I rise in support of H.R. 7, the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act. Madam Speaker, we know from science that everyone's life begins at conception. The right…
I rise in support of H.R. 7, the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act.
Madam Speaker, we know from science that everyone's life begins at conception. The right to life is God-given and is described in our Declaration of Independence as ``unalienable,'' which means something that cannot be taken away. I defend, Madam Speaker, the right to life of everyone in this country and of everyone in this Chamber, even of those opposed to this legislation.
This bill helps promote a culture of life. It reflects the overwhelming opinion held by Americans that taxpayer dollars should not be used to pay for abortion. It also holds President Obama accountable for another one of his broken promises, when he assured us that his health care law would not allow taxpayer funds to be used for abortion.
We know, Madam Speaker, from a September 15, 2014, GAO report on health insurance exchanges that tax dollars are paying for more than 1,000 ObamaCare plans that cover elective abortions. This bill stops that. I insert the GAO report into the Congressional Record.
[From the U.S. Government Accountability Office, Sept. 15, 2014]
Congressional Requesters--Health Insurance Exchanges: Coverage of Non-
excepted Abortion Services by Qualified Health Plans
The Patient Protection and Affordable Care Act (PPACA)
requires the establishment in all states of health insurance
exchanges--marketplaces where eligible individuals may
compare and select among insurance plans offered by
participating private issuers of health coverage. PPACA
requires the insurance plans offered under an exchange, known
as qualified health plans (QHP), to provide a package of
essential health benefits--including coverage for specific
service categories, such as ambulatory care, prescription
drugs, and hospitalization. In addition to these categories
states may require or restrict coverage of other benefits by
QHPs. Consistent with federal and state law, QHPs may cover
other benefits, such as abortion services.
PPACA prohibits the use of federal funds made available to
offset the cost of QHP coverage--that is, income-based tax
credits and subsidies--to pay for ``non-excepted abortion
services,'' which, based on the law applicable to the 2014
benefit year, are abortion services performed except where
the pregnancy is the result of an act of rape or incest, or
the life of the pregnant woman would be endangered unless an
abortion is performed. While QHPs may cover non-excepted
abortion services, PPACA places requirements on the provision
of such coverage. These include the requirement to estimate
the cost of coverage of such services, at an amount of no
less than $1 per enrollee, per month, and to collect from
each enrollee an amount equal to the actuarial value of the
coverage--segregated from any other premium amounts collected
by the QHP--to be used to pay for the costs associated with
providing non-excepted abortion services. In addition, PPACA
directed the Office of Personnel Management (OPM) to contract
with issuers to offer at least two multi-state QHPs in each
state, at least one of which does not cover non-excepted
abortion services.
There are 23 states with laws restricting the circumstances
under which QHPs may provide non-excepted abortion services
as a covered benefit in 2014, and 28 states with no such
laws. Among the 23 states with restrictions, 17 have laws
that do not permit the coverage of non-excepted abortion
services by QHPs, and 6 states permit the coverage of non-
excepted abortion services only in limited circumstances,
such as to prevent substantial and irreversible impairment of
a pregnant woman's major bodily function.
You asked that we provide a list of QHPs that do and that
do not cover abortion services and for additional information
on issues related to that coverage. This report describes
whether non-excepted abortion services are covered by QHPs
within the 28 states with no laws restricting such coverage
for the 2014 benefit year, and provides additional
information--such as the scope and the cost of non-excepted
abortion services coverage--for selected QHPs that cover such
services.
