March 9: my analysis of Reid Mgr’s Amendment to Senate Health Care Reform

I wrote this last own analysis after digging in these bills…

HR 3590 is the Senate health care reform bill, “Patient Protection and Affordable Care Act. Senator Reid’s amendment of HR 3590 greatly affects the issue of abortion coverage. Page 2 of this amendment affects HR 3590, “Title X [of the Public Health Service Act]: Strengthening Quality, Affordable Health Care for All Americans” bill. I found this online at:

I have been puzzled and worried about what might be going on, especially with the spooky, evasive video of Sebelius “explaining” the health care bill and abortion. I consider myself a democrat, but I do not consider myself in league anymore with these people. I foolishly hold the democrat party values of transparency, of fighting for the little guy, of honesty, of protecting everyday people from the powers of big business and various other powers of big money, and I believe that we the people are fine to have a capitalist country, but there is a role for the government to oversee things so that we as a country don’t shoot ourselves in the foot by destroying the environment, failing to provide decent public services such as roads, water, education, and accessible court system to each and every one of us, regardless of our place in society. These jokers have moved well beyond these democrat party principles to socialism, and I am wary of every single one of these so-called democrats.

So, not trusting Reid or Sebelius, or Obama, I took a look at this health care bill, including the last-minute, more-arcane manager’s amendment. I hope this analysis helps people see that the federal government will be setting up a health care access system that will tax each of us a bit in order to make a pool of money for providing a source of payment to someone somewhere to get an abortion. There are no two ways about this: I am a male, and money will leave my pocket, by legislative mandate, to pay for the abortion of some female whom I have never met, much less whom I might have impregnated. This goes for each of us taxpayers who may soon be getting health insurance through any of the 50 state’s soon-to-be developed health insurance exchanges.

Now, because the money will come from each of us and go to a state fund to fund this abortion coverage, similar to the way many states make us pay taxes into state-level high-risk auto insurance programs, the federal legislators can “honestly” declare “no federal dollars will pay for abortions.” This is simple semantics, simple misleading. Not quite lying. But public abortion funding will happen because the federal government will mandate that this be put in place. Call it what you want.

I will walk through the relevant sections of this Reid manager’s amendment to show how this is constructed.

In the “manager’s amendment, there are a bunch of “special sections” that modify the Senate’s health care bill. One section, Section 1303, includes the modification to the rules regarding coverage of abortion. This is on pages 38 to 46 of the bill, noted above with link.

Section 1303 has several parts, each identified by lower-case letters. The parts referring to abortion coverage stipulated or allowed by health care reform are parts (a), (b), and (c).

As with most legislation, this is a challenge to understand. It is not delivered in narrative order, like we would tell a story, tell a joke, or give someone directions on how to do something. It is in a legal order, starting with some definitions, which are then referred to not by words such as “abortion,” but referred to by their outline-identification (such as “services identified in (a)(2)(b)” might refer to abortions, or to something else. So, it is a challenge to follow what is being discussed, since nouns are

replaced not by pronouns but by the letters and numbers identifying the place in the whole bill outline (outline, as in what they made us do in high school when they were trying to teach us to write well-constructed essays).

This is fine – it is how legislation needs to be written. It just makes an attempt to honestly explain it a bit cumbersome. I believe I have written and accurate portrayal of this legislation, and I hope others are trying to do the same. I hope others can identify any errors I have made.

So, what does it say in (a), (b), and (c) of Section 1303 of Reid’s manager’s amendment to the Senate’s health care reform bill?

(a) says: individual states can choose to prohibit their “qualified” health plans, in their state exchange, from covering abortions that are otherwise mandated by the rest of this section. So, the requirements I am about to outline are opt-out state-by-state.

(b) says: plans participating in the health exchanges of each state are not mandated to cover abortion, but can if they want, unless the specific state has prohibited this. So, the mandated plan will be voluntary, based upon health care plan providers if they choose.

Within (b) is the definition of the services to be covered: namely, abortion:


Abortion services: there are two categories of abortions that might be affected by this legislation: this clause sets a definition of abortions which by whatever current federal definitions are in effect cannot be paid for with DHHS funds. This section is mostly irrelevant to the question at hand, but says: if another law says abortion cannot be funded in some way, then the current legislation defers to that other legislation.


