Abortion Funding Fundamentals Under Health Reform

Jessica Arons

Abortion has become a popular sideshow in the three-ring circus of the debate over health care reform. In particular, many questions about abortion funding have arisen—some genuine and some distorted.

Abortion has become a popular sideshow
in the three-ring circus of the debate over health care reform. In
particular, many questions about abortion funding have arisen—some
genuine and some distorted.

Opponents and supporters of abortion rights agreed early on, in theory,
to maintain the status quo with “abortion neutral” health care
legislation. The idea was that health care reform is not the
appropriate place to continue the fight over abortion and neither side
should attempt to use health care reform as a vehicle to further expand
or restrict access to abortion.

In pursuit of this objective, Rep. Lois Capps (D-CA) introduced an amendment
in the House Energy and Commerce Committee that attempted to strike a
balance and preserve the status quo on abortion funding. This proposal
was adopted on
July 30, 2009. On the Senate side, Finance Committee Chairman Max
Baucus (D-MT) has proposed a bill that includes abortion funding
provisions that closely mirror the Capps amendment.

Yet even finding agreement on the current state of play can be a
challenge for an issue as controversial as abortion. This chart
explains the current law on abortion funding and shows how the House
and Senate bills would maintain or change the status quo.

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Current law Capps Amendment to House health care reform bill Senate health care reform bill
The Hyde Amendment
The Hyde Amendment prohibits federal Medicaid and Medicare money from being spent on most types of abortion, including pregnancies that threaten the woman’s health or involve fetal anomalies. Federal money can only be used to pay for an abortion when the pregnancy threatens the life of the woman or results from rape or incest. The Hyde Amendment restrictions would apply to all insurance plans that participate in the health insurance exchange, whether those plans are operated by private insurers or by the government’s “public option.” In other words, no federal funding, including affordability credits or other subsidies, would be used to pay for abortions beyond what is currently allowed. Private premiums would be segregated from public funds and only the private premiums could pay for abortion services beyond those allowed by the Hyde Amendment. The Hyde Amendment restrictions would apply to all insurance plans that participate in the health insurance exchange, whether those plans are operated by private insurers or member-run co-ops. In other words, no federal funding, including affordability credits or other subsidies, would be used to pay for abortions beyond what is currently allowed. Private premiums would be segregated from public funds and only private premiums could pay for abortion services beyond those allowed by the Hyde Amendment.
Other government programs
Laws similar to the Hyde Amendment that restrict coverage of abortion services also apply to military employees and their dependents, federal employee health plans, members of the Peace Corps, women in federal prisons and detention centers, and Native Americans who receive health care through the Indian Health Services. Current restrictions on federal spending for abortion services would not change. Current restrictions on federal spending for abortion services would not change.
States
States have the option to use their own money to pay for abortion services beyond what is permitted under the Hyde Amendment, and 17 states currently do so. Federal money subsidizes these state Medicaid programs even though they cover abortion. Federal money would subsidize plans that cover abortion—just like they currently do for state Medicaid plans and employer plans—but no public money would be used to pay for abortion services not allowed by the Hyde Amendment. Government money would only be used to help pay for the other medical services covered by those plans. Federal money would subsidize plans that cover abortion—just like they currently do for state Medicaid plans and employer plans—but no public money would be used to pay for abortion services not allowed by the Hyde Amendment. Government money would only be used to help pay for the other medical services covered by those plans.
Private insurance
Private insurance companies are allowed to decide whether to cover abortion services, and 87 percent of typical employment plans currently provide such coverage. The federal government subsidizes these plans through an employer tax credit, even if the plans include abortion. Each plan in the exchange could decide whether to cover abortion services beyond those allowed by the Hyde Amendment, provided that at least one plan in each market area offers such services and one plan does not. This provision goes well beyond current law to guarantee that consumers have the option to purchase a plan that suits their medical needs and their values. No abortion services—even those allowed by the Hyde Amendment for cases that threaten the woman’s life or result from rape or incest—can be mandated as part of a minimum benefits package. Each plan in the exchange could decide whether to cover abortion services beyond those allowed by the Hyde Amendment, provided that at least one plan in each market area offers such services and one plan does not. This provision goes well beyond current law to guarantee that consumers have the option to purchase a plan that suits their medical needs and their values. No abortion services—even those allowed by the Hyde Amendment for cases that threaten the woman’s life or result from rape or incest—can be mandated as part of a minimum benefits package.

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