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For immediate release: Tuesday, September 16, 2014
For further information: Tatiana Bergum,
(202) 626-8825 or mediarelations@nrlc.org GAO report confirms elective abortion coverage widespread
in Obamacare exchange plans

WASHINGTON – A report by the Government Accountability Office (GAO), a nonpartisan investigatory arm of Congress, made public today, provides dismaying confirmation of earlier predictions by National Right to Life that federally subsidized abortion coverage would become a widespread feature of Obamacare. The report found that more than one thousand federally subsidized exchange plans currently cover elective abortion.

“It is no surprise that the Obama Administration is spending billions of taxpayer dollars subsidizing the purchase of health plans that cover abortion on demand,” said National Right to Life Legislative Director Douglas Johnson. “Those really responsible for this scandal are the lawmakers, such as Mary Landrieu of Louisiana, Kay Hagan of North Carolina, Mark Begich of Alaska, and Mark Udall of Colorado, who voted against the pro-life amendment that would have prevented this massive federal funding of abortion-covering plans, as well as those who voted to enact the bill after the amendment was rejected, such as Mark Pryor of Arkansas.”

The GAO report focused mainly on determining the prevalence of elective abortion coverage in health plans sold on the exchanges, in the 27 states plus D.C. that currently do not have laws in effect that restrict abortion coverage. The GAO found that on these 28 exchanges, 1,036 plans cover elective abortion while 1,062 do not. The Congressional Budget Office has estimated that between 2015 and 2024, $726 billion will flow from the federal Treasury in direct subsidies for Obamacare health plans.

The Obamacare law was enacted in early 2010 despite objections from pro-life forces that it contained provisions that would result in massive federal subsidies to help scores of millions of Americans buy health plans that cover elective abortion. However, President Obama repeatedly insisted that “no federal dollars will be used to fund abortions.

The GAO findings validate previous charges by National Right to Life that the federal taxpayer is subsidizing the purchase of abortion-covering plans on a massive scale. As Politico reported today, “The vast majority of people who bought coverage on the exchanges did so with subsidies. According to government figures, 87 percent of the 5.4 million people who bought a plan on HealthCare.gov in the last enrollment period did so with at least some subsidy.”

These massive subsidies for abortion-covering plans amount to a sharp break from decades of federal policy under the Hyde Amendment. The Hyde Amendment says that no federal funds “shall be expended for health benefits coverage that includes coverage of abortion,” but the Hyde Amendment does not apply to the Obamacare law. Attempts to include Hyde-like language in the Obamacare law were initially successful in the House but were ultimately blocked by President Obama and his allies in Congress. (For detailed discussion of the history of the Hyde Amendment and the sharp break from Hyde policy contained in Obamacare, see NRL congressional testimony here: http://www.nrlc.org/uploads/ahc/ProtectLifeActDouglasJohnsonTestimony.pdf)

The author of so-called “compromise” language that paved the way for enactment of the law, then-Sen. Ben Nelson (D-Nebraska), said in 2009 that “you have to write two checks: one for the basic policy and one for the additional coverage for abortion. The latter has to be entirely from personal funds.” [155 Cong. Rec. S14134 (Dec. 24, 2009)]. The Nelson “two check” system, previously given great credence by some journalistic “factcheckers,” turns out to be not merely a flimsy gimmick, but a vanished mirage. Although the GAO confirmed that the law requires “issuers to collect from each enrollee in a QHP [Qualified Health Plan] covering non-excepted [elective] abortion services a separate payment for coverage of these services,” the Obama Administration is not enforcing such a requirement. Not a single one of the 18 insurance companies that are selling abortion-covering plans, and that responded to the GAO, actually were collecting a separate payment from enrollees for elective abortion coverage.

Despite assurances that there would be plans available in each state that do not fund elective abortions, the GAO found that in five states – Connecticut, Hawaii, New Jersey, Rhode Island, and Vermont – every insurance plan currently sold on the exchange covers elective abortion. In addition, abortion-covering plans dominated the exchanges in California (96% cover elective abortion, 86 plans out of 90), Massachusetts (98%, 109 plans of 111), New York (95%, 405 plans of 426), and Oregon (90%, 92 plans of 102).

The House of Representatives has passed the No Taxpayer Funding for Abortion Act (H.R. 7), which would apply the traditional Hyde Amendment policy to all federal programs, including the Obamacare premium-subsidy program, and thereby limit federally subsidized plans to coverage of abortion in cases of rape, incest, or threat to the life of the mother. However, Senate Majority Leader Harry Reid (D-Nevada) has prevented Senate action on identical legislation.