To obtain the information we present here, we contacted
every state to determine whether states had laws restricting
the circumstances under which abortion services may be
provided as a covered benefit by QHPs in 2014. Based on our
review of those laws and relevant federal laws and
regulations, we determined that 23 states have laws
restricting the circumstances under which non-excepted
abortion services may be provided as a covered benefit by
QHPs for the 2014 benefit year. In order to report on
whether non-excepted abortion services are covered by QHPs
within the 28 states with no laws restricting such
coverage in 2014, we obtained data on QHPs' coverage of
non-excepted abortion services from the Centers for
Medicare & Medicaid Services (CMS), within the Department
of Health and Human Services (HHS), the agency responsible
for overseeing the establishment of health insurance
exchanges; private issuers of QHPs; state departments of
insurance and state exchange organizations; and from
officials at OPM. While these data sources have different
characteristics and limitations, we have determined that,
when taken together, they are reliable for the purpose of
indentifying which QHPs do and which do not provide non-
excepted abortion services coverage in 2014 within the 28
states with no laws restricting such coverage. To provide
additional information regarding non-excepted abortion
services for selected QHPs that cover such services, we
interviewed and collected documentation from a non-
probability sample of 18 issuers about the QHPs they offer
in 10 states. Our criteria for selecting these issuers
included states with no laws restricting non-excepted
abortion services coverage organized by CMS region, state
uninsured population, and number of issuers covering non-
excepted abortion services. These 18 issuers accounted for
nearly one-quarter of QHPs that covered non-excepted
abortion services and were offered within the 28 states.
We conducted our work from February 2014 to September 2014
in accordance with all sections of GAO's Quality Assurance
Framework that are relevant to our objectives. The framework
requires that we plan and perform the engagement to obtain
sufficient and appropriate evidence to meet our stated
objectives and to discuss any limitations in our work. We
believe that the information and data obtained, and the
analysis conducted, provide a reasonable basis for any
findings and conclusions in this product.
Results
1. Which QHPs participating in health insurance exchanges
provide non-excepted abortion services as a covered benefit,
and which do not?
Within the 28 states with no laws restricting the
circumstances under which QHPs may provide non-excepted
abortion services as a covered benefit in 2014:
--in 5 states (Connecticut, Hawaii, New Jersey, Rhode
Island, and Vermont), all QHPs cover non-excepted abortion
services;
--in 15 states (Alaska, Arizona, California, Colorado, the
District of Columbia, Georgia, Maine, Maryland,
Massachusetts, Montana, New Mexico, New York, Oregon, Texas,
and Washington), some QHPs cover non-excepted abortion
services; and
--in 8 states (Delaware, Illinois, Iowa, Minnesota, Nevada,
New Hampshire, West Virginia, and Wyoming), no QHPs cover
non-excepted abortion services.
Nationally, 1,036 QHPs in these 28 states cover non-
excepted abortion services and 1,062 QHPs do not.
2. For selected QHPs, what is the scope of the non-excepted
abortion services benefits that are provided?
Of the 18 issuers offering QHPs that cover non-excepted
abortion services from which we obtained information, all but
three issuers indicated that the benefit is not subject to
any restrictions, limitations, or exclusions. One issuer told
us that it only covers services for a ``therapeutic
abortion,'' which a health care provider determines to be
medically necessary. Two issuers that offered QHPs in New
York indicated that, consistent with requirements set by the
state-based exchange, they impose a limit of one non-excepted
abortion treatment per year. However, one of these two
issuers indicated they also offer QHPs that were not subject
to this restriction. All 18 issuers also indicated that their
abortion services benefit is subject to the same requirements
as other benefits, such as enrollee out-of-pocket costs--
including deductibles, copayments, and coinsurance--and prior
authorization, all of which can vary depending on the
location where the service is provided. For example, issuers
indicated that if this service is provided in an outpatient
setting--which one issuer noted is the typical location--
enrollees are not required to request prior authorization,
similar to any other service performed in an outpatient
setting. Additionally, if performed in an inpatient setting,
the service would require prior authorization, similar to any
other service performed in such a setting. Issuers indicated
that this benefit is described in member materials where
other covered benefits are listed.
3. For selected QHPs, how do issuers estimate the cost of
non-excepted abortion services coverage, what is this cost,
and how are enrollees billed for this coverage?
To estimate the cost of covering non-excepted abortion
services, issuers we contacted indicated that they generally
reviewed historical costs for these procedures, similar to
the approach used to estimate the actuarial value of the
premium attributable to the cost of other covered benefits.
