Senate Bill Would Allow States To Prohibit Abortion Coverage In Exchange

The new managers amendment to the merged Senate bill incorporates Sen. Bob Casey’s (D-PA) language strengthening the segregation of private and public funds and increasing federal support for adoptions, with a new provision that would allow states “to prohibit abortion coverage in qualified health plans offered through an Exchange in such State if such State enacts a law to provide for such prohibition” (page 38 of the amendment).

In other words, states can opt-out of abortion coverage that goes beyond the Hyde amendment. A state may also repeal the prohibition and allow plans in the exchange to offer abortion coverage, so long as those procedures are financed with private premiums.

In states that don’t prohibit abortion coverage within the exchange, federal dollars can only be used to pay for abortions when the pregnancy threatens the life of the mother or results from rape or incest; private premiums must be used to pay for any other type of abortion, including those for health reasons. Each exchange will also have to offer at least one plan that does not offer abortion.

The managers amendment also gives state Commissions of Insurance the ability to audit insurers to ensure compliance with the segregation of funds in states where abortion is available, increases the Adoption Tax Credit and federal support for adoption.

This compromise differs from the so-called Stupak language in the House bill that prohibits federal funds from being used for abortions or for plans that include abortion services. Nelson brought his own Stupak-like amendment to a vote on the Senate floor, but it ultimately failed.


Under the original compromise, states could have passed laws prohibiting abortion coverage in the exchanges. This language explicitly reiterates that right.

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