 12:46 pm
“the government is directly paying an insurance company that covers abortion by means of a credit”
How does this differ from Medicare Advantage, which the NRLC loved, and where the provisions against abortion are far weaker than in the current bill?
And when was the last time the pro-life industry bothered to care about the widespread funding of abortion through private insurance companies?
Money is indeed fungible. If you pay a premium to a private insurance company, even if your plan does not cover abortion, the highly concentrated nature of the insurance industry means that you are paying a company that is somewhere paying for some abortion. Why is this any morally different from doing it through the tax system?
Put it this way. Imagine that tomorrow, 30 million people who do not have insurance today went out and purchased private insurance that included abortion (this, of course, is pure fantasy). Would the professional pro-life industry object? If not, why not?
Why do we insist on holding public and private initiatives to different standards? After all, health insurance is just one form of collective decision making, one way to pool risks. Whether do we it by private or public means reflects practical considerations, but the moral considerations are the same.
on March 4th, 2010 at 1:57 pm
The question is, why should a Federal Health Care Bill include health insurance that will provide for elective abortions when the intentional destruction of a Human Individual in their Mother’s Womb is not Health Care, to begin with?
Let us not pretend that we don’t already know the answer.
on March 4th, 2010 at 2:34 pm
“Such obviously unscrupulous rhetoric [from the AUL] will probably not have much effect on the prolife Democrats in the House and Senate who may decide the fate of health-care reform (presumably they know what’s actually in the bill).”
I’m not so sure about this part of Matthew’s analysis. If the news blurb I heard on NPR this morning is correct–i.e., that Bart Stupak and 11 other pro-life Democrats have stated they will absolutely not vote for the Senate Bill as is–then the chart and all the parsing and hypotheticals regarding the abortion funding language in the Bill could prove to be a rhetorical exercise only.
on March 4th, 2010 at 2:47 pm
William,
I didn’t mean to suggest that the bill is a done deal; it’s still faces serious obstacles, including the group of congressional Democrats Stupak represents. My point is that neither those prolife Democrats who oppose the Senate Bill nor those who support owe their position to the intentionally confusing boilerplate of groups like Americans United for Life. I assume Stupak opposes the bill because he believes it violates the principle embodied in the Hyde Amendment: no federal funding for any insurance plan that covers abortion, even if the federal government doesn’t pay for abortion itself. His position doesn’t depend on ignorance of the underlying distinction — the sort of ignorance Americans United for Life thrives on and promotes.
on March 4th, 2010 at 3:23 pm
Matthew–
I hope I didn’t imply that I was being critical of your analysis of the AUL position. I think you did a masterful job unpacking the chart and AUL’s argument. I favor the Stupak language, but in this and other of your posts, you’ve made me think more deeply about the language in the Senate Bill, and I thank you for that.
on March 4th, 2010 at 6:33 pm
I said this on an earlier note, but it is worth repeating here. Republicans in the Senate are an insurmountable obstacle to adopting the policy in the Stupak amendment. Not only will they filibuster any votes on health care policy, meaning that only what has already has passed the Senate can go to the President, they are opposed to considering any non-budgetary issues in companion reconciliation legislation. Stupak’s policies are dead, unless a Republican is willing to support the health care bill in the Senate.
Stupak, on one of the morning shows today, said that “where there is a will, there is a way”, suggesting that his policy could be adopted. But any ways I can think of are being systematically, and franticly repudiated by Republicans and the Tea Party movement. They even seem upset by the notion that 11 congressmen should be able to negotiate to have their special interest included in the final bill.
Unless some Republican Senator is opposed enough to abortion to vote for altered legislation that would limit insurance coverage for it, the alternatives are the current Senate bill or the unfettered coverage of abortion that we have now. I doubt that any Republican Senator has that kind of conviction on abortion.
Personally I do not see how unfettered insurance coverage for abortion can be supported by pro-life groups. Can anybody explain that?
on March 4th, 2010 at 6:53 pm
Matthew
Do you oppose abortion on demand?
