Enacted on March 23, 2010, the Patient Protection and Affordable Care Act ("Affordable Care Act") includes provisions that address the coverage of abortion services by qualified health plans that will be available through health benefit exchanges ("exchanges") beginning in 2014. The Affordable Care Act's abortion provisions have been controversial, particularly with regard to the use of premium tax credits or cost-sharing subsidies to obtain health coverage that includes coverage for elective abortion services. This report reviews the Affordable Care Act's abortion provisions and provides background information on the so-called "Hyde Amendment," which restricts the use of federal funds appropriated for the Department of Health and Human Services ("HHS") to pay for elective abortion services provided through the Medicaid program. The Affordable Care Act addresses abortion coverage by the exchange plans with reference to the Hyde Amendment. The report also examines the coverage of elective abortions in the temporary high risk health insurance pool program established by the Affordable Care Act. Under the Hyde Amendment, funds appropriated for HHS may be used to pay for an abortion if a pregnancy is the result of an act of rape or incest, or if a woman's life would be endangered if an abortion were not performed. Following the Affordable Care Act's enactment, Executive Order No. 13535 was issued to "establish an adequate enforcement mechanism to ensure that federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered)." The executive order directed the OMB Director and HHS Secretary to develop a model set of segregation guidelines for state health insurance commissioners to use when determining whether exchange plans are complying with the Affordable Care Act's segregation requirements. The rule indicates that health benefit plans in the program cannot cover abortion services except when the life of a woman would be endangered or when a pregnancy is the result of an act of rape or incest.
The Patient Protection and Affordable Care Act ("Affordable Care Act") includes provisions that address the coverage of abortion services by qualified health plans that will be available through health benefit exchanges beginning in 2014. These provisions have been controversial, particularly with regard to the use of premium tax credits or cost-sharing subsidies to obtain health coverage that includes coverage for elective, non-therapeutic abortion services. The Affordable Care Act addresses abortion coverage by the exchange plans with reference to the so-called "Hyde Amendment," which permits the use of federal funds appropriated for the Department of Health and Human Services ("HHS") to pay for an abortion only if the pregnancy is the result of an act of rape or incest, or if a woman's life would be endangered if the abortion were not performed. The Affordable Care Act permits exchange plans to cover both elective abortions and abortions for which federal funds appropriated for HHS are permitted, but requires plan issuers and enrollees to comply with funding segregation requirements if such plans are offered and selected.
Following the Affordable Care Act's enactment, Executive Order No. 13535 was issued to "establish an adequate enforcement mechanism to ensure that federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered)." The executive order, Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and Affordable Care Act, required the Director of the Office of Management and Budget and the HHS Secretary to develop a model set of segregation guidelines for state health insurance commissioners to use when determining whether exchange plans are complying with the Affordable Care Act's segregation requirements.
After the enactment of the Affordable Care Act, some also questioned whether elective abortions could be covered by health benefit plans offered in the temporary high risk health insurance pool program established by the law. The issuance of an interim final rule by HHS, however, appears to have settled that question. Health benefit plans in the program cannot cover abortion services except when the life of a woman would be endangered or when a pregnancy is the result of an act of rape or incest.