Thursday, December 18th, 2014

Abortion and the Baucus health care bill

Sen. Max Baucus has said he intends to maintain the status quo on abortion.
Sen. Max Baucus has said he intends to maintain the status quo on abortion.

In his long-anticipated plan for health care reform, Senate Finance Chairman Max Baucus hoped to eliminate abortion as a wedge issue.

"This is a health care bill, not an abortion bill," Baucus, D-Mont., said. "The attempt here is to find language that just maintains the status quo."

Maintaining the status quo, however, is a matter of perception. And that’s because there are two competing realities.

On the one hand, the 1976 Hyde Amendment prohibits the use of federal funds for abortions through Medicaid, except in cases of rape, incest or when the mother’s health is in peril. So states that want to offer abortion coverage have to pay for it themselves. Restrictions on public funding for abortions also apply to coverage extended to active and retired military and federal employees.

On the other hand, many private plans currently offer abortion services. A 2003 Kaiser Family Foundation survey found that 46 percent of insured workers had coverage for abortions. Abortion rights groups argue that if the government were to ban the participation of any plan that offers abortion services, it would strip millions of women of benefits they currently get.

Legislators on both sides of the abortion issue are choosing their words very carefully. At PolitiFact we decided to look at two claims from Douglas Johnson of the National Right to Life Committee that we think get to the heart of the rhetoric on both sides.

One is that under the Baucus plan, federal tax dollars would subsidize abortions. The second is that it would send federal subsidies to insurance plans that pay for abortions.

The claims sound similar, but they’re not. In fact, they got rulings on the opposite ends of our Truth-O-Meter.

Here’s what Baucus proposed:

Abortion cannot be a mandated as part of any minimum benefits package except in cases of rape, incest or if the mother’s life is in danger. However, the insurance companies participating in the health insurance exchange wouldn’t be prohibited from offering abortion coverage. The exchange is a virtual marketplace where people can comparison shop for an insurance plan. In fact, every state exchange would have to provide one plan that covers abortion and one that does not.

The Baucus plan explicitly states that no federal funds — whether through tax credits or cost-sharing credits — could be used to pay for abortions (again, except for rape, incest, or the life of the mother).

Insurers participating in any state-based exchange that offers coverage for abortion “must segregate from any premium and cost-sharing credits an amount of each enrollee’s private premium dollars that is determined to be sufficient to cover the provision of those services.” The Health and Human Services secretary would also have to estimate the cost of abortion coverage, and any money used for abortions would have to come from premiums, not federal tax dollars.

The first Johnson claim — that federal tax dollars would subsidize abortions — is contrary to President Barack Obama’s pledge that "no federal dollars will be used to fund abortions."

Johnson, however, contends that, "Funds spent by federal agencies are, by law, federal funds. The claim that under these bills, a federal agency would use ‘private funds’ to subsidize abortions is absurd on its face — a political hoax."

Johnson also pointed to $6 billion in federal seed money in the Baucus plan to cover start-up costs and meet solvency requirements for co-ops, one segment of the exchange (think of it as a credit union, but for health insurance). But we think it’s a stretch to call that money an abortion subsidy.

The wording in the bill isn’t entirely clear, but by our reading, the way it would work is that the government would provide health care subsidies of a certain amount whether an insurer covers abortion or not. So if an insurer wants to cover abortion, that additional cost would be on the insurer, who would presumably pass that cost on to the insured. So the bottom line is that people who choose plans that cover abortion would have to pay the added cost of such coverage. We don’t think it’s fair to call that tax dollars. And so we ruled Johnson’s statement False.

But we found Johnson was on firmer ground when he said the Baucus bill "contains provisions that would send massive federal subsidies directly to both private insurance plans and government-chartered cooperatives that pay for elective abortion."

The Baucus plan would, in fact, allow private companies participating in the exchange, as well as the co-op, to offer abortion services. And people in both those plans could see federal subsidies.

When Obama said no tax dollars would be used to fund abortions, what he did not say is whether his plan might expand access to abortion coverage for millions of women.

If millions of uninsured people would now get insurance due to the health care plan, and some of the plans offer abortion insurance, we think it’s fair to conclude the Baucus plan would mean more women would have access to abortion services.

And so we ruled Johnson’s claim that the Baucus plan would send federal subsidies to plans that cover abortion True .

Planned Parenthood calls the Baucus plan "a carefully crafted compromise which assures that access to abortion would neither be mandated nor prohibited — and that women would not lose health care benefits that they have had for decades, while also addressing concerns that no federal funds would be used for abortion."

Again: Federal subsidies to plans that offer abortion, yes; taxpayer subsidizing of abortion, no.