The Patient Protection and Affordability Act

ObamaCare

  • ObamaCare raided the Medicare Trust Fund by $716 billion, causing seniors to lose life-saving medical care. (Congressional Budget Office, 07/24/2012)
  • ObamaCare’s “Independent Payment Advisory Board” of bureaucrats (the infamous “Death Panel”) will tell you and your doctor what health care you can get and what it will cost – even if you are willing to pay for it yourself.
  • ObamaCare lets bureaucrats make the rules about abortion coverage.
  • HHS Secretary Kathleen Sebelius already issued rules requiring all insurers, includingself-insured churches, to provide—free of charge – all birth control devices, even those that cause abortions.  There is no respect for the First Amendment.

The Big Three Obamacare Abortion Lies of the Year

December 31, 2013

Editor’s note. The following came from the office of pro-life Rep. Chris Smith (R-NJ). Washington, D.C. — Even as President Obama’s now infamous claim, “[i]f you like your plan you can keep it,” is being recognized as the “Lie of the Year”…Read More>>

 

ObamaCare:  Abortion and the Threat of Rationing

Wanda Franz, Ph.D.

            On March 23, 2010, President Obama signed into law the anti-life, unpopular Health Restructuring Plan (ObamaCare), passed by the slimmest of margins. If this plan is not repealed before its most dangerous provisions come into effect, the result will be government-funding of abortion and the rationing denial of lifesaving medical treatment, and consequent premature and involuntary death, of an unknown but immense number of Americans. The pro-life movement must devote itself to educating the American people about these facts.

ObamaCare is one of the most dangerous laws ever passed in the United States.  It is dangerous because it turns our health care over to the bureaucrats in Washington, who will apply their notoriously wasteful approach toward micromanaging our personal health needs/

First of all, Obama’s health care law is so hard to understand because many of the most dangerous parts of the bill aren’t actually written.  Instead, the law allows government agencies to implement provisions in the future.  Health care managed by government bureaucrats.

Second, if this plan is not repealed before its most dangerous provisions come into effect, the result will be government-funding of abortion and the rationing denial of lifesaving medical treatment.  The pro-life movement must devote itself to educating the American people about these facts.

Finally, the law incorporates a whole new set of values into our health care system.  It emphasizes ways to save money at the expense of the quality of the doctor-patient relationship.  This change in values is a hall-mark of all the healthcare systems around the world that are built on the concept of socialized medicine.  By studying these systems, we can anticipate the direction our health care is taking.

Abortion Issues

There are two major abortion-related concerns in the health care law.  The first is the proposed insurance program that would be run entirely by the federal government.  It is also known as the public option and the law allows the government to fund abortions through this program. The law provides for the Secretary of Health and Human Services to mandate coverage of any medical service, including abortions.  This will be done in the same way as was recently demonstrated when Secretary Kathleen Sebelius mandated that employers provide for free birth control, including abortifacients, to their employees

The second is the proposed new premium-subsidy program to help tens of millions of people buy health insurance.  This program provides “affordability credits” to low-income individuals to make it possible for them to buy the health insurance, as required by the law.  The law allows the government to use “affordability credits” to subsidize both public plans and private insurance plans that cover elective abortions.

Rationing

      Under the new health care law, it is not just the unborn who are threatened by the cold hand of government. Now it is also those already born, who are in danger, because the inevitable result of the new health care law will be the rationing of medical care. And rationed care leads to involuntary euthanasia of the elderly and of those whose “quality of life” is considered too poor for modern medical care.

The Powell Center for Medical Ethics has been warning about this potential threat during the entire debate on the bill.  The Director of the Center, Burke J. Balch, J.D., points out that “Over-promising plus under-funding forces rationing.”  The history of government-run health care programs in other countries has demonstrated that they are not financially sustainable.  Sooner or later such programs run out of money.  As funding is limited, rationing is imposed to save money.

We already have evidence for this in the United States.  Massachusetts instituted universal health insurance coverage in 2006 with subsidies for the low-income uninsured so they could afford the mandated policies.  But the state found that expected savings did not materialize.  It appears that costs were larger than predicted; and the system ran out of money sooner, rather than later.  Under normal circumstances in the United States, people would simply begin to pay more, out of their own pockets, to get care that the government program could not provide.  Or, alternatively, they would make their own considered decisions about what forms of health care they would like to have.

