Guidelines issued for Obamacare’s (hidden) $1 abortion surcharge

Yesterday the Department of Health and Human Services  issued its final rule for establishing state health care exchanges under Obamacare.

As expected, the rule provides for taxpayer funding of insurance coverage that includes elective abortion.

Let me back up. I spent some time talking to friends in the House this morning to understand and explain this.

Insurance companies that want to participate in Obamacare’s exchange program must follow certain guidelines – the “rule” issued yesterday, which is actually a whole bunch of rules.

The attraction for insurance companies to participate in the exchange program is that under Obamacare the federal government will pay all or a part of someone’s insurance premium who makes up to 400% above the poverty level. But those people can only choose their insurance from an Obama-approved company in the “exchange.” This amounts to thousands or millions or prospective new insurees whose payments will be totally or mostly guaranteed.

Insurance companies participating in the exchange program do not have to provide elective abortions. [UPDATE 3/14, 2:15p:  Douglas Johnson, Legislative Director for National Right to Life Committee, has sent me some corrections to my post, beginning here: “This is true, as far as the current rule goes.  But there is nothing in the law, or the rule, to prevent the Obama Administration from later requiring health plans in general (whether on the exchange or off the exchange, whether subsidized or not) to cover all abortions as a ‘preventive service,’ using the same authority that has been employed to issue the recent contraceptive mandate.  The new rule on exchanges merely says that Title I of the Affordable Care Act cannot be construed to require an exchange-participating plan to provide abortions ‘as part of its essential health benefits, as described in section 1302(b) of the Affordable Care Act.’  (‘Essential health benefits is a term of art, referring to one type of federal mandate authorized under ObamaCare.  The ‘preventive health services’ authority is separate and distinct.”] In fact, some states have passed laws disallowing insurance companies in their states from offering elective abortions in the Obamacare exchange program.

But if an insurance company participating in the Obamacare exchange program does offer elective abortions, everyone who buys insurance from that company will have to pay a $1 separate surcharge every month to cover the cost of abortions. It doesn’t matter if you are pro-life. It doesn’t matter if you’re a 72-yr-old woman who will never abort. You have to pay the $1 surcharge. [UPDATE 3/14, 2:15p: Per Johnson: “The law and rule both say that the payment may not be less than $1 a month.  The ‘abortion surcharge’ could certainly be more than $1 a month.”]

If you pay for your insurance by check, you will have to write out two checks every month, one for the premium and one for $1. If you pay for your insurance by automatic bank withdrawal, you will see two withdrawals every month, one for the premium and one for $1. If you pay for your insurance by credit card, you will see two charges on your bill every month, one for the premium and one for $1. [UPDATE 3/14, 2:15p: Per Johnson: “There is nothing in the rule that actually spells out a two-payment scheme.  HHS has not yet spelled out the details of any payment scheme.”]

This was the accounting gimmick added by supposedly pro-life Democrat U.S. Senator Ben Nelson so the government could try to say it does not subsidize elective abortions. Nelson is now retiring, in small or large part due to this. Pro-lifers now abhor him.

But there’s more. The HHS rule issued yesterday will force insurance companies to go to great lengths to hide the reason for the $1 surcharge.

The rule states insurance companies will not be allowed to mention the surcharge in their advertising. They can only advertise the total premium amount.

The rule states insurance companies will not be allowed to itemize “abortion” on bank, credit card statements, or anywhere as the reason for the $1 monthly charge.

The only place the reason for the $1 monthly surcharge will be listed is in the 20 pages of fine print you get when you enroll in your insurance plan.

But people will ask. Abortion proponents know this and hate the separate surcharge. I’m hopeful Obamacare will never see the light of day, but if it does the $1 surcharge will only stigmatize abortion even more.

There is more to the rule that goes a bit into the weeds, but I’ll stop here. Steven Ertelt at does a good job on pulling those weeds.

25 thoughts on “Guidelines issued for Obamacare’s (hidden) $1 abortion surcharge”

  1. Jill- If I am missing the answer to this question, I’m sorry but…for those of us who already pay for our insurance…does this mean that if our company opts into this program that we will begin to see the the dollar surcharge? Or will this be for new buyers of insurance? 

