By Jost, Timothy Stoltzfus
Commonweal , Vol. 139, No. 9
On March 12 the federal government released regulations that will determine how the state health-insurance exchanges established by the Affordable Care Act will work. Within days, the law's opponents charged once again that millions of Americans will receive federal subsidies to pay for abortions. According to the critics, the new regulations will also end up tricking prolife Americans into inadvertently signing up for insurance plans that cover abortions.
Not true. In fact, the Affordable Care Act may be the single most prolife piece of legislation ever adopted by Congress. Once it is fully implemented, it will extend insurance coverage for life-saving medical care to millions of Americans, thousands of whom die each year because they lack access to care. The law explicitly forbids insurers to ''make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life." All insurers in the individual and small-group market will be required to cover maternity care, a benefit often missing from today's individual policies. None will be required to cover elective abortions.
Moreover, the law prohibits use of its new federal tax subsidies to pay for abortions, except where they can otherwise be covered by federal funds (in cases of rape, incest, or to save the life of the mother). The law also protects the conscience rights of health-care providers to refuse to perform abortions, and it prohibits discrimination against such providers.
So why do prolife advocates continue to attack the Affordable Care Act? The law requires states to establish government-regulated exchanges, or markets, where consumers can shop for health-insurance plans and, if necessary, pay for them using federal tax credits. The provisions that prohibit the use of federal funding to pay for abortions covered through the exchanges are complicated, and for those determined to find a sinister purpose in the legislation, these provisions and the regulations that implement them can be twisted to suggest one.
The March 12 regulations governing health-insurance exchanges are intended to implement the Affordable Care Act, and simply repeat--often verbatim--the statute's language regarding abortion. Contrary to what has been suggested, they do not introduce new proabortion measures. In state insurance exchanges, Americans will be able to choose a private insurance plan from several offerings. Lower - and middle-income Americans will be eligible for federal tax credits that will help them pay for the plan they choose. The private plans offered through exchanges must cover specific basic benefits--including maternity care--but otherwise can offer whatever benefits consumers might want.
The Affordable Care Act explicitly permits states to prohibit plans in the exchange from covering abortions; one-third of states have already taken advantage of that provision to pass laws barring all exchange plans from covering abortion (twice as many as now prohibit all private insurers from paying for abortions). In the absence of a state law prohibiting abortion coverage, the new law allows insurers the choice of issuing policies that do or do not cover abortions. The federal government will make national "multistate" plans available through individual state exchanges. At least one multistate plan that does not cover elective abortions must be available in each state. But no exchange plan is required to cover abortions.
If an insurer decides to cover abortions, it must set up a complicated and burdensome system to ensure that no federal dollars pay for abortions. The law and regulations require insurers that offer abortion coverage to first determine the "actuarial value"--that is, the full cost of providing abortion coverage to those who want to buy it. Terminating a pregnancy costs insurers much less than providing maternity and newborn care over the life of an insurance policy. …