A government report appears to confirm the U.S. bishops’ long-running concerns that the Affordable Care Act forces millions of Americans to pay hidden abortion surcharges for their health insurance coverage.
The Sept. 15 report from the nonpartisan U.S. Government Accountability Office also found that most insurers do not segregate private funds used for abortion apart from the federal money allotted for subsidizing health insurance. The report identified more than 1,000 health insurance plans — all eligible for federal premium subsidies — that cover elective abortion.
The U.S. Department of Health and Human Services said the Center for Medicare and Medicaid Services will work with states and health insurance issuers to make sure they understand their obligations under the Affordable Care Act, which an HHS official told reporters on background does not permit federal funds to be used for abortion coverage, consistent with federal law.
However, Richard Doerflinger, the associate director of the U.S. Conference of Catholic Bishops’ pro-life office, told Our Sunday Visitor that the administration’s promise to give insurance issuers more guidance on how to follow the law is inadequate because the law is responsible for the problem.
“The law is itself a barrier to informed consent,” Doerflinger said. “The law actually says the insurance companies are to inform people about this coverage only through the overall list of benefits that is given to them after the time of enrollment. Obviously, you want straight answers to your questions about this particular thing and you want that before you actually enroll.”
The bishops’ conference opposed the passage of President Barack Obama’s signature health care law in 2010 because of their position that the legislation violated the Hyde Amendment and other long-standing federal laws that prohibit abortion funding. Those laws forbid using tax dollars to subsidize an entire health plan that covers elective abortion, but the bishops warned that the ACA created a looser policy of subsidizing plans and then separating funds for abortion.
The law’s mechanism for creating separate payments for elective abortion (apart from abortions performed as a result of rape, incest and to save the mother’s life) also appears to be inadequate, because the law directs insurers to tell enrollees — only after they have signed up for coverage — about the total combined payment for a plan that has abortion coverage. There is no itemized bill or statement that informs consumers how much they pay for abortion in their plan.
“These are all problems the bishops’ conference saw,” Doerflinger said. “We didn’t know how badly it would be implemented, but we saw the roots of the problem in the law.”
In 28 states that permit elective abortions without restrictions to be covered on their health insurance exchanges, the GAO report identified 1,036 qualified health plans that allow elective abortion. Most of those plans, according to the GAO report, admitted that “the benefit is not subject to any restrictions, limitations or exclusions.”
The GAO report also found that most of the insurers “do not itemize the premium account associated with non-excepted abortion services coverage on enrollees’ bills nor indicate that they send a separate bill for that premium account.”
Of the 18 health insurance issuers that the GAO report surveyed, four said that they were not telling consumers at the point of enrollment whether or not their health plans contained abortion coverage. Officials from two issuers also told the government watchdog group that they had only recently learned of the notification requirement. In addition, the report notes that five states — Connecticut, Rhode Island, Vermont, Hawaii and New Jersey — run health care exchanges where every single insurance plan covers abortion.
“In this GAO report, for the first time in a government-issued document, it specifies that we have five states where you have no choice, where every last person in any exchange program is paying for abortion out of their monthly premium, and that is a very under-reported story,” said Casey Mattox, an Alliance Defending Freedom senior counsel who is representing Barth E. Bracy, the Rhode Island Right to Life Executive Director who filed a federal lawsuit earlier this year in Connecticut challenging that state’s health care exchange.
Other observers found some positive news in the GAO report. Kristen Day, executive director of Democrats For Life of America, pointed out that the report indicates that 23 states restrict the circumstances under which abortion can be covered on their health care exchanges. Of those, 17 states do not permit any qualified health plans to cover abortion, while six states permit coverage under limited circumstances.
Even in the 28 states that do not have laws restricting abortion coverage on their health care exchanges, there are eight states that currently do not have any qualified health plans offering abortion services.
“Prior to the Affordable Care Act, five states restricted abortion coverage in insurance. A majority of health care insurance companies and organizations, including the Republican National Committee, covered abortion. The debate on the ACA brought awareness to the number of plans covering abortion and increased demand and awareness of non-abortion covering plans,” Day said.
In March 2010, President Barack Obama secured passage of the Affordable Care Act when he signed an executive order stating that the Hyde Amendment’s restrictions on federal abortion funding extended to the new health care law. The executive order helped gain the support of congressional pro-life Democrats, including former Michigan Rep. Bart Stupak, who had earlier tried to amend the ACA directly to prohibit abortion coverage.
Critics, including New Jersey Rep. Chris Smith, the Republican co-chairman of the Bipartisan Congressional Pro-Life Caucus, said the executive order was a “ploy” to garner pro-life support. In prepared remarks, Smith said that the GAO report proved that “the ironclad promises made by the president are absolutely untrue.”
In an email message to OSV, Stupak reiterated the position of Democrats for Life, and he noted that the GAO report quoted the ACA’s stated prohibition against the use of federal funds to pay for abortion services.
“This fact has not changed; the law and executive order prohibits the use of federal tax dollars to pay for abortions,” Stupak said. “Without a proper accounting, you cannot conclude whether or not federal funds are being used to pay for abortions. Also, every exchange must have at least one (qualified health plan) that does not offer any abortion services.”
However, Doerflinger said the ACA is “seriously flawed” on abortion funding and added that the bishops’ conference is pushing for legislation to address the problem. Smith has filed a bill — the No Taxpayers Funding for Abortion and Abortion Insurance Full Disclosure Act — that would prohibit the use of federal tax subsidies for abortion providing plans and that would require exchanges to disclose up front whether a health insurance plan covers abortion. Doerflinger said a more modest bill to require health insurers to disclose abortion coverage before enrollment may have a better chance of becoming law.
“We have not joined efforts to repeal the Affordable Care Act,” Doerflinger said, “But we have focused on specific moral problems like this that we want fixed.”
Brian Fraga writes from Massachusetts.