    I know that may be a strange question, but I’m sorry. Just trying to connect this on even more personal terms. So that when the time comes, I can ask my insurance company the questions I need to. I appreciate what you do! 


  2. That’s crazy, Jill.  How can they claim abortions aren’t subsidized when everyone is being charged for them??  That’s not even “accounting”, it’s just lying.


  3. I wonder what insurance reps will be instructed to say when people ask “what’s the $1 surcharge for?”  Will they lie?  Will the government tell them what they must say and how they must lie?


  4. Wasn’t the executive order supposed to prevent this? I knew that thing wasn’t worth the paper it was printed on.


  5. Ashley, I read the actual rules this morning, and it does seem that you by law can’t see this surcharge on a statement, you would have to check your plan for the fine print. It says companies must provide you notice of the coverage during enrollment in some section of the plan, but then that notice, advertising and Exchange advertising can’t even tell if it’s $1 a month or more, whatever it costs the company to provide abortions. I might be wrong, this whole plan is clumsy and hard to follow, and other rules might govern how companies tell people what is covered. Death by bureaucracy.


  6. Jen/JoAnna, they’re saying the GOVERNMENT isn’t subsidizing the abortions, which is just a shell game, an accounting gimmick. Chris is right, the whole thing is clumsy. Ashley, I don’t know whether people in your situation will be grandfathered in under the old system, but I doubt it.


  7. JoAnna, this was part of the bill. This was the phony agreement that got Nelson, Stupak and Co. to sign on. Their argument is that it’s not taxpayer-funded abortions because of this “separate” accounting. Of course, if you read the rule, you’ll notice it says the second the Hyde Amendment is failed to be re-added (comes up to a vote every year) then elective abortions qualify for tax-funding. And this rule only covers these insurance plans. This administration cynically expects people not to care about the details, and even for people like me who look into it, it’s so confusing that it’s nearly impossible to understand, let alone explain to someone else. CYNICAL.


  8. Jill, follow me here for a second:  Would I be correct in thinking that the trouble here is that the insurance plans that provide ANY OB/GYN coverage are also the ones that will provide elective abortion coverage, and that’s how women will be stuck buying a plan that funds abortions even if they don’t want abortions?  That’s how Obama will manipulate the coverage and the plans in order to get the most people buying plans that cover elective abortions and thus pay his $1 surcharge.  Right?


  9. There you have it, folks: proof, pudding, the whole shi-bang.

    And Vannah is still thinking about voting for Obama.

    Do us a favor, Van. Should you vote for this guy, promise us you won’t consider yourself pro-life again.



  10. Pro-lifers now abhor Ben Nelson? I’m sorry, but hatred for an individual and being pro-life don’t go together. 


  11. What a mess.  And Obama and company purposefully created it this way – so the money flows in, no one sees it in their face – after all, who will miss $12 a year?
    but in 10 years – it’s $120, and you know that premiums just go up, not down.
    The not-seeing-part – it’s the same sort of ruling regarding using human aborted fetal cells in business – not having to acknowledge it, state it or see it.  All under cover of darkness.
    Lord have mercy.  We are in a huge amount of trouble. 
    This is only the beginning – what this administration can do in front of our face.   Wait until he can do things behind his back with a second term. 
    Lord, please – supernatural help here!! Have mercy on our nation and our world.


  12. I expect Jen is exactly right. Since the government has successfully tied abortion and hormonal birth control to ‘reproductive healthcare’ any insurance plan that covers OBGYN services will be forced by decree to bundle abortion and hormonal contraceptive coverage. Just like ‘mental healthcare’ can’t cover just *one* type of mental disorder (can’t cover alcohol addiction but not depression for instance), insurance carriers likely won’t be ‘allowed’ to cover only ‘some’ reproductive healthcare. So, regardless of what you want or if you’re prolife, you’re choice is going to be ‘women’s care’ or no ‘women’s care’. And since government involvement always drives up care it’s rapidly going to become far too expensive to obtain prenatal/birth services without insurance, so it will be ‘pay for abortions or not obtain pregnancy care’.

