Abortion and ObamaCare

By Carrie Gordon Earll
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Focus on the Family

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The rollout of the Affordable Care Act (ACA or ObamaCare) is making news as citizens discover the cancellation of their health insurance policies and the sometimes unaffordable cost of replacing them.

Along with these headlines, there’s another topic that deserves attention: The expansion of abortion through ObamaCare.

When the federal health-care law was debated before the U.S. Congress in 2009, Focus on the Family joined other pro-life organizations to oppose it as it represented the potentially largest expansion of abortion since Roe v. Wade.For the first time, the government is set to facilitate and possibly subsidize abortion in private health-care plans through ObamaCare’s implementation.

Lingering Questions

To date, troubling questions still exist about ObamaCare and abortion, including:

  1. Does the ACA put the federal government in the role of facilitating and possibly subsidizing abortion?
  2. Will Americans, who enroll in health-care policies offered through their state exchanges, know before purchasing a policy if it includes abortion?

Quick Facts About ObamaCare

Before we look at those two questions, here are some basic facts you need to know. As with most of ObamaCare, the abortion component is complicated, with many moving parts.

Here’s a short summary of the issues involved:

Individual Mandate

  • The Individual Mandate was upheld as constitutional by the U.S. Supreme Court in 2012.
  • It requires all American citizens to purchase a government-approved healthcare plan or pay a penalty.
  • The health-care plan may be employer-provided; a publicly funded program, such as Medicare or Medicaid; through a state health-insurance exchange; or a policy offered outside of an exchange.

State Exchanges

  • The ACA requires states to set up government-operated health insurance markets or “exchanges” that offer qualified health plans meeting ACA mandates for specific coverage.
  • An exchange is designed to allow private insurance companies to offer health-care policies to individuals and families who do not receive insurance through their employer.
  • If a state did not act by Jan. 1, 2014, the federal government has the option of setting up an exchange in a state apart from state input.
  • Plans sold on state exchanges may qualify for federal assistance in the form of tax credits and subsidizes, if the citizen purchasing the plan is eligible for such assistance.

Hyde Amendment

  • Since 1976, a government policy called the “Hyde Amendment” prohibits federal funding of abortion and funding of any insurance plan that includes abortion, except in cases of rape, incest or to save the life of the mother.
  • It primarily affects Medicaid recipients who can have abortions funded by tax dollars in these rare instances.
  • During the ObamaCare debate in Congress, President Obama insisted the proposed law followed the Hyde Amendment; pro-life members of Congress disagreed, saying specific provisions in the bill created a way to bypass the amendment.

Abortion in the Affordable Care Act (ACA)

  • The ACA allows health-care plans to include abortion coverage.
  • It allows states to pass laws prohibiting plans that allow abortion.
  • To date, approximately one-half of states explicitly ban health-care plans covering abortion beyond what’s allowed under the Hyde Amendment; the remaining states allow such plans.
  • You can read how abortion pertains to the law in Section 1303 of the Act found on pages 778-781.

What You Need to Know

So, now back to the questions posed previously:

Does the ACA put the federal government in the role of facilitating and possibly subsidizing abortion?

Multi-State Plans

  • The ACA requires the federal Office of Personnel Management (OPM) to contract with at least two health-care insurers in each state to provide “multi-state plans” (MSP).
  • The MSPs are private sector or non-profit insurers.
  • At least one MSP in each state must include a plan that excludes abortion coverage; other plans may cover abortion.
  • The OPM is funded by public dollars from all 50 states, irrespective of whether a state allows or prohibits the sale of health-care policies covering abortion.
  • Under the ACA, the OPM may contract with and facilitate the operation of health-care plans that pay for abortions.
  • To date, the OPM reports only two existing MSPs offering elective abortion. However, only a fraction of the MSPs to be established are currently in place.

Taxpayer Subsidies for Health-Care Plans

  • The ACA allows health plans that pay for abortion to participate in state exchanges which are eligible for federal subsidies.
  • Many Americans will qualify for federal subsidies in the form of premium credits and cost-sharing subsidies.
  • Individuals and families not receiving employer-provided insurance and who have a gross income between 133% and 400% of the federal poverty level (FPL) may qualify for federal assistance when purchasing plans through state exchanges.
  • Based on 2013 levels, a family of four, earning as much as $94,200 gross annually (400% of the FPL), would be eligible for a subsidized health insurance plan.
  • These plans may cover abortion (see MSPs) and the government will send checks to policy holders to offset the cost of the plans.
  • So individuals and families who enroll in a health-care plan that covers abortion can qualify for subsidies to offset the cost of that plan.

Will These Federal Subsidies be Used to Pay for Abortions?

  • Federal subsidies cannot be used to directly purchase the abortion coverage portion in the plan, or to pay for abortions beyond what’s allowed by the Hyde Amendment.
  • So, the ACA sets up an accounting designation to “segregate” abortion coverage funding.
  • Any plan sold on a state exchange that includes abortion coverage must set up two separate accounts for receiving premiums and paying claims: One for abortion and the other everything else.
  • The same process applies to every consumer purchasing an exchange plan with abortion coverage, not just those who receive federal subsidies for purchasing health care.
  • The ACA requires everyone who purchases these plans to pay an “abortion premium” — a minimum of $1 per month surcharge per enrollee to pay for abortions.
  • The premium may be much more, but cannot be less than $1.
  • Watchthis 45-second video clip(segment begins at 5:15) of U.S. Health and Human Services Secretary Kathleen Sebelius explaining the required abortion surcharge.

As a result, the ACA requires insurance plans with abortion coverage sold on state exchanges to set up what amounts to an “abortion slush fund” that collects premiums from every enrollee — regardless of the enrollee’s gender, age or view on abortion — to pay for abortions.

Do Americans who enroll in health-care plans offered through their state exchanges know if it includes abortion before purchasing a policy?

The “Hidden” Abortion Premium

  • Americans are enrolling in private plans within state exchanges that cover abortion and may not realize it.
  • The section of the law governing the abortion premium arguably mandates the plan not be transparent in informing enrollees. See text on page 781 under “(3) Rules relating to notice, (A) and (B).”
  • Pro-life members of U.S. House and Senate have introduced legislation to require full disclosure in these policies (“Abortion Insurance Full Disclosure Act,” H.R. 3279 and S. 1848.)


1. Does the ACA put the federal government in the role of facilitating and possibly subsidizing abortion?

  • The federal Office of Personnel Management (OPM) is funded by taxpayer dollars, including from residents of states prohibiting abortion coverage from available health-care policies. So, the ACA state abortion “opt-out” does not prevent public funding of OPM’s activities under the ACA.
  • Under the ACA, OPM may contract with and facilitate the operation of health-care plans paying for abortions.
  • Under the ACA, individuals and families who enroll in an exchange-offered health-care plan covering abortion can qualify for subsidies to offset the cost of that plan, as long as the “abortion premium” is segregated and paid with non-taxpayer funds.

2. Will Americans who enroll in health-care policies offered through their state exchanges know before purchasing a policy if it includes abortion?

  • In states permitting insurance plans on the state exchange to include abortion, some consumers may unknowingly purchase a plan with abortion coverage, be charged for that coverage and fund abortion — even if it violates their pro-life views.

Copyright © 2014 Focus on the Family. All rights reserved.

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About the Author

Carrie Gordon Earll

Carrie Gordon Earll is the vice president of government and public policy at Focus on the Family, where she leads a staff that provides expertise on a range of social policy topics affecting life issues, marriage and religious liberties. She also serves as the senior policy analyst for bioethics, researching and writing on a range of topics including abortion, end-of-life …

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