No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2015by Representative Keith J. Rothfus
Posted on 2015-01-22
ROTHFUS. 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 [[Page H501]] 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.
Mr. ROTHFUS. 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.