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.

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