President's promise broken: Secret $1 surcharge for abortion

Originally published March 14, 2012

Two years ago, President Obama signed an executive order banning federal funding for abortions in health care reform and extended the restrictions to the newly created health care insurance exchanges. Under the current law, federal funds cannot go toward abortion except in cases of rape, incest, and when the life of the pregnant woman is at risk.

“The President’s promise to women and children has been broken,” said FFL President Serrin Foster. “This is most disappointing because it affects those most vulnerable — the poor and working poor, young working women who are otherwise uninsured, and students who are not on their parents’ plan, and who will now be forced to pay $1 for an abortion surcharge through the exchange. A dollar is a dollar too much for abortion. Abortion does nothing to address the unmet needs of women.”

The Department of Health and Human Services has issued a final rule regarding establishment of the state health care exchanges required under the Patient Protection and Affordable Care Act (PL 111-148).

A health insurance exchange is a set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies. Under Federal law, all exchanges must be fully certified and operational by January 1, 2014.

As authorized by P.L. 111-148, the final rule provides for taxpayer funding of insurance coverage that includes 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 issued today.

To comply with the accounting requirement, plans will 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 fee to directly subsidize abortions.

“If abortion was such a great thing, why keep this coverage such a secret?” Foster asked.

The final rule mentions, but does not address, concerns about abortion coverage in “multi-state” plans administered by the Federal Government’s Office of Personal 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 “Specific standards for multi-state plans will be described in future rulemaking published by OPM…”