Jon O. Shimabukuro
Legislative Attorney
The Patient Protection and Affordable Care Act (“PPACA”) includes provisions that address the coverage of abortion services by qualified health plans that will be available through health benefit exchanges beginning in 2014. These provisions have been controversial, particularly with regard to the use of premium tax credits or cost-sharing subsidies to obtain health coverage that includes coverage for elective, non-therapeutic abortion services. PPACA addresses abortion coverage by the exchange plans with reference to the so-called “Hyde Amendment,” which permits the use of federal funds appropriated for the Department of Health and Human Services (“HHS”) to pay for an abortion only if the pregnancy is the result of an act of rape or incest, or if a woman’s life would be endangered if the abortion were not performed. PPACA permits exchange plans to cover both elective abortions and abortions for which federal funds appropriated for HHS are permitted, but requires plan issuers and enrollees to comply with funding segregation requirements if such plans are offered and selected.
Following PPACA’s enactment, Executive Order No. 13535 was issued to “establish an adequate enforcement mechanism to ensure that federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered).” The executive order, Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and Affordable Care Act, requires the Director of the Office of Management and Budget and the HHS Secretary to develop a model set of segregation guidelines for state health insurance commissioners to use when determining whether exchange plans are complying with PPACA’s segregation requirements. The executive order also directs the HHS Secretary to “ensure that program administrators and recipients of Federal funds are aware of and comply with the limitations on abortion services imposed on [community health centers] by existing law.” Despite the executive order, some have questioned whether funds provided under PPACA could be used to pay for elective abortions at community health centers. Some have also questioned whether elective abortions could be covered by health benefit plans offered in the temporary high risk health insurance pool program established by PPACA. The issuance of an interim final rule by HHS, however, appears to have settled that question. Health benefit plans in the program cannot cover abortion services except when the life of a woman would be endangered or when a pregnancy is the result of an act of rape or incest.
Date of Report: September 10, 2010
Number of Pages: 11
Order Number: R41013
Price: $29.95
Follow us on TWITTER at http://www.twitter.com/alertsPHP or #CRSreports
Document available via e-mail as a pdf file or in paper form.
To order, e-mail Penny Hill Press or call us at 301-253-0881. Provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.
Legislative Attorney
The Patient Protection and Affordable Care Act (“PPACA”) includes provisions that address the coverage of abortion services by qualified health plans that will be available through health benefit exchanges beginning in 2014. These provisions have been controversial, particularly with regard to the use of premium tax credits or cost-sharing subsidies to obtain health coverage that includes coverage for elective, non-therapeutic abortion services. PPACA addresses abortion coverage by the exchange plans with reference to the so-called “Hyde Amendment,” which permits the use of federal funds appropriated for the Department of Health and Human Services (“HHS”) to pay for an abortion only if the pregnancy is the result of an act of rape or incest, or if a woman’s life would be endangered if the abortion were not performed. PPACA permits exchange plans to cover both elective abortions and abortions for which federal funds appropriated for HHS are permitted, but requires plan issuers and enrollees to comply with funding segregation requirements if such plans are offered and selected.
Following PPACA’s enactment, Executive Order No. 13535 was issued to “establish an adequate enforcement mechanism to ensure that federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered).” The executive order, Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and Affordable Care Act, requires the Director of the Office of Management and Budget and the HHS Secretary to develop a model set of segregation guidelines for state health insurance commissioners to use when determining whether exchange plans are complying with PPACA’s segregation requirements. The executive order also directs the HHS Secretary to “ensure that program administrators and recipients of Federal funds are aware of and comply with the limitations on abortion services imposed on [community health centers] by existing law.” Despite the executive order, some have questioned whether funds provided under PPACA could be used to pay for elective abortions at community health centers. Some have also questioned whether elective abortions could be covered by health benefit plans offered in the temporary high risk health insurance pool program established by PPACA. The issuance of an interim final rule by HHS, however, appears to have settled that question. Health benefit plans in the program cannot cover abortion services except when the life of a woman would be endangered or when a pregnancy is the result of an act of rape or incest.
Date of Report: September 10, 2010
Number of Pages: 11
Order Number: R41013
Price: $29.95
Follow us on TWITTER at http://www.twitter.com/alertsPHP or #CRSreports
Document available via e-mail as a pdf file or in paper form.
To order, e-mail Penny Hill Press or call us at 301-253-0881. Provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.
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