Rule Implementing Health Care Exchanges Provides Funding for Abortion

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On Monday, March 12, 2012, the Department of Health and Human Services issued a final rule regarding establishment of the state health care exchanges required under the Patient Protection and Affordable Care Act (PL 111-148).

The rule provides for taxpayer funding of insurance plans that include elective abortion.  This departure from the longstanding policy is accomplished through an accounting arrangement described in the Affordable Care Act and reiterated in the final rule. 

To comply with the accounting requirement, plans collect a $1 abortion surcharge from each premium payer.  The enrollee will make two payments, $1 per month for abortion and another payment for the rest of the services covered.  As described in the rule, the surcharge can only be disclosed to the enrollee at the time of enrollment.  Furthermore, insurance plans may only advertise the total cost of the premiums without disclosing that enrollees will be charged a $1 per month to directly subsidize abortions.

The final rule mentions, but does not address concerns about abortion coverage in “multi-state” plans administered by the Federal Government’s Office of Personnel Management (OPM).  There is nothing in the Affordable Care Act to prevent some OPM (government administered) plans from covering elective abortion, and questions remain about whether OPM multi-state plans will include elective abortion.  If such plans do include abortion, there are concerns that the abortion coverage will even be offered in states that have prohibited abortion coverage in their state exchanges. The final rule indicates that specific standards for multi-state plans will be forthcoming in future rules from OPM.