We are already doing that with Social Security pensions.  Most people recognize that they will not be able to live comfortably on Social Security benefits alone so they seek other pensions or make additional retirement investments for themselves to cover the gap between what Social Security provides and what they actually need or would like to have.

When it comes to health care, “progressives” find the equivalent solution unacceptable.  It creates a “two-tiered” system, they protest:  a system that would provide government-mandated care to one class of people and better care for those who are well-insured or are willing to spend their own money for it.  That arrangement strikes the “progressives” in and out of government as “unfair.”

What is the “progressive” solution?  Prevent those who would want to buy better care from doing so.  In Massachusetts, another health care bill was passed that would limit what anyone can pay for health care.  If you limit what people can pay for things, they will only be able to buy a limited product, resulting in everyone having equally poor care.  This is rationing and this is what ObamaCare has brought to the entire United States.

Another way this will be done is through the so-called “Independent Payment Advisory Board,” also known as the “Death Panel,” that can advise on both government- and privately-funded medical care. The Secretary of Health and Human Services or other bureaucrats can impose so-called “quality and efficiency standards” on all health care providers if they want to participate even in nongovernmental insurance plans. Thus, the government will tell the health profession what diagnostic tests and medical care are approved according to these so-called “quality and efficiency” standards. These standards are specifically designed to force you to spend your funds only on health care below the rate of inflation.  In other words, your health care will be determined by the government, not by doctors when this section of the bill goes into effect in 2015.

When you go to your doctor, he normally will give you a list of possible treatments.  Now, however, he will not be able to list those that are not approved by the “Independent Payment Advisory Board.”  Even if he believes that an “unapproved” treatment would be the best for your particular case, his hands will be tied.  He will not be free to make only the medically appropriate treatment decisions.  Instead, every medical decision will also be a political decision.

Treatment that a doctor and patient in consultation deem needed or advisable to save the patient’s life or preserve or improve the patient’s health but which the government decides is too costly—even if the patient is willing and able to pay for it—will run afoul of the imposed standards.  In effect, there will be one uniform national standard of care, established by Washington bureaucrats and set with a view to limiting what private citizens are allowed to spend on saving their own lives, even if they can afford to buy the additional care.

The Impact on the Elderly

Obviously, the elderly are especially vulnerable to these dangerous provisions.  The reality is that human beings generally develop more health problems as they age.  Most of us spend most of our health care dollars in our old age.  That is when we need the care.  That is the reason that ObamaCare targets the elderly for most of the cuts.  Here are some of the negative effects the health care law will have on senior citizens in America.

(1)  Obama’s plan calls for cutting funding from the Medicare Trust Fund to pay for ObamaCare.  The Congressional Budget Office (July 24, 2012) reported that, so far, $716 billion have been cut from the fund that provides for the medical care of the elderly.

(2)  The dramatic cuts are resulting in cuts to the reimbursement rates for doctors, which is forcing many to stop accepting new Medicare patients.  Already, the Mayo Clinic in Arizona has announced that it will stop treating many Medicare patients.  Soon, elderly patients will have trouble finding doctors to treat them.

(3)  The very popular “private fee-for-service plans,” known as Medicare Advantage Plans have been cut.  Such plans would not have been forced to ration treatment, as long as senior citizens chose to pay more for them.  In a complex, indirect way, Section 3209 of the Health Care Reform Law will change the old law to make it possible for the federal government to follow the Massachusetts example at any time it wants.  It took the bureaucrats of Massachusetts only a few years to seek to impose rationing.  How long will it take the federal government?  In this way the Government will be able to prevent the elderly from spending their own money to save their own lives.

(4)  Patients will be pushed and cajoled into rejecting lifesaving treatment in order to reduce costs.  Under a new “Shared Decision-making” program, the federal government will contract with private entities to produce “patient decision-making aids” and doctors and other health care providers will be brought to regional centers to be trained in their use.  The orientation of these groups can be seen by the comments on their web sites, for example:  “Toward the end of life, too many people receive ineffective, expensive medical treatments.”  Under the guise of giving accurate and unbiased information to guide their informed consent, these groups develop material whose clear bias is to push and persuade patients to reject medical treatment.

Thus, the elderly in America have the most to fear from ObamaCare.  However, everyone in America will eventually be old and sick enough to suffer from the new provisions introduced by this very bad law.  All Americans have a stake in repealing it.

