Senators clash over abortion fee rule

Proposal would change how individuals are billed for abortion coverage

Sen. Cindy Hyde-Smith, R-Miss., joined 13 other Republican senators in a letter urging the HHS to move forward with a rule that would change how individuals are billed for abortion coverage. (Tom Williams/CQ Roll Call file photo)

Senate Democrats and Republicans at odds over a proposed rule that would change how individuals are billed for abortion coverage sent two competing letters to Health and Human Services this week.

The public comment period for the rule closed Tuesday, amassing over 74,000 comments.

The Republican letter, led by Mississippi Sen. Cindy Hyde-Smith, urges HHS Secretary Alex Azar to move forward with the rule.

The proposal would require enrollees under the 2010 health care law to submit separate premiums for essential health benefits and for abortion coverage. The abortion fee would be required to be at least $1.

“The proposed rule aligns with the clear meaning and congressional intent of Section 1303 by eliminating the hidden abortion surcharge in many ACA plans,” the 14 Republican senators wrote, referring to part of the health care law.

Republicans argue that the Obama administration had not been fully enforcing the requirement.

“Despite the plain meaning of the text, [the administration] interpreted ‘separate’ to mean ‘together,’” the Republicans wrote. They added that Obama-era regulations went too far by allowing the requirement to be satisfied by “sending the enrollee a single monthly invoice or bill” that itemizes the premium amount for abortion services.

Republicans say the health plan issuer should be required to clearly identify a separate premium for abortion coverage on monthly bills.

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Democrats, led by Senate Health, Education, Labor, and Pensions ranking member Patty Murray of Washington urged Azar to withdraw the rule over concerns that it could reduce overall medical coverage and decrease abortion access.

“The proposed rule is clearly intended to make it harder for women to access abortion care and to prevent insurers from offering abortion coverage,” reads the Democrats’ letter, signed by 34 senators. “It is the latest administrative action in a long line of attacks by the Trump-Pence administration to undermine access to comprehensive sexual and reproductive health care, particularly abortion, and to sabotage the health care system.”

The senators’ comments echo lobbyists’ praise and concerns as advocacy groups on both sides of the abortion debate pressed their supporters to submit comments ahead of Tuesday’s comment deadline.

The nonpartisan Kaiser Family Foundation estimates the proposed rule could affect 3.1 million enrollees, who live in the states that offer plans that include abortion coverage.

Other action

Given the divided Congress, it is unlikely that lawmakers will be able to pass any legislative changes this year related to abortion and reproductive health, but House Democrats and lobbyists have hinted that they intend to introduce bills this year to counteract moves by the administration to restrict abortion.

“The new House Democratic Majority will fight back against these attacks, and work to reverse the damage inflicted by years of GOP attacks on women’s right to choose and access to affordable contraception,” Henry Connelly, a spokesman for Speaker Nancy Pelosi, said last month.

Advocates are currently awaiting a final rule that would change which types of providers are able to receive Title X family planning grant money. The proposed version of the rule would eliminate funding for health care providers that refer for or provide abortions, such as Planned Parenthood.

In addition, final rules go into effect next week that would broaden the types of employers that could refuse to cover contraception, due to a religious or moral objection.

The anniversary of Roe vs. Wade, the landmark 1973 Supreme Court case that ensured a woman’s right to abortion, is later this month and the March for Life, the country’s largest yearly anti-abortion rally, is Jan. 18.

Montana GOP Sen. Steve Daines and House Pro-Life Caucus chairmen Daniel Lipinski, an Illinois Democrat, and Christopher H. Smith, a New Jersey Republican, are slated to speak at the rally. March for Life has not yet announced participation from the White House, but President Donald Trump addressed the event last year.

A spokesperson for the group said a presence from the administration is still a possibility.

Advocates and lawmakers typically make announcements to tie in with both events.

Last year, HHS announced the new conscience and religious freedom division in its Office for Civil Rights a day before the March for Life.

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