    (P.S. to mods, having difficulty accessing my standard yahoo email, so my alternate gmail account is now listed, it’s still the same Jespren!)


  13. Hi Chris 12:51PM

    Stupak made the mistake of trusting a sociopath, a huge mistake, and look where it got him and our country. I hope Stupak realizes that Obama couldn’t care less what price Stupak had to pay, like he couldn’t care less about throwing his long time pastor and mentor, Jeremiah Wright, under the first bus he saw.


  14. Hi Carder 2:10PM

    I like Vannah very much and I hope she will come to realize the type of mind this is and its potential danger.  Obama is a man devoid of conscience, people are objects to serve his purpose and if he destroys them in the process, well that’s their problem.
    You sure don’t see him shedding any tears over the forced “retirements” of Stupak and Nelson. Of course not, they served his purposes.
    The majority of Catholics supported him and he kicked them in the teeth when it served his purposes.
    This latest news concerning Obama doesn’t surprise me in the least.


  15. Jespren,

    Interesting prediction, that.  I bet you have it right.  If my daughters, who are getting ready to leave the nest and get married, want to have children, I’m sure Sebelius and Obama would love to corner them into plans that force them to pay for everyone else’s abortions.  Want prenatal coverage?  Pay for all forms of “preventative care,” especially abortion.  If Obama is re-elected, our daughters and their future babies will be threatened with forced abortion.  

    Lord, forgive me for not fighting harder to end abortion these last 39 years. 

    First they came for the unborn, and I whined, “I’m too chicken to speak up.  It might make them mad.” 

    Then they came for my church, and most people said, “So what?  We all use contraceptives anyway.” 

    Then they came after the newborns, and we were still more afraid, so we all said, “Surely, they’re not really serious are they?” 

    Then they came for my daughters and told them, “If you want prenatal care, you will pay for ALL ABORTIONS.  And you will get permission from the government before you start a family.” 

    Then they started suggesting that now that I’m over 50, if I get cancer, I’m too expensive to treat. 

    Finally, they came for our grandchildren, but there weren’t any left.


  16. Has anyone heard of ‘Agenda21’?  It is easier to control a small crowd verses a large crowd.  It is all about getting the population small enough to control. 


  17. Jill, I am trying to find the ‘Born Alive’ bill that Obama voted ‘present’ on. I know it is out there somewhere but I can’t seem to find it….any suggestions on how to find it? 


  18. I didn’t vote for Obama, and i’m not trying to defend him….

    But i read the bill. and it is pretty confusing…

    First of all the bill says no one has to participate in anything
    (below is actual quote from law):
    No individual, company, business, nonprofit entity, or health
    insurance issuer offering group or individual health insurance coverage
    shall be required to participate in any Federal health insurance
    program created under this Act (or any amendments made
    by this Act), or in any Federal health insurance program expanded
    by this Act (or any such amendments), and there shall be no
    penalty or fine imposed upon any such issuer for choosing not
    to participate in such programs. 
    And i also found the thing about the $1 surcharge,
    it says “service in (1)(B)(i)… will cost no less then $1”
    (see below for quote from actual law… ill quote 1.B.i afterwards)

    (i) IN GENERAL.—The Secretary shall estimate the
    basic per enrollee, per month cost, determined on an
    average actuarial basis, for including coverage under
    a qualified health plan of the services described in
    paragraph (1)(B)(i).
    (ii) CONSIDERATIONS.—In making such estimate,
    the Secretary—
    (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;
    (III) may not estimate such a cost at less
    than $1 per enrollee, per month.

    If you go back to see what 1.B.i says:

    PROHIBITED.—The services described in this clause 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.

    However, the section right after the “$1 per enrolee, per month” says:


    health care provider or health care facility may be discriminated
    against because of a willingness or an unwillingness, if doing
    so is contrary to the religious or moral beliefs of the provider
    or facility, to provide, pay for, provide coverage of, or refer
    for abortions.

    Its pretty confusing. 


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