Financial Unsustainability of the Health Care Law

The supporters of ObamaCare always argued that it would save money and lower costs.  Many of the estimates done during the debate on the bill by the Congressional Budget Office (CBO) showed a modest cut in the budget deficits.  However, these estimates were based on two problematic assumptions.

First, President Obama took money from the Medicare Trust Fund to pay for ObamaCare — $716 billion as of July 24, 2012 – which undercuts the budget designed to serve America’s elderly. This is especially dangerous, since those on Medicare will not be able to use their own money to buy the care they desire.

Second, CBO estimates were based on the tricky accounting system built into the law, which delayed the point at which the full program would be implemented.  The most egregious example of this was that of the CLASS Act.

The Community Living Assistance Services and Supports was a voluntary long-term care insurance program set up to charge participants for five years before they became eligible for services.  The money collected in the first five years would be used to pay for other programs during that time, thus giving the Health Care Law the appearance of solvency.  However, the Law also required the program to pay for itself, and there was no way that the money used on other programs in the first five years could be used to pay for services after that.

On October 14, 2011, the Administration was forced to admit that the CLASS program was unsustainable and it was cancelled.  With that, the Administration also cancelled a primary mechanism for helping to pay for the thousands of new people brought into the government-funded health care program.  This is only the first of many programs that will be exposed as unsustainable.  For example, the cuts in Medicare are forcing health care providers to stop caring for Medicare patients and thousands of employers are dropping their health care plans forcing employees into the federal health care.

In West Virginia, the Governor has already called for massive budget cuts (Dominion-Post, September 4, 2012), in part, because of increases in Medicaid.

The Court Challenge

At the center of the payment plan for ObamaCare is the so-called “personal mandate” which requires every American to participate in this government-managed health care system by buying health insurance.  ObamaCare added millions of people to the government-supported health care system.  All of these new people will have their health care paid for by the Federal system.  In order to pay for this greatly enlarged system, ObamaCare has invented the “Individual Responsibility Requirement,” which mandates that every American participate, regardless of their personal wishes or else pay a penalty.

The Attorneys General of 27 states believed this was unconstitutional, since it requires citizens to buy a particular product.  They took this to the Courts for litigation, and, in June of 2012, the Supreme Court ruled that the penalty could be leveled, as it can be considered to be a tax.  Therefore, Obama has, according to the Court, imposed the largest tax on Americans in our history.

Thus, it falls to the American people and the legislative branch of our government to repeal this very bad tax.

Health Care Values

To advocate for rationing is to make a huge change in the fundamental value system that undergirds America’s health care system.  Traditionally, we have assumed that our health care is based on the values expressed in American’s founding documents.  The Declaration of Independence says that, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the Pursuit of Happiness.”

These self-evident truths are, of course, drawn from the Judeo-Christian belief in the inherent value of each individual person, created by God in His image.  Therefore, each American has an unalienable right to life, which the health care system should make every effort to provide.  Of course, human beings aren’t perfect and the institutions they develop and operate are never perfect.  However, Americans clearly expect that their medical system will have the goal of serving them, not rationing their care.

This attitude has traditionally been represented by the Hippocratic Oath.  Those who would incorporate rationing into our health care blame the Hippocratic Oath for the desire of health care personnel to help their patients. Dr. Ezekiel Emanuel is a health adviser to President Barack Obama and has been appointed to two key positions:  health-policy adviser at the Office of Management and Budget and a member of the federal Council on Comparative Effectiveness Research.

Dr. Emanuel had this negative “put-down” about doctors who refused to ration the care of their patients:

“Patients were to receive whatever services they needed, regardless of its cost.  Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life….Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs.”

It becomes clear that, rather than basing medical care on the “inalienable right to Life,” those who would ration our care are concerned only with costs.  Dr. Emanuel’s goal is “to provide socially sustainable, cost-effective care.”  The new value system is rooted in the financial well-being of the society as a whole.  For him, individual lives must be sacrificed to this greater good.

The Wall Street Journal reports on Dr. Emanuel’s idea of health care reform:  “True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008 issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the ‘overuse’ of medical care:  ‘Medical school education and post graduate education emphasize thoroughness,’ he writes.  ‘This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath’s admonition to ‘use my power to help the sick to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of cost or effect on others.’

