The extreme abortion language included in the House bill has been left out of the Senate bill, in favor of a provision that more closely tracks with the Capps amendment that was originally included in the House bill, only to be replaced by the Stupak Coathanger amendment, as well as used for the original Senate Finance committee language. The current Senate bill has added a provision stating that the HHS Secretary must ensure that no federal funds are used for abortion, if he/she determines that abortion should be a benefit in that plan. It continues to require that plans participating in the exchange have to include two plans, one that covers abortion services and one that does not.
Here's Capps's statement on the Senate bill, via e-mail.
“I am pleased that the Senate has adopted a reasonable, common ground approach on this difficult question. It appears that their approach closely mirrors my language which was originally included in the House bill. It ensures that federal funds do not pay for abortions but allows continued access to this legal medical procedure. This is a bill about health insurance reform not about expanding or contracting access to abortion services. I am glad that the Senate has rejected the more extreme Stupak language and look forward to continuing to work with my pro-life and pro-choice colleagues on a reasonable compromise on this issue.”
Her office provided this breakdown of key provisions:
- Voluntary Choice of Coverage of Abortion Services
- Abortion cannot be a mandated benefit as part of a minimum benefits package.
- A qualified health plan would determine whether it will cover:
- no abortions
- only those abortions allowed under Hyde (rape, incest and life endangerment)
- or abortions beyond those allowed by Hyde
- No Federal Funds for Abortion Coverage in the Community Health Insurance Option
- If the Secretary chooses to cover abortion services in the public plan beyond those allowed by Hyde, he/she must:
- Guarantee compliance with the provision prohibiting the use of Federal funds to pay for abortions (beyond those allowed by Hyde)
- Guarantee that, according to three different accounting standards, no Federal funds will be used; and
- Take all necessary steps to ensure that the United States does not bear the insurance risk for abortions that do not meet the Hyde exceptions in the public plan.
- State Flexibility and the Community Health Insurance Option
- States may require the coverage of additional benefits in the Community Health Insurance Option, but must assume costs associated with covering these benefits.
- A State may elect to require coverage of abortions beyond those allowed by Hyde only if no Federal funds are used for this coverage.
- The U.S. Government may not bear the insurance risk for a State’s required coverage of abortions beyond those allowed by Hyde.
- Hyde Amendment Exceptions and the Community Health Insurance Option:
- Abortions currently permitted by Hyde shall be covered in the Community Health Insurance Option to the same extent as they are under Medicaid (only cases of rape, incest and life endangerment).
- Consumer Choice Assured Among a Variety of Plans in the Exchanges
- The Secretary would ensure that in each State Exchange, at least one plan provides coverage of abortions beyond those permitted by Hyde and at least one plan does not provide coverage of abortions beyond those permitted by Hyde.
- Strict Prohibition on the Use of Federal Funds to Pay for Abortion Services
- No tax credit or cost-sharing credits may be used to pay for abortions beyond those permitted by the Hyde Amendment (only cases of rape, incest and life endangerment).
- Segregation of Funds
- Issuers of health insurance plans that offer coverage for abortion beyond those permitted by the Hyde amendment must segregate from any premium and cost-sharing credits an amount of each enrollee’s private premium dollars that is determined by the Secretary to be sufficient to cover the provision of those services.
- Actuarial Value of Optional Service Coverage
- The HHS Secretary would be required to estimate, on an average actuarial basis, the basic per enrollee, per month cost of including coverage of abortions beyond those permitted by the Hyde Amendment.
- In making such estimates, the Secretary may take into account the impact of including such coverage on overall costs, but may not consider any cost reduction estimated to result from providing such abortions, such as prenatal care.
- In making the estimate, the Secretary would also be required to estimate the costs as if coverage were included for the entire covered population, but the costs could not be estimated at less than $1 per enrollee, per month.
- Provider Conscience Protections
- No individual health care provider or health care facility may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions.
- Application of State and Federal Laws
- No pre-emption or interference with State laws. State laws regarding the prohibition of or requirement of coverage or funding for abortions and State laws involving abortion-related procedural requirements are not preempted.
- The provision similarly provides that Federal conscience protections and abortion-related antidiscrimination laws would not be affected by the bill.
- The rights and obligations of employees and employers under Title VII of the Civil Rights Act of 1964 would also not be affected by the bill.
- In addition, this bill does not affect State or Federal laws, including section 1867 of the Social Security Act (EMTALA), requiring health care providers to provide emergency services.
That's probably not enough for Stupak, seems to have been enough (for now, anyway) for Ben Nelson. Celebrating the continuation of the incredibly discriminatory Hyde amendment hardly seems appropriate, but at least this doesn't send us marching backwards.