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By Catharine Richert November 21, 2009

Boehner claims that the Senate health care bill includes an abortion fee

Republicans have found another flaw in the health care bill: They say Democrats are trying to impose a monthly abortion fee on anyone enrolled in the public health care option.

"Senate Majority Leader Harry Reid's (D-NV) massive, 2,074-page bill would levy a new 'abortion premium' fee on Americans in the government-run plan," wrote House Republican Leader John Boehner on the GOP's Web site.

The House version of the health care bill included an amendment promoted by Rep. Bart Stupak, D-Mich., to prevent abortion from being offered through the public plan, as well as additional restrictions for insurers who sell on the exchange.

But the Senate version of health care reform represents a clean slate and includes a provision similar to one added by Rep. Lois Capps, D-Calif., to the original version of the House legislation that would prevent the government from spending federal dollars on abortion procedures.

Here's how the Senate bill would treat the issue:

Health insurance companies participating in the insurance exchange, a virtual marketplace where consumers could compare and shop for insurance plans, could decide whether to offer abortion coverage. In each state, there would have to be at least one plan that offers the insurance and one that does not. People who get federal subsidies to help pay for coverage through the exchange could buy plans that offer abortion insurance. But the bill includes accounting rules to ensure that no tax dollars are used to pay for the procedure. The government can only pay for abortions in instances of rape, incest or to save the life of the mother, but the Health and Human Services secretary could decide to include abortion coverage beyond that. In any case, the public plan would be subject to the same rules.

We've covered the many claims from the left and the right about how abortion would be treated under health care reform, and you can read all of them here .

But Boehner's claim that the Senate bill includes a monthly "abortion fee" was new to us. Intrigued, we went directly to Page 122 of Section 1303 of the bill, the language Boehner is concerned about.

That section deals with measures the government will take to ensure that no plan offered through the exchange will use federal dollars to cover abortion procedures.

If a plan through the exchange does offer abortion coverage, "the issuer of the plan shall ... segregate an amount equal to the actuarial amounts determined under subparagraph for all enrollees," the language says. The Health and Human Services secretary "shall estimate the basic per enrollee, per month cost, determined on an average actuarial basis, for including coverage under a qualified health plan." Finally, the secretary "shall estimate such costs as if such coverage were included for the entire population covered; and may not estimate such a cost at less than $1 per enrollee per month."

All that legalese means this: Because insurance companies participating in the exchange may not use tax dollars to pay for abortion procedures, they must ensure that an adequate amount of private funding -- which will come from private premiums -- is set aside. Per premium, that funding can be no less than $1 dollar a month; otherwise, it's up to the insurance company. All this is to ensure that there's enough private premiums to pay for abortions should participants need them.

So, the bill does require that abortion coverage through the exchange be paid for with private premiums.

But does the bill language dictate an abortion fee as Boehner says?

Usha Ranji, a policy analyst for the Kaiser Family Foundation, says no.

"I don't understand what [Boehner's] reference is to," she said. The provision simply "outlines some technical direction of how you would establish cost of an abortion benefit."

Lara Cartwright-Smith of George Washington University's public health school concurred, adding that everyone participating in the exchange would have the option of choosing a plan that does not include abortion.

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So, back to Boehner's claim. The bill does not require a fee, or a charge above and beyond the premium cost specifically to cover abortions. And technically speaking, we don't know whether the public option will offer abortion coverage or not. Instead, it gives the Health and Human Services secretary a minimum for estimating the cost of covering abortions. So we give Boehner a False.

Our Sources

House Republican Leader, Blog entry , Nov. 19, 2009

House Republican Leader, Blog entry , Nov. 20, 2009

CongressDaily, Boehner Attacks Fee Provision, But Claim Comes Up Short, by Kasie Hunt, Nov. 20, 2009

George Washington University, An Analysis of the Implications of the Stupak/Pitts Amendment
for Coverage of Medically Indicated Abortions
, Nov. 16, 2009

The New York Times, comparison of House and Senate bills , accessed Nov. 20, 2009

Senate Finance Committee, health reform bill , accessed Nov. 20, 2009

Lara Carwright-Smith, George Washington University School of Public Health, Nov. 20, 2009

Emily Kryder, spokeswoman for Rep. Lois Capps, Nov. 20, 2009

Tait Sye, Planned Parenthood, Nov. 20, 2009

Douglas Johnson, National Right to Life Counsel, Nov. 20, 2009

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Boehner claims that the Senate health care bill includes an abortion fee

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