Dr. Emanuel is planning health care reform that will limit costs.  But he is also planning a complete change in the doctor-patient relationship, in which the doctor no longer serves the patient with single-minded devotion.  Instead, he envisions a relationship totally rooted in a cost-benefit relationship.  Clearly, this not what most patients would ask from their doctors.”

The goal of Obama’s new Health Care Reform Law is to cut health-care costs.  However, it is clear that the method for doing that is to ration care by preventing patients from obtaining medical treatments that the government considers too expensive.  Many more people are put into the program, but the cuts come by limiting what the health care industry can provide to its clients. ObamaCare does this is by creating the “Independent Payment Advisory Board” that will provide suggestions for limiting what everyone spends on health care.  Government bureaucrats will then have the authority, based on its recommendations, to set “quality and efficiency” standards that doctors will be forced to follow, meaning all medical decisions will ultimately be made by the government, not by your doctor.

Advocates for rationing are very impressed with the government-controlled program in Great Britain.  In England, there has been extensive reporting on cases of denial of needed care in the government-run health care programs.  Care is rationed by simply denying the use of expensive newer drugs and denying or delaying therapies—especially for elderly patients.  Data fromCanadaandEnglandindicate that the survival rates for many illnesses are much lower than in theUnited Stateswhere the drugs and therapies are readily available.

One of the worst fears of the elderly is that they will not be able get the medical care they need because it isn’t considered “cost-effective” by someone else.  This has never been a wide-spread problem in theUnited States.  However, is that about to change?  Do pro-lifers have to worry not only about the lives of the unborn but also their own?  Is our health care system about to change for the worse?  The passage of the Obama Health Care Reform unfortunately has made the answers to these questions a definite “yes.”

How will the government go about determining who receives care and who doesn’t?   Once again, health care providers are looking to England.  David Catron (in The American Spectator, 7/24/09) has explained how the new health care law could work:

“…like its European counterparts, meaning that it will assign a monetary value to your life and deny your care if you contract a malady whose cost-of-treatment exceeds that amount.

If you are under the impression that it is impossible to calculate the value of human life, you are obviously not a progressive policy expert or health care bureaucrat.  This calculation, so elusive for philosophers and sages throughout the millennia, is child’s play for such people.  They have, in fact, already devised a formula for pricing out your life.  It is called the “quality-adjusted-life-year” or QALY, and it assigns a numerical value to a year of life.  A year of perfect health, for example, is given a value of 1.0 while a year of sub-optimum health is rated between 0 and 1.  If you are confined to a wheelchair, a year of your life might be valued at half that of your ambulatory neighbor.  If you blind or deaf, you also score low.  All that remains is to assign a specific dollar value to the QALY and, voila, your life has a price tag….

And, lest you imagine that QALY is a mere academic concept unlikely to be applied in the real world, it is already being used in countries burdened with socialized medicine.  In Great Britain, for example, the National Institute for Health and Clinical Excellence (NICE) uses ‘cost per QALY’ to determine if patients should receive expensive treatment or drugs.  It was with this formula that NICE calculated the precise amount six months of an average Brit’s life is worth.  As the Wall Street Journal reports, ‘NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months.’  In other words, patients whose country has guaranteed them ‘free’ health care are in some cases refused treatment because the incremental cost per additional QALY is too high.”

Given the enormous change in basic values that is needed to accept the notion of rationing, it is clear why Obama and his supporters do not want to talk to the American public about rationing, even though they are busy implementing it in the new health care law.  Instead, Americans will have Dr. Emanuel’s plans forced upon them.  In the Wall Street Journal, Betsy McCaughey describes Dr. Emanuel’s plans:

“In the Lancet, January 32, 2009, Dr. Emanuel and co-authors presented a ‘complete lives system’ for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others.  ‘One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism….Other things being equal, we should always save five lives rather than one.

However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear.  In  fact,  Dr. Emanuel makes a clear choice:  ‘When implemented the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.’

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains:  ‘Unlike allocation by sex or race, allocation by age is not invidious discrimination…Treating 65 year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.”  In other words, Dr. Emanuel will just discriminate against them on the basis of age.  This is the new value system perpetrated on America through the new Health Care Law.

This is today’s reality.  The law legitimizing these practices has been passed.  This law will lead to involuntary euthanasia in the “Land of the Free”—supposedly free.  We must work to repeal the new Health Care Reform Law not only to prevent the funding of abortions with our tax dollars, but also to prevent government-sanctioned denial of health care when our own lives are at stake.

 

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