I think this a fair question.
on March 4th, 2010 at 8:47 pm
Why don’t we give our brains a rest and simply accept that the Pro-Life movement is a wholly owned subsidiary of the Republican party. An over-simplification? Maybe; but I can still hear Fr. Paone at the 1984 Republican Convention: “Is’nt it great to be with Catholics who are not afraid to be political.”
on March 4th, 2010 at 8:55 pm
Oops. That should be the 1994 Republican Convention. And since this is also National Grammar Day I need to change “Is’nt” to “Isn’t.”
on March 4th, 2010 at 10:39 pm
Why don’t we simply accept the fact that so-called progressive Catholics simply pay lip service to pro-life principles and are really a wholly owned subsidiary of the Democrat Party? I can still see the list of Catholics who signed on to the Obama campaign despite his radical pro-abortion agenda for the “Common Good.”
on March 4th, 2010 at 11:18 pm
The editorial board of the Christian Science Monitor thinks there should be a “full-throated debate over abortion,” with the language in the Congressional health care reform bills the fodder for the opening salvos.
http://news.yahoo.com/s/csm/20100304/cm_csm/285026
on March 4th, 2010 at 11:44 pm
Thanks for this post and effort to make sense of a complex issue, Matt.
Here’s an eye-catching item at The Post by Matt Miller:
Sorry, Bart Stupak — the feds already subsidize abortion
By Matt Miller
http://voices.washingtonpost.com/postpartisan/2010/03/sorry_bart_stupak_–_the_feds.html
on March 5th, 2010 at 7:00 am
Matthew
Please look at the text of the bill. It says the monies go into a separate account that may not include the money from the subsidized credit (a fiction), not that the account only includes the surcharge. It may include more than the surcharge – in other words the unsubsidized portion. So if a person has a $1100 insurance bill, and $100 is a surcharge, and $500 is subsidized, the insurer has $600 available to pay into the “segregated fund.” How they distinguish one $500 from another is an accounting method.
on March 5th, 2010 at 11:22 am
Many folks in this discussion are aware that the US Bishops are also critical of the Senate bill and strongly favor the House bill with the Stupak language. Many of the resources the bishops make available, such as letters and bulletin inserts, state that the Senate bill is not acceptable and urge Catholics to contact their senators and representatives, but don’t explain why the Senate bill is defective. That may create the impression that the bishops aren’t really familiar with the contents of the bills, or are simply favoring conservative politics.
The bishops have prepared a one-page table that compares the two bills and points out the major areas of difference between them from the perspectives of abortion funding and conscience protection.
To my mind, this exhibit raises serious questions about the Senate bill, despite the Senate bill’s segregation-of-funds scheme. I urge everyone trying to understand pro-life objections to the Senate bill to take a look at this exhibit.
http://www.usccb.org/healthcare/Life_Issuechart.pdf
on March 5th, 2010 at 12:23 pm
Jim, thanks. It is a helpful chart, though a little dense. Does it really say the Senate can mandate abortion coverage, but not as “essential health benefits”? That kind of gibberish is so characteristic of Congress. What mandates are not essential?
To my mind, the chart raises questions about the House plan as well as the Senate plan. And its principal difficulty is that it does not have a column for current practice, which would force it to clarify some of the information. It would also make it more pertinent to the current situation, where the House plan is blocked by the Republicans in the Senate.
on March 5th, 2010 at 1:22 pm
“The editorial board of the Christian Science Monitor thinks there should be a “full-throated debate over abortion,” with the language in the Congressional health care reform bills the fodder for the opening salvos.”
I reckon the CSM is not popular in these parts, nevertheless, even some here would agree with what I consider the more important observation they make: “Sad, isn’t it, that the abortion issue has now been reduced to an accounting problem.”
on March 5th, 2010 at 1:29 pm
Sean,
That is a fair question. Yes, I oppose abortion on demand.
Your representation of the Senate Bill is innaccurate. The premium paid into the account that does not cover abortion cannot be used by the insurance company to pay for abortion; there is no traffic between the two accounts. None.
on March 5th, 2010 at 2:18 pm
F.Y.I: http://action.aul.org/site/MessageViewer?em_id=6461.0&dlv_id=9161
Be sure to read Dr.Yoest’s op-ed piece in The Wall Street Journal as well.
on March 5th, 2010 at 2:21 pm
It seems quite possible (likely?) that the votes in the House that Rep. Stupak allegedly controls are the difference between the Senate bill passing and not passing. Apparently, Congress is now considering drafting separate legislation to address the Stupak faction’s abortion concerns.
http://thehill.com/blogs/blog-briefing-room/news/85097-hoyer-dems-could-create-separate-abortion-bill-to-satisfy-stupak
That a Democratic Congress, run by Speaker Pelosi, would even publicly admit they are considering a bill that restricts abortion in some way, is an event I never expected to see.
on March 5th, 2010 at 2:37 pm
Matthew
I did not say there was traffic between the accounts, I said that distinguishing between them is an accounting exercise only.
