The U.S. bishops' pro-life chairman on Sept. 16 urged Congress to bring the federal health care law "into compliance with the Hyde amendment" and exclude elective abortions from health plans subsidized with federal funds.
"At a minimum, Congress should not delay in enacting a law to require full disclosure of abortion coverage and abortion premiums to Americans purchasing health plans," said Cardinal Sean P. O'Malley of Boston, who is chairman of the U.S. bishops' Committee on Pro-life Activities.
The GAO report "confirms the U.S. bishops' long-standing concern about abortion coverage" in the Affordable Care Act, the cardinal said.
He made the comments a day after the nonpartisan Government Accountability Office released a report assessing such coverage in plans across the country.
The Affordable Care Act was passed in 2010 without Hyde amendment-like protections, the long-standing federal statutory restriction that that says federal funds cannot be used abortion services, except in cases of rape or incest, or when the life of the woman would be endangered.
An effort to insert restrictions on abortion funding in the House version of the health care bill failed. Before the Senate passed the bill that was eventually signed into law by President Barack Obama on March 23, 2010, the U.S. Catholic bishops repeatedly urged U.S. senators to put Hyde-like language in the measure.
A day after he signed the health care bill, Obama issued an executive order applying the Hyde amendment restrictions to health insurance exchanges getting federal subsidies. But at the time Catholic and other pro-life leaders raised questions as to whether his executive order would stop any expanded use of taxpayer funds for abortion.
The GAO, which was asked to prepare its report by a group of Republican lawmakers, gathered information from February to September of this year. The federal agency identified more than 1,000 plans eligible for federal premium subsidies that cover elective abortions.
The report stated that the health care law "prohibits the use of federal funds made available to offset the cost of QHP (qualified health plans) coverage -- that is, income-based tax credits and subsidies -- to pay for non-excepted abortion services," that is, abortions not excepted under Hyde.
It said 23 states have laws restricting the circumstances under which qualified health plans can provide non-excepted abortion services as a covered benefit. Seventeen of those states have laws that do not permit coverage of any abortions; six of them permit coverage of non-excepted abortions "only in limited circumstances, such as to prevent substantial and irreversible impairment of a pregnant woman's major bodily function."
However, the report said, 28 states have no laws restricting such abortion coverage. In five of those states -- Connecticut, Hawaii, New Jersey, Rhode Island and Vermont -- all qualified health plans "cover non-excepted abortion services," it said.
In 15 of the 28 states, some plans cover non-excepted abortion services; of those 15, the number of plans providing abortion coverage ranged from 2 percent in Texas to 98 percent in Massachusetts. For example, in New York 405 out of 426 plans subsidize abortion on demand, in California, 86 out of 90 plans; and in Oregon, 92 out of 102.
The Affordable Health Care law requires all 50 states and the District of Columbia to offer at least two qualified health care plans, at least one of which does not cover non-excepted abortion services.
The GAO report said the Centers for Medicare and Medicaid Services, which is part of the Department of Health and Human Services, has provided limited guidance about the rules relating to coverage of abortion by health care plans. The HHS agency told the GAO "that additional clarification may be needed."
The health care law requires insurers to estimate the cost of coverage of abortion per enrollee per month and to collect from each enrollee a premium for that coverage that is "segregated from any other premium amounts."
Cardinal O'Malley in his statement criticized the lack of full disclosure on abortion coverage in federally subsidized health plans.
"Surveys have shown that most Americans do not want elective abortion in their health coverage, and do not want their tax dollars to fund abortions," he said. "Their wishes are not being followed, and it can be difficult or impossible for them to find out whether those wishes are respected even in their own health plan."
Cardinal O'Malley added: "The only adequate solution to this problem is the one the Catholic bishops advocated from the beginning of the health care reform debate in Congress: Bring the Affordable Care Act into compliance with the Hyde amendment and every other federal law on abortion funding, by excluding elective abortions from health plans subsidized with federal funds."
As co-chair of the Congressional Pro-Life Caucus, U.S. Rep. Chris Smith, R-New Jersey, also criticized the lack of transparency on coverage.
"Americans throughout the country have raised serious concerns that they find it nearly impossible to determine whether the plan they purchase finances the killing of unborn children," he said.