Obamacare 2015 Includes Federal Subsidies for Abortion

It’s been open enrollment for ObamaCare for a week now, and it’s open season for taxpayer funding of health insurance plans that provide coverage for abortion on demand.  In spite of President Obama’s promise that no federal tax dollars be used for abortion under his signature health care law, the Patient Protection and Affordable Care Act (PPACA), over a thousand health insurance plans that provide coverage for abortion on-demand are expected to receive federal subsidies in the 2015 enrollment season.

Last Thursday, Rep. Chris Smith (R-NJ), co-chair of the Bipartisan Congressional Pro-life Caucus, reintroduced the No Taxpayer Funding for Abortion Act and the Abortion Insurance Full Disclosure Act (H.R.7).

In a press conference on Capitol Hill announcing the launch of a obamacareabortion.com (a joint project of the Family Research Council and the Charlotte Lozier Institute that lists the plans in each state’s exchange that provides elective abortion coverage), Rep. Smith excoriated the president for violating his promise: “The President issued an executive order… that said… ‘the Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly created health insurance exchanges.’”

The Hyde Amendment stipulates that no federal taxpayer funds be appropriated for abortion or for “health benefits coverage that includes coverage of abortion.”

“Obamacare therefore violates Hyde by funding insurance plans that pay for abortion on-demand,” Rep. Smith said.

Arina Grossu, Director for the Center for Human Dignity at the Family Research Council, spoke of the current administration’s lack of transparency in failing to disclose which insurance plans cover elective abortions: “the Obama Administration has been unwilling… for the 2015 new enrollment… to inform Americans about abortion coverage in Obamacare plans,” Grossu said.

In September of this year, the Government Accountability Office (GAO) revealed in a report that 1,036 health insurance plans provided coverage for abortion on demand. This constitutes almost half of all plans in the 28 states (including the District of Columbia) that did not prohibit abortion coverage on their state-run or federally-run state exchanges for 2014. For the 2015 enrollment period, that number is expected to increase even as the number of states allowing such coverage decreases to 27.

In Section 1334 of the PPACA, the law clearly states that each state exchange must have at least two multi-state qualified health plans, one of which must not provide for abortion coverage except for cases of rape, incest, or endangerment of the life of the mother as a result of the pregnancy.

Due to a phase-in stipulation which does not require all states to have multi-state plans until 2017, five states did not have even one insurance plan that did not cover elective abortions in 2014, the GAO reports. If you happen to have lived in Connecticut, Hawaii, New Jersey, Rhode Island, or Vermont in 2014 and your employer dumped you into the state exchange, you would have had no option but to purchase a plan that covers elective abortion. Connecticut recently added plans that exclude elective abortion coverage but only after being threatened with a lawsuit. As for the remaining states, it is likely that no insurance options free from forced payments for elective abortions will be available in 2015.

As part of the PPACA, federal subsidies in the form of “premium assistance tax credits” are available for persons of certain income levels purchasing a plan through a state exchange. The Congressional Budget Office (CBO) estimates that these subsidies will climb to $855 billion dollars by 2024. Since there is no stipulation in the PPACA that these subsidies be barred from plans including elective abortion, billions of dollars in federal tax credits will fund insurance plans that include abortion coverage.

According to the Department of Health and Human Services (HHS) model guidelines per Section 1303 of PPACA and President Obama’s executive order prohibiting the use of “tax credits and cost-sharing reduction payments to pay for abortion services,” insurance plans offering elective abortion coverage must segregate funds for an abortion procedure from all other health care coverage. A special premium for abortion separate from the standard insurance premium must be collected from the enrollee. Funds from this premium are not supposed to be subsidized by tax credits, reduction payments, or through the Community Health Center (CHC) Fund established by PPACA nor are any portion of the standard premium supposed to go towards abortion coverage.

The segregation of funds model by its very design is contrary to longstanding policy under the Hyde Amendment. Hyde prohibits the use of federal tax dollars for abortion (except in cases of rape, incest, or life endangerment of the mother) and for health insurance plans that include elective abortion coverage.

Furthermore, section 1303 of PPACA stipulates that “an amount equal to the actuarial value of the coverage” ought to be collected for the purpose of paying for abortion procedures if a plan offers elective abortion coverage. The “actuarial value” may or may not take into account certain administrative and human capital costs necessary to apply such coverage.