“Abortions for which Federal funding is allowed”:

this clause sets the term for these to be: those permitted under (1)(B)(ii); so anywhere you see the term ” (1)(B)(ii)”, this refers to abortion funding permissible per the Reid Manager’s Amendment. Here, abortion gets translated into “services permissible under (1)(B)(ii).” Anywhere you see that phrase, it is just a synonym for abortion.

So, (2)(A) declares that the federal cost-sharing or cost-offset part of any

fed-provided or exchange-offered cannot be used to cover abortions; this seems

to declare that federal dollars will not pay for abortions. OK, you legislators are technically not lying.

However, the next part, part B, gives the work-around to permit the federal law to make tax dollars pay for abortions:

1303 (b)(2)(B)

Establishment of allocation accounts

1303 (b)(2)(B)(i)

“collect from each enrollee in the plan (without regard to the enrollee’s age, sex, or family status) a separate payment for each of the following:”

This declares that each of our health insurance premiums, if paid to a private or public plan that is part of the “exchange,” will include a “separate” payment; in other words, a tax. Like, when you get your phone bill, and there is an FCC “fee” of some standard amount in addition to whatever amount was advertised by the telephone company.

1303 (b)(2)(C): Segregation of Funds

This section says that the money collected in (B)(i)(I) [define above] will be used to “exclusively” pay for “services” that are specifically prohibited by (1)(B)(i). In other words, the $12-per-year-or-more collected from each and every exchange-involved enrollee will be put in a specific fund to pay for

abortions that cannot be paid for by federal funds (as defined in (1)(b)(i). In other words, if a Hyde Amendment-type rule prohibits federal funds from covering abortion, then this state-gathered fee is specifically in place to pay for these abortions.

How much money? Well, there are two ways this could be calculated. First, a state could calculate the anticipated costs, which would roughly be the dollars needed to provide number of abortions expected per year. This is the same general principal as with any insurance provider, including car insurance, life insurance. Technically, these estimates are done by “actuaries,” and the estimates are called “actuarial values.” This term is used in the next piece of the legislation. This “actuarial value” would fluctuate from year to year, as events fluctuate, and as we see our car insurance and health insurance fluctuate from year to year. The other way to do this would be to demand a flat fee that would hopefully cover all the costs. States do this with fees often. And if the fees happen to be insufficient to cover the costs, then typically the state figures somewhere else to get the money to cover the actual costs, such as out of general revenue.

Would this be the case with federally mandated state-pool money to cover abortion? Or if a state’s fund ran out in November, would there be no abortions in December? This current legislation says nothing about this. It would be up to states to deal with this likelihood.

1303 (b)(2)(D)(i) “Actuarial Value”

Wordy legalese. This says that the plan can set this fee or tax to be whatever they are determining it might need to be to cover the abortions that will be sought under this new health reform system. My guess is that more liberal/progressive states might actually push to get this to be close to the actual costs, while less liberal/progressive states will set this at the federally mandated minimum (up next in the bill text).

1303 (b)(2)(D)(ii) “Considerations”

There are a few details here, but the real deal is in consideration III:

1303 (b)(2)(D)(ii)(III)

“may not estimate such a cost at less than $1 per enrollee, per month.”

That is the heart that declares that any of us who buy health insurance through any plan that is part of the “health insurance exchange” will have this fee, which will be in its own, dedicated fund, and that fund will be used to somehow pay for abortions in the state. This will be the case unless your state happens to go ahead and declare that it will opt out of this mandate. 

So, generally, that is how, at this point (end of December 2009) with the Reid amendment, HR 3590, abortion coverage will be federally mandated, with each health care exchange subscriber helping pay for abortions at a level of at least $12 per plan per year, unless a state opts out of covering abortion this way, and with no specific provisions for how to pay for desired abortions if this specific, dedicated fund runs out of money. By this plan, our employees in DC can declare that there are no federal dollars paying for abortions, and that our health insurance premiums are not covering abortion, and that any abortions paid for by any legislative mandates are paid for from totally “separate” funds.

Hopefully, when you hear these talking points, you can map these deceptive words to the actual parts of the legislation.

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