All but one of the issuers from which we obtained information
estimated the cost of the coverage of non-excepted abortion
services to be less than $1 per enrollee, per month. For
example, officials from one issuer told us that their
actuaries estimated that the cost for non-excepted abortion
services ranged between 10 cents and 20 cents per enrollee,
per
month, calculated across multiple states, while officials
with another issuer said that the cost for these services
ranged from 10 cents to 70 cents per enrollee, per month. All
but two of the issuers that estimated the cost to be less
than $1 indicated they rounded the amount up to comply with
PPACA's requirement that the cost of such coverage be
estimated at no less than $1 per enrollee, per month. The
other two issuers noted that they did not round up the amount
to the statutory minimum of $1 and, therefore, were not using
this statutory minimum as a basis for determining premium
amounts to collect from enrollees for non-excepted abortion
services. The highest cost estimated by the issuers we
interviewed was $1.10 per enrollee, per month. For several of
the issuers we contacted, the premium amount associated with
non-excepted abortion services coverage was reported to also
be $1; however, for other issuers the premium amount varied
from the cost issuers estimated for this coverage. For
example, the issuer that estimated the cost of coverage of
non-excepted abortion services at $1.10 per enrollee, per
month, indicated that when adjusted to a paid cost based upon
plan design and administrative expenses, the premium amount
collected from enrollees ranged from 51 cents to $1.46,
depending on the specific QHP.
Fifteen issuers and the Washington Health Benefit
Exchange--which bills enrollees on behalf of issuers offering
QHPs in the state-based exchange, including for 2 of the 18
issuers from which we obtained information--did not itemize
the premium amount associated with non-excepted abortion
services coverage on enrollees' bills nor indicate that they
send a separate bill for that premium amount. Officials from
the remaining issuer from which we obtained information told
us that their bills indicate that there is a $1 charge ``for
coverage of services for which member subsidies may not be
used.''
4. For selected QHPs, how are consumers shopping for QHPs
able to determine whether non-excepted abortion services are
covered?
PPACA does not establish any requirements on whether or how
information about non-excepted abortion services should be
made available to consumers before they enroll in QHPs,
though six of the issuers we contacted indicated that they
made available such information about coverage for abortion
services--which they stated includes both excepted and non-
excepted abortion services--to consumers shopping for QHPs.
These issuers indicated that there are various ways consumers
may determine if their QHPs provide coverage for abortion
services before they enroll. For example, issuers said that
QHP materials--such as their summary of benefits and coverage
or member policies, such as the Evidence of Coverage
document--indicate that abortion services are covered, and
these materials are available to consumers shopping for QHPs
through the issuer's website or through the exchange's
website. Specifically, officials with one issuer informed us
that their Evidence of Coverage document, which provides
details about the features of their QHPs, was available
through the state-based exchange and the benefit--``voluntary
termination of pregnancy''--is identified in that document
under ``Family Planning Services.'' Eleven issuers indicated
that consumers shopping for QHPs do not have access to such
information; some of these issuers indicated that consumers
would need to call the issuer directly before enrolling to
determine whether a QHP provides coverage for abortion
services.
PPACA requires that QHP issuers providing non-excepted
abortion services coverage notify enrollees at the time of
enrollment that those services are covered. While most
issuers from which we collected information indicated they
were notifying enrollees that abortion services were provided
as a covered benefit, four issuers indicated they were not
disclosing this information to enrollees. Officials with two
of these four issuers told us they had only recently become
aware of this requirement, and were in the process of
updating their enrollee materials to come into compliance
with the notification requirement. Officials with the other
two issuers, both of which offered QHPs in the same state,
told us that they are not providing enrollees with
notification of the coverage of non-excepted abortion
services at the time of enrollment. These officials said that
they use model plan materials developed by the state that do
not specifically indicate that non-excepted abortion services
are a covered benefit, and that such information would only
be provided upon enrollee request.
As hundreds of thousands march today on the anniversary of the Roe v. Wade decision, I urge my colleagues to join me in committing to defend the sanctity of life and vote ``yes'' on this bill.