There is also evidence that many health insurers are not segregating premiums as required by ObamaCare. The Centers for Medicare & Medicaid Services (CMS), the agency of HHS in charge of setting-up the state exchanges, requires that insurers segregate funds by either itemizing a separate charge for abortion premiums or collecting a separate bill for abortion premiums.

The GAO found that none of the insurers from which they collected information neither itemized a separate charge detailing an abortion surcharge nor collected a separate bill for abortion premiums. Only one insurer itemized a line at all in reference to the abortion surcharge which was listed as “for coverage of services for which member subsidies may not be used.” The GAO also revealed that the Washington Health Benefit Exchange did not even collect a premium from enrollees whose 1) plans were fully subsidized in 2014 and 2) enrolled in a plan that included coverage for elective abortion. As such the Washington Health Benefit Exchange used federal subsidies to pay for the portion of coverage that pertains to elective abortions.

While it is clear that federal tax credits and reduction payments are being applied directly to insurance plans that provide abortion coverage, it is not clear to what extent premiums for abortion are segregated from all other health insurance premiums. State health insurance commissioners are charged with ensuring compliance with the segregation of funds. The GAO’s discovery of insurers failing to itemize demonstrates there has not as of yet been any credible audit of insurers for their compliance to Section 1303 of the PPACA.

ObamaCare is perhaps the single greatest expansion of funding for elective abortion coverage. While the “actuarial value” of abortion coverage for most insurers is estimated to be only a fraction of a dollar per enrollee per annum, ObamaCare stipulates that a minimum surcharge of one dollar must be assessed. For all the insurers from which the GAO used for its report, only two insurers estimated the cost of coverage more than $1 (none more then $1.10), some reporting estimated rates as low as ten cents. As such, for some insurers this constitutes a ten-fold increase in funds available to provide coverage for elective abortion procedures.

In another instance, Planned Parenthood, the nation’s largest abortion provider, received $655,000 in grants from HHS to serve as navigators in educating prospective enrollees about the health care exchanges.

Due to a secrecy clause in ObamaCare's Section 1303, it is difficult to determine which health care plans include coverage for elective abortion services. The clause stipulates that plans which include this coverage only disclose that they offer such coverage as “part of the summary of benefits and coverage explanation, at the time of enrollment.” Since many insurers are not itemizing the abortion surcharge, it is difficult to determine whether a plan offers this coverage even after enrollment.

It’s been open enrollment for ObamaCare for a week now, and it’s open season for taxpayer funding of health insurance plans that provide coverage for abortion on demand.  In spite of President Obama’s promise that no federal tax dollars be used for abortion under his signature health care law, the Patient Protection and Affordable Care Act (PPACA), over a thousand health insurance plans that provide coverage for abortion on-demand are expected to receive federal subsidies in the 2015 enrollment season.

Last Thursday, Rep. Chris Smith (R-NJ), co-chair of the Bipartisan Congressional Pro-life Caucus, reintroduced the No Taxpayer Funding for Abortion Act and the Abortion Insurance Full Disclosure Act (H.R.7).

In a press conference on Capitol Hill announcing the launch of a obamacareabortion.com (a joint project of the Family Research Council and the Charlotte Lozier Institute that lists the plans in each state’s exchange that provides elective abortion coverage), Rep. Smith excoriated the president for violating his promise: “The President issued an executive order… that said… ‘the Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly created health insurance exchanges.’”

The Hyde Amendment stipulates that no federal taxpayer funds be appropriated for abortion or for “health benefits coverage that includes coverage of abortion.”

“Obamacare therefore violates Hyde by funding insurance plans that pay for abortion on-demand,” Rep. Smith said.

Arina Grossu, Director for the Center for Human Dignity at the Family Research Council, spoke of the current administration’s lack of transparency in failing to disclose which insurance plans cover elective abortions: “the Obama Administration has been unwilling… for the 2015 new enrollment… to inform Americans about abortion coverage in Obamacare plans,” Grossu said.

In September of this year, the Government Accountability Office (GAO) revealed in a report that 1,036 health insurance plans provided coverage for abortion on demand. This constitutes almost half of all plans in the 28 states (including the District of Columbia) that did not prohibit abortion coverage on their state-run or federally-run state exchanges for 2014. For the 2015 enrollment period, that number is expected to increase even as the number of states allowing such coverage decreases to 27.

In Section 1334 of the PPACA, the law clearly states that each state exchange must have at least two multi-state qualified health plans, one of which must not provide for abortion coverage except for cases of rape, incest, or endangerment of the life of the mother as a result of the pregnancy.

