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HR 3962 [formerly HR 3200] on abortion

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The forced-birthers are out in force in the blogosphere, looking for federal funding of abortions in the bill, so I thought I'd help them out.

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The public plan and the exchange[s]

The public plan might or might not pay for abortions that don't fall under the Hyde amendment. The Secretary of HHS cannot require private insurance plans offered through the exchange[s] to cover abortions of any kind. Fortunately Sec HHS can't prevent private insurance from paying for abortions either. Abortion cannot be listed as part of the essential benefits package.

If you want to know why people might NOT want to choose the public plan, here's one reason that some women will "choose" to stay with private insurance.

Oh well, at least it doesn't prohibit abortion coverage outright.


SEC. 222. ESSENTIAL BENEFITS PACKAGE DEFINED.
[...]

(e) ABORTION COVERAGE PROHIBITED AS PART OF MINIMUM BENEFITS PACKAGE.

  • (1) PROHIBITION OF REQUIRED COVERAGE.—The Health Benefits Advisory Committee may not recommend under section 223(b), and the Secretary may not adopt in standards under section 224(b), the services described in paragraph (4)(A) or (4)(B) as part of the essential benefits package and the Commissioner may not require such services for qualified health benefits plans to participate in the Health Insurance Exchange.
  • (2) VOLUNTARY CHOICE OF COVERAGE BY PLAN.—In the case of a qualified health benefits plan, the plan is not required (or prohibited) under this Act from providing coverage of services described in paragraph (4)(A) or (4)(B) and the QHBP offering entity shall determine whether such coverage is provided.
  • (3) COVERAGE UNDER PUBLIC HEALTH INSURANCE OPTION.—The public health insurance option shall provide coverage for services described in paragraph (4)(B). Nothing in this Act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of services described in paragraph (4)(A).
  • (4) ABORTION SERVICES.—
    • (A) ABORTIONS FOR WHICH PUBLIC FUNDING IS PROHIBITED.—The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is not permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.
  • (B) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED.—The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.

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Existing state and federal abortion laws

More good news, bad news. If your state has liberal abortion laws, they won't be affected. If your state has restrictive abortion laws, those won't be affected either.

The good federal abortion laws won't be affected, but neither will the bad ones, including the conscience[less] clause.

SEC. 258. APPLICATION OF STATE AND FEDERAL LAWS REGARDING ABORTION.

  • (a) NO PREEMPTION OF STATE LAWS REGARDING ABORTION.—Nothing in this Act shall be construed to preempt or otherwise have any effect on State laws regarding the prohibition of (or requirement of) coverage, funding, or procedural requirements on abortions, including parental notification or consent for the performance of an abortion on a minor.
  • (b) NO EFFECT ON FEDERAL LAWS REGARDING ABORTION.—
    • (1) IN GENERAL.—Nothing in this Act shall be construed to have any effect on Federal laws regarding—
      • (A) conscience protection;
      • (B) willingness or refusal to provide abortion; and
      • (C) discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion.
  • (c) NO EFFECT ON FEDERAL CIVIL RIGHTS LAW.— Nothing in this section shall alter the rights and obligations of employees and employers under title VII of the Civil Rights Act of 1964.

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Conscience [snort] clause

In fact, the conscience[less] clause is so important, it gets its own section.

SEC. 259. NONDISCRIMINATION ON ABORTION AND RESPECT FOR RIGHTS OF CONSCIENCE.

  • (a) NONDISCRIMINATION.—A Federal agency or program, and any State or local government that receives Federal financial assistance under this Act (or an amendment made by this Act), may not—
    • (1) subject any individual or institutional health care entity to discrimination; or
    • (2) require any health plan created or regulated under this Act (or an amendment made by this Act) to subject any individual or institutional health care entity to discrimination, on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.
  • (b) DEFINITION.—In this section, the term ‘‘health care entity’’ includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.
  • (c) ADMINISTRATION.—The Office for Civil Rights of the Department of Health and Human Services is designated to receive complaints of discrimination based on this section, and coordinate the investigation of such complaints.

