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Proposed abortion restrictions and health insurance coverage

Anti-abortion activists and legislators have tried for years to overturn Roe v. Wade, the landmark 1973 court ruling that legalized abortion. Failing that, abortion opponents have turned their attention to your health insurance policy and its abortion coverage -- an attempt to block both public programs and private insurers from paying for the politically charged procedure.

Two bills pending in the U.S. House, the No Taxpayer Funding for Abortion Act (H.R. 3) and the Protect Life Act (H.R. 5111), would create complex new rules governing abortion funding. What would happen if they became law -- including the effect on health insurance -- still is being analyzed.

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U.S. Rep. Chris Smith, R-N.J., is the main sponsor of the No Taxpayer Funding for Abortion Act; U.S. Rep. Joe Pitts, R-Pa., is the main sponsor of the Protect Life Act. Both pieces of legislation were being considered by U.S. House committees the week of Feb. 7, 2011.

'Extreme attacks' on women's health

Abortion rights supporters say the bills would greatly expand the definition of federal funding for abortion and might motivate private health insurers nationwide to drop abortion coverage.

These bills represent "a serious legislative threat," Planned Parenthood of America Federation spokesman Tait Sye says.

Cecile Richards, president of Planned Parenthood, said in a statement that the true intent of the No Taxpayer Funding for Abortion Act is "to end insurance coverage for virtually all abortions, including private insurance coverage that Americans pay for with their own money, even in cases involving the most severe dangers to a woman's health."

Nancy Keenan, president of NARAL Pro-Choice America, says the two bills are an assault on "women’s freedom and privacy."

"This debate is just getting started. Any member of Congress who has signed his or her name to this agenda must be held accountable for such extreme attacks against women’s reproductive health services," Keenan said in a statement.

Abortion funding is 'fiscally irresponsible'

For their part, proponents say the bills simply would prevent the federal health care reform law from expanding federal funding of abortion.

"It is imperative that the federal government stays out of the business of subsidizing the morally objectionable practice of abortion," U.S. Rep. Joe Pitts, R-Pa., said when his Protect Life Act was introduced.

In a speech on the House floor promoting his bill, Smith said: "The ugly truth is that women are victimized by abortion -- wounded and hurt physically and emotionally. Women deserve better than abortion."

Abortion opponents hope to see the abortion rate reduced by allowing less insurance coverage for the procedure. While the loss of coverage wouldn't stop abortions altogether, studies have shown it might reduce the more than 1.2 million abortions that American women have annually.

The nonprofit Guttmacher Institute, a research and policy group, has found that taxpayer funding bans can reduce the abortion rate by as much as 25 percent. A typical procedure costs $451, an amount many lower-income women might find a barrier to obtaining an abortion. Guttmacher says 42 percent of women obtaining abortions have incomes below the federal poverty level.

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The conservative Family Research Council says: "Government funding for abortion is both morally and fiscally irresponsible."

While these new bills -- particularly the No Taxpayer Funding measure (H.R. 3) -- likely would be vetoed by President Obama and then face a tough override vote in Congress, abortion rights activists say they plan to work actively against passage.

The current controversy is in the crosshairs of two interesting statistics about American attitudes: While two-thirds of Americans have historically said they think abortion should remain legal, two-thirds believe federal money shouldn't pay for the procedure.

What the bills say

The two bills seek to more broadly define when federal dollars are enabling abortions to be provided. Two aspects of the new legislation could particularly affect consumers' health insurance coverage, says Adam Sonfield, a senior policy associate at Guttmacher.

First, new state health exchanges being created under the federal health care reform law for people who cannot obtain private insurance because of pre-existing conditions would be prohibited from offering abortion coverage. The state exchanges, set to debut in 2014, would lose their federal funding if they offered abortion services, even if such services were paid for with state or private funds. Federal funds could not be mixed with other funding in an exchange that offers abortion.

"This sets up some very strict, overly burdensome rules for segregating federal and private dollars," Sonfield says.

Second and perhaps more importantly, H.R. 3 (Smith's bill) views the tax credits and tax deductions that individuals and businesses receive for paying health insurance premiums or out-of-pocket costs as a form of federal funding – a big change from current policy, which considers only direct federal payments to insurance programs.

If your insurance plan covers abortion, your tax credits for health care costs would be disqualified under H.R. 3. Since this credit can easily run into five figures for many families, the theory is this would strongly discourage people from seeking policies that include abortion – and would encourage insurance companies to drop abortion from their plans.

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H.R. 3 also targets the tax shelter provided by health savings accounts, or HSAs. If HSA money were used to cover abortion co-pays or related charges not paid by insurance, the entire amount deposited in the HSA would lose its tax-exempt status.

Cardinal Daniel DiNardo, chairman of the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops, has urged members of Congress to pass the No Taxpayer Funding for Abortion Act and the Protect Life Act so that federal money won't support abortion.

In a letter to members of Congress, DiNardo wrote that passage of the No Taxpayer Funding for Abortion Act would allow federal health care bills to "be debated in terms of their ability to promote the goal of universal health care, instead of being mired in debates about one lethal procedure that most Americans know is not truly ‘health care’ at all."

In a statement, the Congressional Pro-Choice Caucus rejected that line of thinking from DiNardo and other abortion opponents. The two abortion funding proposals would “actually cut off millions of women from the private health care they have access to today, even preventing them from using their own money for medically necessary procedures,” the congressional caucus said.

Health insurance rates may rise

Guttmacher's Sonfield says that if either of the abortion measures is passed, a women seeking abortion coverage theoretically could obtain it through a separate health insurance "rider." But in states that already have bans on insurance coverage for abortions, that hasn't worked, he says. Why? Only people likely to use abortion services would want the rider, making it too risky of a pool of policyholders for insurers.

Tom Loker, a longtime observer of federal health policies and chief operating officer of benefit plans administrator Ramsell Corp., says abortion coverage likely would become unattainable if the Pitts and Smith bills became law. This, in turn, would cause health insurance premiums to rise, Loker says.

This would happen because the lack of coverage for abortion would mean more uninsured patients would be seeking services. Hospitals pass the tab for that uncompensated care along to private insurers, Loker says. In addition, the change might mean a rise in abortions performed by unlicensed providers – which are more likely to result in health complications and expensive hospital admissions. Again, more costs would be shifted to consumers in the form of higher health insurance premiums, Loker says.

Loker says he doubts the tax credit penalty ever will become law. "We'll see what happens," he says. "But if it did, the most likely scenario is that it's going to increase premium costs."

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