From the December 22 Washington Times editorial:

The current prohibition on government funding for abortion made exceptions for when a woman's life purportedly was in danger or when the pregnancy purportedly was a result of rape or incest. If passed, the new law will charge an “abortion premium” tax on all Americans that forces everyone to fund abortions. The only escape will be if individual states pass opt-out provisions to the program, which will be difficult to implement.

On Page 41 (lines 5-8) of Senate Majority Leader Harry Reid's manager amendment, the proposed rules mandate that everyone buying insurance through new exchanges or through the new government-run plan must pay a monthly abortion premium to be used for elective abortion services. This fee applies “without regard to the enrollee's age, sex or family status.” That means that people who have no possibility of wanting an abortion themselves will pay for others to have them. On Page 43 (lines 1-7), insurance companies will be required to assess the cost of elective abortion coverage, and on Page 43 (lines 20-22) they are mandated to charge a minimum of at least $1 per enrollee per month to cover abortion.

Provisions only affect those who choose to purchase policy that covers elective abortion

Page 41-43 only apply to plans that cover abortions restricted under Hyde Amendment. The provisions to which the Times refers apply only to “the case of a plan to which subparagraph (A) applies.” Subparagraph (A) refers to “a qualified health plan [that] provides coverage of services described in paragraph (1)(B)(i).” Paragraph (1)(B)(i) refers to “abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is not permitted,” i.e., abortions restricted by the Hyde Amendment, which forbids the use of federal funds for abortions except in cases of life endangerment, rape or incest.

Manager's amendment states insurance policies not required to provide abortion coverage. The manager's amendment explicitly states that “nothing in this title (or any amendment made by this title), shall be construed to require a qualified health plan to provide [abortion services] as part of its essential health benefits for any plan year.” From Section 1303(b)(1)(B):

"(1) VOLUNTARY CHOICE OF COVERAGE OF ABORTION SERVICES-

''(A) IN GENERAL.-Notwithstanding any other provision of this title (or any amendment made by this title)-

''(i) nothing in this title (or any amendment made by this title), shall be construed to require a qualified health plan to provide coverage of services described in subparagraph (B)(i) or (B)(ii) as part of its essential health benefits for any plan year; and

''(ii) subject to subsection (a), the issuer of a qualified health plan shall determine whether or not the plan provides coverage of services described in subparagraph (B)(i) or (B)(ii) as part of such benefits for the plan year.

Provision is not an "'abortion premium' tax"

Contrary to the Times'claim that the manager's amendment institutes an "'abortion premium' tax," there is no extra charge assessed to consumers in order to pay for abortions.Rather, the bill sets up requirements by which insurance plans segregate their funds so that federal dollars are not used to pay for abortion coverage.

Bill prohibits health insurers from using federal subsidies “for the purposes of paying for” abortion services restricted by Hyde. The bill states that if a “qualified health plan” offered under the health insurance exchange provides coverage of abortion services for which public funding is banned, “the issuer of the plan shall not use any amount attributable” to the subsidies created under the bill “for purposes of paying for such services.” From Section 1303(b)(2)A):

''(2) PROHIBITION ON THE USE OF FEDERAL FUNDS.-

''(A) IN GENERAL.-If a qualified health plan provides coverage of services described in paragraph (1)(B)(i), the issuer of the plan shall not use any amount attributable to any of the following for purposes of paying for such services:

''(i) The credit under section 36B of the Internal Revenue Code of 1986 (and the amount (if any) of the advance payment of the credit under section 1412 of the Patient Protection and Affordable Care Act).

''(ii) Any cost-sharing reduction under section 1402 of the Patient Protection and Affordable Care Act (and the amount (if any) of the advance payment of the reduction under section 1412 of the Patient Protection and Affordable Care Act).

Manager's amendment provisions establish a separate premium to segregate funds used to pay for abortions from federal funds. The Times refers to a provision that requires issuers to “collect from each enrollee” in plans that cover abortions “separate payment” for “an amount equal to the actuarial value of the coverage of” abortion services. This value must be at least $1 per enrollee, per month. All such funds are deposited into a separate account used by the issuer to pay for abortion services; federal funds and the remaining premium payments are used to pay for all other services. The Times provided no evidence that segregating the payments in this way would result in any additional fee to policyholders. From Section 1303(b)(2)(B):

''(B) ESTABLISHMENT OF ALLOCATION ACCOUNTS.-In the case of a plan to which subparagraph (A) applies, the issuer of the plan shall-

''(i) collect from each enrollee in the plan (without regard to the enrollee's age, sex, or family status) a separate payment for each of the following:

''(I) an amount equal to the portion of the premium to be paid directly by the enrollee for coverage under the plan of services other than services described in paragraph (1)(B)(i) (after reduction for credits and cost-sharing reductions described in subparagraph (A)); and

''(II) an amount equal to the actuarial value of the coverage of services described in paragraph (1)(B)(i),and

''(ii) shall deposit all such separate payments into separate allocation accounts as provided in subparagraph (C). In the case of an enrollee whose premium for coverage under the plan is paid through employee payroll deposit, the separate payments required under this subparagraph shall each be paid by a separate deposit.

From Section 1303(b)(2)(C)(ii)

''(ii) ALLOCATION ACCOUNTS.-The issuer of a plan to which subparagraph (A) applies shall deposit-

''(I) all payments described in subparagraph (B)(i)(I) into a separate account that consists solely of such payments and that is used exclusively to pay for services other than services described in paragraph (1)(B)(i); and

''(II) all payments described in subparagraph (B)(i)(II) into a separate account that consists solely of such payments and that is used exclusively to pay for services described in paragraph (1)(B)(i).

From Sec. 1303(b)(2)(D):

'(D) ACTUARIAL VALUE.-

''(i) IN GENERAL.-The issuer of a qualified health plan shall estimate the basic per enrollee, per month cost, determined on an average actuarial basis, for including coverage under the qualified health plan of the services described in paragraph (1)(B)(i).

''(ii) CONSIDERATIONS.-In making such estimate, the issuer-

''(I) may take into account the impact on overall costs of the inclusion of such coverage, but may not take into account any cost reduction estimated to result from such services, including prenatal care, delivery, or postnatal care ''

(II) shall estimate such costs as if such coverage were included for the entire population covered; and
(III) may not estimate such a cost at less than $1 per enrollee, per month.

Current law allows coverage for abortions restricted by Hyde under Medicaid through similar fund segregation

Seventeen states use state funds to cover abortions for Medicaid recipients in circumstances beyond Hyde. According to a December 1 study by the Guttmacher Institute, 17 states provide coverage under Medicaid for “all or most medically necessary abortions,” not just abortions in cases of life endangerment, rape, and incest. Those states “us[e] their own funds” -- not federal funds -- “to pay” for the procedures. Therefore, in 17 states, Medicaid, a federally subsidized health care program, covers abortions in circumstances in which federal money is prohibited from being spent on abortion.