Catholic Health World

Pro-life issues and the Patient Protection and Affordable Care Act

By MICHAEL RODGERS
CHA senior vice president of advocacy/public policy
and LISA SMITH
CHA senior director of government relations

Throughout its long history, CHA has affirmed and reaffirmed its commitment to supporting life and pro-life concerns. As part of the principles that guided the association throughout the legislative reform process, CHA clearly stated that health care must promote and protect the inherent dignity of every individual from conception to natural death.

Clearly, this has been a challenging time for the ministry. CHA has long been committed to addressing the burden of inadequate access to basic health services for the millions of individuals who lack health insurance. It has never wavered in its complete commitment to protecting life from the moment of conception until death. However, as the debate on health reform intensified, there was confusion and disagreement over what the legislation would or would not do regarding abortion and conscience protections.

CHA and the United States Conference of Catholic Bishops have always been in agreement on the moral issue of abortion. As CHA's President and Chief Executive Officer Sr. Carol Keehan, DC, has said, "On the moral issue of abortion, there is no disagreement. On the technical issue of whether the Senate bill prevents federal funding of abortion, we differ."

CHA spent many hours analyzing and reviewing the legislative language before concluding it will not lead to federal funding for abortion. That conclusion was essential to CHA's decision to support passage of the final health care reform bill.

The basic structure of the law is well known by now. Small businesses, individuals and families will be able to purchase private health insurance coverage through state exchanges. Those needing assistance in order to afford coverage can receive federal health insurance tax credits. The federal tax credit is available for individuals and families under 400 percent of the federal poverty level on a sliding income scale.

Individuals who want to purchase through the exchange a policy with abortion coverage would be required to pay for the abortion coverage with their own money by writing a separate check that would be deposited in a segregated account. The law imposes strict accounting requirements to ensure that these segregated private funds are in fact kept separate from federal funds.

A summary of the abortion-related provisions in the new health care law, The Patient Protection and Affordable Care Act, is posted on CHA's web page under the headline: "Summary of abortion related provisions in health care reform legislation" (member access required).

Fairly late in the debate, concerns were raised that new funding designated in the act to support community health centers under the auspices of the U.S. Department of Health and Human Services would not be subject to the Hyde amendment restriction, which prohibits federal funds from paying for abortions except in cases of rape, incest or when the life of the mother is at risk. This is because the Hyde amendment itself only applies to funds that go through the annual appropriation process.

However, upon CHA staff review, the association is confident that the new community health center funding will not in fact be used for abortions. First, these centers do not provide abortion services, according to the National Association of Community Health Centers as well as policy experts consulted by CHA. Second, the Obama Administration has continued to state in several ways its intention that there be no federal funding for abortion under the health care reform law, and this prohibition extends to community health centers. In a letter specifically addressing the community health center funding, Health Resources and Services Administration Administrator Mary Wakefield stated: "Currently, federal funding for community health centers may not be used to pay for abortions, subject to the Hyde exception. We at HRSA are absolutely committed to adhering to this standard. For over 30 years, regulations have been in place that prohibit federal funds from being used for abortion services in programs administered by HRSA and other Public Health Service agencies (subject to the Hyde exceptions). These regulations govern the community health center program and will apply to the new Community Health Center Fund."

In his executive order of March 25, President Obama confirmed his commitment to ensure the new law is implemented as enacted with no federal funding of abortion, reiterating that no community health center funds are to be used for abortion. The president also observed that long-standing federal conscience protections already existing in the Church and Weldon amendments were unaffected by the new health reform legislation.

The Church amendment established that federally funded public health institutions could not require individuals to perform or assist in sterilization or abortion procedures to which they had moral or religious objections. The Weldon amendment gives conscience protections to health care providers including physicians and nurses, hospitals, health insurance companies, and other health care entities, to prevent them from being forced by state or federal governments to perform, pay for, provide coverage of, or refer for abortions.

Prior to enactment of the patient protection act last month, CHA spoke directly with White House and congressional leaders to reiterate the association's position that there would be no federal funding of abortion. During those discussions, the president repeated his position that the reform act maintain current Hyde restrictions governing abortion policy and extend those restrictions to the newly created health insurance exchanges.

Finally, on the issue of conscience protections, there has been a lot of confusion throughout the ministry about the need to include in the health care reform legislation language similar to the Weldon provider conscience protections contained in the annual Labor/HHS appropriations legislation.

The Weldon amendment has been included and enacted into law every year since 2004. It is important to note that the conscience protections of the Weldon amendment contained in the annual appropriations bill will continue to apply to providers under the new health care reform law, so it was unnecessary to specifically include the Weldon language in the health care reform legislation.

As the patient protection law goes through its implementation phase with resultant regulations, CHA will continue to be vigilant in its efforts to ensure that health care is provided in a manner that promotes and protects the inherent dignity of every individual from conception to natural death. 

Copyright © 2010 by the Catholic Health Association of the United States
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