Due to a phase-in stipulation which does not require all states to have multi-state plans until 2017, five states did not have even one insurance plan that did not cover elective abortions in 2014, the GAO reports. If you happen to have lived in Connecticut, Hawaii, New Jersey, Rhode Island, or Vermont in 2014 and your employer dumped you into the state exchange, you would have had no option but to purchase a plan that covers elective abortion. Connecticut recently added plans that exclude elective abortion coverage but only after being threatened with a lawsuit. As for the remaining states, it is likely that no insurance options free from forced payments for elective abortions will be available in 2015.

As part of the PPACA, federal subsidies in the form of “premium assistance tax credits” are available for persons of certain income levels purchasing a plan through a state exchange. The Congressional Budget Office (CBO) estimates that these subsidies will climb to $855 billion dollars by 2024. Since there is no stipulation in the PPACA that these subsidies be barred from plans including elective abortion, billions of dollars in federal tax credits will fund insurance plans that include abortion coverage.

According to the Department of Health and Human Services (HHS) model guidelines per Section 1303 of PPACA and President Obama’s executive order prohibiting the use of “tax credits and cost-sharing reduction payments to pay for abortion services,” insurance plans offering elective abortion coverage must segregate funds for an abortion procedure from all other health care coverage. A special premium for abortion separate from the standard insurance premium must be collected from the enrollee. Funds from this premium are not supposed to be subsidized by tax credits, reduction payments, or through the Community Health Center (CHC) Fund established by PPACA nor are any portion of the standard premium supposed to go towards abortion coverage.

The segregation of funds model by its very design is contrary to longstanding policy under the Hyde Amendment. Hyde prohibits the use of federal tax dollars for abortion (except in cases of rape, incest, or life endangerment of the mother) and for health insurance plans that include elective abortion coverage.

Furthermore, section 1303 of PPACA stipulates that “an amount equal to the actuarial value of the coverage” ought to be collected for the purpose of paying for abortion procedures if a plan offers elective abortion coverage. The “actuarial value” may or may not take into account certain administrative and human capital costs necessary to apply such coverage.

There is also evidence that many health insurers are not segregating premiums as required by ObamaCare. The Centers for Medicare & Medicaid Services (CMS), the agency of HHS in charge of setting-up the state exchanges, requires that insurers segregate funds by either itemizing a separate charge for abortion premiums or collecting a separate bill for abortion premiums.

The GAO found that none of the insurers from which they collected information neither itemized a separate charge detailing an abortion surcharge nor collected a separate bill for abortion premiums. Only one insurer itemized a line at all in reference to the abortion surcharge which was listed as “for coverage of services for which member subsidies may not be used.” The GAO also revealed that the Washington Health Benefit Exchange did not even collect a premium from enrollees whose 1) plans were fully subsidized in 2014 and 2) enrolled in a plan that included coverage for elective abortion. As such the Washington Health Benefit Exchange used federal subsidies to pay for the portion of coverage that pertains to elective abortions.

While it is clear that federal tax credits and reduction payments are being applied directly to insurance plans that provide abortion coverage, it is not clear to what extent premiums for abortion are segregated from all other health insurance premiums. State health insurance commissioners are charged with ensuring compliance with the segregation of funds. The GAO’s discovery of insurers failing to itemize demonstrates there has not as of yet been any credible audit of insurers for their compliance to Section 1303 of the PPACA.

ObamaCare is perhaps the single greatest expansion of funding for elective abortion coverage. While the “actuarial value” of abortion coverage for most insurers is estimated to be only a fraction of a dollar per enrollee per annum, ObamaCare stipulates that a minimum surcharge of one dollar must be assessed. For all the insurers from which the GAO used for its report, only two insurers estimated the cost of coverage more than $1 (none more then $1.10), some reporting estimated rates as low as ten cents. As such, for some insurers this constitutes a ten-fold increase in funds available to provide coverage for elective abortion procedures.

In another instance, Planned Parenthood, the nation’s largest abortion provider, received $655,000 in grants from HHS to serve as navigators in educating prospective enrollees about the health care exchanges.

Due to a secrecy clause in ObamaCare's Section 1303, it is difficult to determine which health care plans include coverage for elective abortion services. The clause stipulates that plans which include this coverage only disclose that they offer such coverage as “part of the summary of benefits and coverage explanation, at the time of enrollment.” Since many insurers are not itemizing the abortion surcharge, it is difficult to determine whether a plan offers this coverage even after enrollment.