The Baucus Plan and Abortion — Part II

The Senate Financial Services Committee will be voting TOMORROW on several pro-life amendments to Sen. Max Baucus’ proposed health care bill. Here’s more analysis of the bill from MRL legal counsel Jim Cole (see part I):

The actual text of Senator Baucus’ health care bill is still being kept off-line at this time. Apparently the Senate Finance Committee worked on the proposal in this past week, but unlike all other bills, which are assigned bill numbers and are printed on-line, the actual language of the Baucus proposal has no bill number and remains hidden from the ordinary citizen. The Government’s site for finding bills on-line, the “Thomas” site of the Library of Congress, has a link to “Senate Finance Committee Version: America’s Healthy Future Act of 2009,” but it pulls up only the “Chairman’s Mark” summary that was described in the first installment of this series. (You may examine the “Chairman’s Mark” yourself here.) The Thomas site’s list of Senator Baucus’ bills does not include the actual bill, either.

The bill is not only hidden from view, it is also a moving target. Amendments are being offered in committee, but there is nothing on-line to reflect the texts of amendments. Only fleeting and frequently erroneous descriptions of amendments appear from time to time in the news media.

As a result, all comments from an ordinary citizen like myself on the Baucus proposal are provisional. Only the summary called the “Chairman’s Mark” is available to work with. Readers are asked to keep in mind that when our Senate masters finally deign to unveil to us what they are legislating, the text may differ from what is described here. We can only work with what is available at this time.

Mandating Abortion Coverage In Health Care Plans

Let me describe another way that abortion is required to be covered by health insurance and health care plans by the Baucus proposal. In the first installment of this series, I related how all new health care plans will have to cover abortion in the same situations that the government must pay for in the Medicaid program. Chairman’s Mark (“CM”), p. 26. (To oversimplify, these consist of when pregnancy threatens the physical life of the mother and when pregnancy has resulted from rape and incest. Except for the Hyde Amendment, Medicaid would have to pay for all abortions for Medicaid-eligible patients, not just abortions in these situations.) Insurance companies and health plans may offer greater coverage of abortion if they desire. As was pointed out in the first installment, if and when the Hyde Amendment is ever terminated, the Baucus proposal will force health policies and plans to cover all abortions.

There is second provision of the Baucus bill that functions to expand mandatory abortion coverage. It comes into play in connection with health plan “exchanges” created by the Baucus bill. Every health policy and plan must be available in an “exchange” to be established by each state under the supervision of the federal government. CM, p. 14. (Think of something akin to stock exchanges.) Each state must immediately establish a health insurance/ plan exchange for individuals and for small groups, and two or more states may combine exchanges into a regional exchange. CM, p. 16. In later years, the exchanges will include employer plans of 50+ employees. Id. If any state proves recalcitrant and fails to establish its exchange within 24 months, then the federal government will establish a nonprofit corporation to serve as that state’s exchange. CM, p. 11. After three years of operation of the state exchange, a state may license one or more private organizations to operate additional exchanges. CM, p. 16. The Baucus plan requires every state exchange to approve at least one health plan that offers abortion coverage that exceeds the federal minimum requirements: “The Secretary would ensure that in each state exchange, at least one plan provides coverage of abortions beyond those for which Federal funds appropriated for the Department of Health and Human Services are permitted.” CM, p. 27.

It is unclear how the Secretary will “ensure” that at least one such plan is in place, but the financial leverage that the federal government will exert in connection with its health insurance subsidies will offer plenty of enforcement muscle for the Secretary to use. Subsidies may slow or stop if a state does not comply. Thus, in any state where there might be reluctance by insurers to cover abortions beyond the Hyde Amendment minimums within the premium levels that will be allowed within the exchanges, the federal government will ensure that at least one insurer steps up to the plate to cover all abortions as part of their policies or plans.

In sum, not only must every private plan offer abortion services in at least the same circumstances that the Government pays for in Medicaid, but at least one plan per exchange must offer abortion coverage that exceeds the Government’s minimum. This would substantially increase the pressure on insurance companies and health plans to offer abortion benefits in excess of the minimum required for every plan. Senator Baucus is not trying to reduce abortion coverage in health insurance and plans; he is trying substantially to increase it.

Succeeding installments of this series will point to the provisions of the Baucus plan that will compel all taxpayers to help pay for abortions by means of public subsidies of private plan premiums.