Health Care Reform and Abortion, a Ball of Confusion--Again?

A micro-controversy related to last Spring's drawn-out battle over whether or not the Patient Protection and Affordable Care Act (PPACA), the nation's engine of health care reform, included end-run bureaucratese that would allow federal funding for abortion was stirred up by the release of guidelines for the creation of high-risk insurance plans in Pennsylvania and New Mexico, among the first states to tap into health-care reform resources. Pennsylvania received $160 million in federal monies to establish a plan for approximately 4,000 Pennsylvanians with pre-existing conditions that lock them out of private coverage.

Both state plans initially included language which, according to the National Right to Life Committee, indicated that abortion procedures could be covered, essentially confirming the NRLC's darkest suspicions of the Obama administration's intentions regarding health care reform and abortion funding. The federal Department of Health and Human Services quickly issued a clarification. "As is the case with [Federal Employee Health Benefit] plans currently, and with the Affordable Care Act and the President's related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered. Our policy is the same for both state and federally-run PCIP programs... The contracts to operate the Pre-existing Condition Insurance Plan include a requirement to follow all federal laws and guidance." A spokesperson for HHS said that additional guidance for states is forthcoming, presumably to avoid similar confusion.

The clarification was acknowledged by Cardinal Daniel DiNardo of Galveston-Houston, chairman of the U.S. Catholic bishops’ Committee on Pro-Life Activities, who said: “We welcome this new policy, while continuing to be gravely concerned that it was not issued until after some states had announced that pro-abortion health plans were approved and had begun to enroll patients. This situation illustrates once again the need for Congress to enact legislation clearly stating once and for all that funds appropriated by PPACA will not pay for abortions or for insurance coverage that includes abortion. The issue of government involvement in the taking of innocent human life should not remain subject to the changeable discretion of executive officials or depend on the continued vigilance of pro-life advocates." 

While DiNardo reiterated the USCCB's concerns about abortion-funding and health care reform, he did note the importance of the creation of insurance programs for high risk patients. “It is vitally important for people with serious medical conditions who have been unable to obtain coverage to receive the help offered by programs such as this—and for them to be assured that their coverage will be life-affirming, not life-threatening,” the Cardinal said.

Pennsylvania and New Mexico officials likewise issued clarifications about their plans. Pennsylvania's Insurance Department issued the following statement: "Pennsylvania will—and has always intended to—comply with the federal ban on abortion funding in the coverage provided through our federally funded high risk pool. This program will provide much-needed assistance for the sickest of the sick. The likelihood that any of those covered will seek abortion services is remote, but if they do need such services, they will have to pay for them out their own pocket."

After the rhetorical and political storm stirred up by abortion and health care, it's a little disheartening that such ambiguity could have been allowed so early in the process of the national reform effort. Unless, of course, it wasn't. Roseanne Placey, a spokesperson for Pennsylvania's Insurance Department was adamant that the Pennsylvania plan would never have allowed abortions procedures with federal dollars. "All through the proposal, we said we would comply with all federal guidelines and all federal law," Placey said, a week or so into this controversy, some exasperation was evident in her voice. "We know we can't use federal money [for abortion procedures]. We couldn't do it and we would never do it."

Placey expressed some frustration with local prolife groups she says she has previously worked with. Placey said a draft of the policy solicitation has been available since June and comment was invited. It was only after the plan was accepted by the federal Department of Health and Human Services that concerns with the plan's language was raised. "If they thought there was some loophole [that would have allowed federal funding for abortion], why didn't they say so when it was still a draft?" she asked. "We know the federal law; we always intended to comply with federal law," Placey said. "Elective abortions are not covered."

Indeed the plan solicitation clearly states that administrative subcontractors would have to be in compliance with federal law and baldly notes that elective abortions were not allowed under the plan. But the solicitation also includes the following: "Abortions: Includes only abortions and contraceptives that satisfy the requirements of 18 Pa.C.S. § 3204-3206 and 35 P.S. §§10101, 10103-10105." FactCheck.org agrees with the NRLC that wording was a reasonable cause for concern.

What remains to be seen is if the barrage of clarifications is enough to settle the current contretemps. Other states will, one can only assume, take greater care in drafting proposals going forward, and it's pretty clear that the NRLC and the bishops will continue to closely follow further developments: the former with perhaps an overeagerness to pounce on misunderstandings, and the latter, perhaps with a growing confidence in the direction of reform. To that end, the Democrats for Life of America have issued an update on the concerns the U.S.C.C.B. raised during the congressional debate over health care in March. The Dems for Life note some of the pro-life components of the nascent reform effort and try, yet again, to assuage some of the concerns raised by the bishops and pro-life agencies.

For more on this: Faith in Public Life

Kevin Clarke