Will You Have toPay for Abortions in Your Health Plan? (en español)

By Richard M. Doerflinger

September 13, 2013

It's enough to confuse anyone. Some supporters of the new health care law known as the Affordable Care Act (ACA) say it will not spend taxpayer funds on abortion coverage. Yet we're hearing that Americans purchasing a health plan on the "exchanges" now being set up in most states must pay a monthly surcharge for elective abortions. What are the facts?

First, the good news. Twenty-three states have passed laws to exclude most abortions from all plans on their health exchanges. In these states Americans will be able to choose from a full range of health plans without surgical abortions. (Tragically, even these plans are covered by the Administration's "contraceptive mandate," which includes some drugs like Ella [ulipristal] that can cause an early abortion. That mandate continues to be disputed in Congress and the courts.) Even in the other states, the ACA requires at least one plan to exclude most abortions; other health plans may exclude them, at the option of the insurer.

The bad news: Most secular insurers will probably cover elective abortions (unless forbidden by state law), as they did before passage of the ACA, because they think abortion is cheaper than childbirth (and far cheaper than live dependents who may need care as they grow up). And the ACA makes this situation worse, in four ways.

First, the health plans that cover abortion on demand will receive federal tax subsidies when the enrollee meets income requirements. So, in violation of the policy in every other federal health program, your tax dollars will subsidize plans that cover abortion.

Second, if you find yourself in one of these abortion-including plans, you will be required to pay a surcharge for other people's abortions. The charge will start at a minimum of $1 a month and increase as needed. Congress made this charge "separate" so it can claim that no taxpayer funds are going to abortions themselves. Yet insurers are forbidden by law to allow anyone to opt out of the payment.

Third, the ACA forbids the insurer to give you any special warning that your plan covers abortions. The abortion coverage can only appear in the fine print along with all other "services."

Fourth, the ACA forbids the insurer to tell you how much you are paying for abortions. It must charge you for the full amount of your coverage (abortion plus everything else), then divide the funds into separate accounts later. This is designed to prevent you from refusing to write the separate check for abortions.

In short, there will be tax subsidies for health plans that cover abortion, and many Americans will be forced by law to pay premiums for abortion itself. Despite claims that there won't be "taxpayer funding of abortion," the ACA expands federal support for abortion, and restricts the freedom of those who object to paying for it.

So if you don't have employer coverage or another group health plan, and must choose an individual plan on your state exchange, what can you do? You can find out if you live in one of those 23 states. If not, you can find the one plan in your state that can't cover elective abortions, and search out plans that choose not to cover them. (Catholic and other pro-life organizations may be able to help with this search.) You can urge your state and federal legislators to fix this situation, so universal health care truly becomes the life-affirming reality that Catholics and so many others have hoped for. And we can all pray that those in our government, and the insurance industry, will be enlightened to see the fundamental difference between healing and killing.

Mr. Doerflinger is Associate Director of the Secretariat of Pro-Life Activities, U.S. Conference of Catholic Bishops.For more on the bishops' pro-life activities, see www.usccb.org/prolife; to write to Congress on conscience rights in health care see www.nchla.org.