The actual words of the statute are:
SEGREGATION OF FUNDS.—In the case of a plan to which subparagraph (A) applies [one the covers abortion], the issuer of the plan shall, out of amounts not described in subparagraph (A), [non-credit funds] segregate an amount equal to the actuarial amounts determined under subparagraph (C) for all enrollees from the amounts described in subparagraph (A)
Interestingly, that actuarial amopunt must be based on all enrollees and all enrollees must pay it. That means the population base includes males, prepubescent, and post menopausal females. So, in other words, the majority of covered persons who can’t even obtain an abortion must pay for the “service” and those that would get the “service” don’t pay the full cost.
on March 5th, 2010 at 3:10 pm
Sean,
I’m not sure what you’re citing. I’ve been referring to “Section 1303. Special Rules” of the Senate Bill, which I’ll copy below. I still don’t know quite what you mean when you say the segregation of funds is an accounting exercise only. It is indeed an accounting arrangement, one that prevents the government from paying for abortions, which is what we want, isn’t it?
You also seem to misread the passage about actuarial value. In (D)(ii)(I) the bill stipulates that in determing the cost of coverage for elective abortion the insurer “may take into account the impact on overall costs of the inclusion of such coverage, but may not take into account any cost reduction estimated to result from such services, including prenatal care, delivery, or postnatal care.” In other words, insurance companies cannot make plans that cover elective abortion cheaper just because the companies may spend less for abortions than they do for prenatal care, delivery, and postnatal care. This will likely mean that people will not be lured into choosing a plan that covers elective abortion just because it’s less expensive. And remember: Under the Senate plan, states would be allowed to keep all plans that cover elective abortion out of their insurances exchanges, whereas every exchange would have to offer at least one plan that does not cover elective abortion.
Here’s the relevant section of the Senate Bill:
Sec. 1303. Special Rules.
(a) State opt-out of abortion coverage —
(1) In general — 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.
(2) Termination of opt out — A state may repeal a law described in paragraph (1) and provide for the offering of such services through the exchange.
(b) Special rules relating to coverage of abortion services.
(1) Voluntary choice of coverage of abortion services.
(a) In general, notwithstanding any other provision of this title (or any amendment made by this title)
(i) nothing in this title (or any amendment made by this title), shall be construed to require a qualified health plan to provide coverage of services described in subparagraph (B)(i) or (B)(ii) as part of its essential health benefits for any plan year; and
(ii) subject to subsection (a), the issuer of a qualified health plan shall determine whether or not the plan provides coverage of services described in subparagraph (B)(i) or (B)(ii) as part of such benefits for the plan year.
(B) Abortion services —
(i) Abortions for which public funding is prohibited — The services described in this clause are abortions for which the expenditure of federal funds appropriated for the Department of Health and Human Services is not permitted, based on the law as in effect as of the date that is six months before the beginning of the plan year involved.
(ii) Abortions for which public funding is allowed — The services described in this clause are abortions for which the expenditure of federal funds appropriated for the Department of Health and Human Services is permitted, based on the law as in effect as of the date that is 17 months before the beginning of the plan year involved.
(2) Prohibition on the use of federal funds —
(A) In general, if a qualified health plan provides coverage of services described in paragraph (1)(B)(i), 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.
(B) Establishment of allocation accounts. — In the case of a plan to which subparagraph (A) applies, 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 services described in paragraph (1)(B)(i) (after reduction for credits and cost-sharing reductions described in subparagraph 4 (A)); and
(II) an amount equal to the actuarial value of the coverage of services described in paragraph (1)(B)(i), and
(ii) shall deposit all such separate payments into separate allocation accounts as provided in subparagraph (C).