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Insurance companies' contracts with providers

Your insurance plan, if bought through the exchange[s], might pay for abortions, but there's no guarantee that their providers will actually perform abortions.

SEC. 304. CONTRACTS FOR THE OFFERING OF EXCHANGE PARTICIPATING HEALTH BENEFITS PLANS.
[...]

  • (d) NO DISCRIMINATION ON THE BASIS OF PROVISION OF ABORTION.—No Exchange participating health benefits plan may discriminate against any individual health care provider or health care facility because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions.

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Individual Affordability Credits

If you need help [subsidy] to buy insurance through the exchange[s], somehow this money cannot be spent on any abortions you may have.

Sec. 341. Availability through Health Insurance Exchange.
[...]

(3) PROHIBITION OF USE OF PUBLIC FUNDS FOR ABORTION COVERAGE.—An affordability credit may not be used for payment for services described in section 222(d)(4)(A).

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School-based health clinics

Can't have those irresponsible teenagers getting abortions at school! Not on the taxpayers' dime!

Among the many many many other provisions in this monster bill is a program of grants for school-based health clinics, which is really really really good, but could easily have been in another bill.

SEC. 2511. SCHOOL-BASED HEALTH CLINICS.
[...]
‘‘(c) USE OF FUNDS.—Funds awarded under a grant under this section—

  • ‘‘(1) may be used for—
    • ‘‘(A) providing training related to the provision of comprehensive primary health services and additional health services;
    • ‘‘(B) the management and operation of SBHC programs, including through subcontracts; and
    • ‘‘(C) the payment of salaries for health professionals and other appropriate SBHC personnel; and
  • ‘‘(2) may not be used to provide abortions.

[...]
‘‘(3) SCHOOL-BASED HEALTH CLINIC.—The term ‘school-based health clinic’ means a health clinic that—

  • ‘‘(A) is located in, or is adjacent to, a school facility of a local educational agency;
  • ‘‘(B) is organized through school, community, and health provider relationships;
  • ‘‘(C) is administered by a sponsoring facility;
  • ‘‘(D) provides comprehensive primary health services during school hours to children and adolescents by health professionals in accordance with State and local laws and regulations, established standards, and community practice; and
  • ‘‘(E) does not perform abortion services.

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Post-partum depression

This bill does a lot of good things that make it hard to kill just because of the bad things it does. Grrrrrrrrrrrr.

Among the good things is more research on post-partum depression [good] but even this gets made into a vessel for anti-abortion sentiment.

Sense and Congress ought not to be allowed in the same sentence.

SEC. 2529. POSTPARTUM DEPRESSION.
[...]
(c) SENSE OF CONGRESS REGARDING LONGITUDINAL STUDY OF RELATIVE MENTAL HEALTH CONSEQUENCES FOR WOMEN OF RESOLVING A PREGNANCY.

  • (1) SENSE OF CONGRESS.—It is the sense of the Congress that the Director of the National Institute of Mental Health may conduct a nationally representative longitudinal study (during the period of fiscal years 2011 through 2020) on the relative mental health consequences for women of resolving a pregnancy (intended and unintended) in various ways, including carrying the pregnancy to term and parenting the child, carrying the pregnancy to term and placing the child for adoption, miscarriage, and having an abortion. This study may assess the incidence, timing, magnitude, and duration of the immediate and long-term mental health consequences (positive or negative) of these pregnancy outcomes.
  • (2) REPORT.—Beginning not later than 3 years after the date of the enactment of this Act, and periodically thereafter for the duration of the study, such Director may prepare and submit to the Congress reports on the findings of the study.

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Indian Health Service

There are several hundred pages devoted to this, which may or may not be a good thing. Certainly the IHS is woefully under-funded and this needs to be fixed, but I haven't read any of the rest of it.

I have no clue what the following means, but somebody obviously thought it needed enshrinement in law.

‘‘SEC. 804. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH SERVICE.
‘‘Any limitation on the use of funds contained in an Act providing appropriations for the Department for a period with respect to the performance of abortions shall apply for that period with respect to the performance of abortions using funds contained in an Act providing appropriations for the Service.

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There you have it, your baby-killing tour of the Bestest Health Bill Evah.

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