Abortion funding in the Affordable Care Act

The US Conference of Catholic Bishops has repeatedly charged that the Patient Protection and Affordable Care Act (PPACA) will fund elective abortions (defined here as any abortions other than instances of rape or incest, or medical situations in which the mother’s life is endangered). They have denied that there even exists a reasonable case against their interpretation of the law, calling the view that the law will not fund abortions a "fundamental disagreement" that represents disobedience to the bishop's authority. However, while the law's prohibitions against federal funding of elective abortions are not as tight as previous law, it is unlikely that it will result in federal tax dollars actually paying for elective abortions in the foreseeable future.

Community Health Centers
The funding that the law authorized and appropriated for Community Health Centers (CHCs) is not explicitly covered by the Hyde amendment, leading to concerns that this loophole could be exploited by pro-choice administration officials to fund abortions. However, the other funds in the pool into which this money will flow are covered explicitly by the Hyde amendment, and administration officials have publicly pledged not to allow these funds to be used for elective abortion. Also, current regulations governing CHCs explicitly prohibit elective abortions. For this and other reasons, Planned Parenthood clinics do not currently qualify as CHCs, although some have sought such a classification. Finally, claims that court rulings will inevitably force CHCs to provide elective abortions if the law provides such a loophole are overstated.

Subsidized Health Plans
The law allows subsidized health plans to cover abortion, but it requires that all abortion coverage be paid for by private premium payments. The law includes several provisions designed to give real meaning to this segregation of federal funds from payments for abortion. The law also ensures that every individual eligible for a subsidized plan will have access to at least one option that does not cover abortion, so only those who choose a plan covering abortion will be forced to pay the separate premium for abortion coverage.

A related question is whether these provisions will tend to increase or decrease the prevalence of health plans covering abortion. The USCCB envisions that only one plan without abortion will be available, assuming that all other options in the exchange will cover abortion. Thus they worry that many families will feel compelled to choose one of the plans with abortion because it best meets their family's needs and then be "forced" to pay for others' abortions. This argument does not give much credit to pro-life Americans, who will surely take into account whether a plan covers abortion before choosing it. If there is a large demand for plans that do not cover abortion, the market will provide a variety of non-abortion options to choose from. Indeed, the law's provision that requires a separate payment for the abortion services covered by plans including abortion will draw much needed attention to those plans that do cover abortion. In all likelihood, by better informing consumers of abortion coverage policies, the law will lead to a decrease in the number of health insurance plans covering abortion. This would not take much, given that the majority of employment-based health plans current include coverage for abortion, whether the employers and employees paying the premiums are aware of it or not.

Legislative History
The Stupak amendment added to the health care bill initially passed in the House in 2009 is considered the strictest language prohibiting federal funding of elective abortions. A similar amendment was introduced in the Senate in December 2009 and rejected in favor of a somewhat looser alternative. This has been widely interpreted by Catholic critics of the final version of the PPACA as indicating the Senate's intent to fund elective abortions with the bill, but this interpretation depends crucially on whether the Senate's alternative approach actually allows federal funding of abortions. An alternative interpretation is that while pro-choice Senators accepted the compromise that the bill would not fund elective abortions, they simply preferred an alternative implementation of this compromise that they found more acceptable.

In early 2010, Republican Senators refused to allow any further changes to their bill, so only budget-related changes allowed through the Reconciliation process were politically feasible. As a result, several pro-life House supporters of the Affordable Care Act accepted the Senate's version of the abortion-related provisions, which were reinforced by a mostly symbolic Executive Order of the President stating that federal funds would not be allowed to pay for elective abortions under the law.

Developments Since Passage
Francis Cardinal George stated in a speech on Nov. 15, 2010 that "developments since the passage of the legislation have settled the empirical issue: our analysis of what the law itself says was correct, and our moral judgments are secure and correct." It is possible that he was referring to the federal funds approved for the Pennsylvania PCIP, which the National Right to Life Committee charged would cover "any legal abortion." However, two independent fact-checking organizations labeled that charge false.