In the case of an enrollee whose premium for coverage under the plan is paid through employee payroll deposit, the separate payments required under this subparagraph shall each be paid by a separate deposit.
(C) Segregation of funds.
(i) In general, the issuer of a plan to which subparagraph (A) applies shall establish allocation accounts described in clause (ii) for enrollees receiving amounts described in subparagraph (A).
(ii) Allocation accounts — The issuer of a plan to which subparagraph (A) applies shall deposit:
(I) all payments described in subparagraph (B)(i)(I) into a separate account that consists solely of such payments and that is used exclusively to pay for services other than services described in paragraph (1)(B)(i); and
(II) all payments described in subparagraph (B)(i)(II) into a separate account that consists solely of such payments and that is used exclusively to pay for services described in paragraph (1)(B)(i).
(D) Actuarial value
(i) In general, the issuer of a qualified health plan shall estimate the basic per enrollee, per month cost, determined on an average actuarial basis, for including coverage under the qualified health plan of the services described in paragraph 20 (1)(B)(i).
(ii) Considerations — In making such estimate, the issuer:
(I) may take into account the impact on overall costs of the inclusion of such coverage, but may not take into account any cost reduction estimated to result from such services, including prenatal care, delivery, or postnatal care;
(II) shall estimate such costs as if such coverage were included for the entire population covered; and
(III) may not estimate such a cost at less than $1 per enrollee, per month.
(4) No discrimination on basis of provision of abortion — 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.
(c) Application of state and federal laws regarding abortion.
(1) No preemption of state laws regarding abortion — Nothing in this act shall be construed to preempt or otherwise have any effect on state laws regarding the prohibition of (or requirement of) coverage, funding, or procedural requirements on abortions, including parental notification or consent for the performance of an abortion on a minor.
(2) No effect on federal laws regarding abortion
(a) In general, nothing in this act shall be construed to have any effect on federal laws regarding:
(i) conscience protection;
(ii) willingness or refusal to provide abortion; and
(iii) discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion. …
Sec. 1553. Prohibition Against Discrimination on Assisted Suicide.
(a) In general, the federal government, and any state or local government or health care provider that receives federal financial assistance under this act (or under an amendment made by this act) or any health plan created under this act (or under an amendment made by this act), may not subject an individual or institutional health care entity to discrimination on the basis that the entity does not provide any health care item or service furnished for the purpose of causing, or for the purpose of assisting in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.
(b) Definition — In this section, the term ”health care entity” includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.
(c) Construction and treatment of certain services — Nothing in subsection (a) shall be construed to apply to, or to affect, any limitation relating to:
(1) the withholding or withdrawing of medical treatment or medical care;
(2) the withholding or withdrawing of nutrition or hydration;
(3) abortion; or
(4) the use of an item, good, benefit, or service furnished for the purpose of alleviating pain or discomfort, even if such use may increase the risk of death, so long as such item, good, benefit, or service is not also furnished for the purpose of causing, or the purpose of assisting in causing, death, for any reason.
on March 5th, 2010 at 5:52 pm
Matthew
Here is the link to the bill on the congressional web site, Thomas.
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590eas.txt.pdf
It has some not insignificant differences from the language you cite – for example, the Secretary of HHS sets the actuarial rates, not the insurer. And as you see the funds segregation are different.
This is one of the problems with this bill – no one can say for certain what’s in it.
on March 5th, 2010 at 6:27 pm
Matthew
After looking at your quote, I suspect what you are looking at is someone else’s “simplification” of the bill. I spend a lot of time reading legislation, and this looks nothing like any legislation I have ever read.
Example:
“In general, nothing in this act shall be construed to have any effect on federal laws regarding:”
“In general”? Your quate uses that phrase several times. So maybe if does maybe it doesn’t?
Where does the cite come from?
on March 5th, 2010 at 6:44 pm
The Catholic News Service: “Here is the text of key abortion language in the Patient Protection and Affordable Care Act, the Senate-passed version of health reform legislation.”
on March 5th, 2010 at 7:34 pm
Sean,
The section I quoted starts on page 2069 of the document you provide. Please stop saying no one can know what’s in this bill.
on March 6th, 2010 at 5:50 pm
F.Y.I.: http://www.docstoc.com/docs/15284081/Stupak-Amendment-to-HR-3692-Rev-108