U.S. Senate
HR3590 (2009)
Patient Protection and Affordable Care Act
111th Congress
1st Session
AMENDMENT. NO. 2786
Calendar No. 175
Purpose: In the nature of a substitute.
Introduction
Original
The American Constitution requires all revenue bills to begin
in the House of Representatives. The US Senate took HR3590, a bill
unrelated to health care that began in the House, and used its power of
amendment to replace the entire text of the original bill with the
text of this health care reform bill over 2,000 pages long. This
proposed "amendment" was introduced in the US Senate on 19 November,
2009.
Section 1303 of the bill contained the original protection of
conscience provisions [1303.(a)(1)A;1303.(a)(3);
1303.(b)(2)A], which are reproduced here
in context.
Amendments were proposed by Senators Tom Coburn [7
December, 2009] and Sam Blakcburn [15
December, 2009] to strengthen protection of conscience provisions,
but parliamentary procedures were used to keep the amendments from
coming to a vote.
The following provisions were replaced on 19 December, 2009, by
revisions proposed by one of the bill's sponsors, which became
law when the bill passed on
24 December, 2009. [Administrator]
SEC. 1303. SPECIAL RULES.
(a) SPECIAL RULES RELATING TO COVERAGE OF ABORTION SERVICES.-
(1) VOLUNTARY CHOICE OF COVERAGE OF ABORTION SERVICES.-
A) IN GENERAL.-Notwithstanding
any other provision of this title (or any amendment made by this title), and
subject to subparagraphs (C) and (D)-
(i) nothing in this title (or any amendment made by this
title), shall be construed to require a qualified health plan to provide
coverage of services described in subparagraph (B)(i) or (B)(ii) as part of
its essential health benefits for any plan year; and
(ii) the issuer of a qualified health plan shall determine
whether or not the plan provides coverage of services described in
subparagraph (B)(i) or (B)(ii) as part of such benefits for the plan year.
B) ABORTION SERVICES.-
i) Abortions for which public funding is prohibited - The
services described in this clause are abortions for which the expenditure of
Federal funds appropriated for the Department of Health and Human Services
is not permitted, based on the law as in effect as of the date that is 6
months before the beginning of the plan year involved.
(ii) Abortions for which public funding is allowed - The
services described in this clause are abortions for which the expenditure of
Federal funds appropriated for the Department of Health and Human Services
is permitted, based on the law as in effect as of the date that is 6 months
before the beginning of the plan year involved.
(C) PROHIBITION ON FEDERAL FUNDS FOR ABORTION SERVICES IN
COMMUNITY HEALTH INSURANCE OPTION.-
(i) Determination by Secretary -The
Secretary may not determine, in accordance with subparagraph (A)(ii), that
the community health insurance option established under section 1323 shall
provide coverage of services described in subparagraph (B)(i) as part of
benefits for the plan year unless the Secretary-
(I) assures compliance with the requirements of paragraph
(2);
(II) assures, in accordance with applicable provisions of
generally accepted accounting requirements, circulars on funds management of
the Office of Management and Budget, and guidance on accounting of the
Government Accountability Office, that no Federal funds are used for such
coverage; and
(III) notwithstanding section 1323(e)(1)(C) or any other
provision of this title, takes all necessary steps to assure that the United
States does not bear the insurance risk for a community health insurance
option's coverage of services described in subparagraph (B)(i).
(ii) State Requirement.-If a State
requires, in addition to the essential health benefits required under
section 1323(b)(3)(A), coverage of services described in subparagraph (B)(i)
for enrollees of a community health insurance option offered in such State,
the State shall assure that no funds flowing through or from the community
health insurance option, and no other Federal funds, pay or defray the cost
of providing coverage of services described in subparagraph (B)(i). The
United States shall not bear the insurance risk for a State's required
coverage of services described in subparagraph (B)(i).
(iii) Exceptions.-Nothing in this
subparagraph shall apply to coverage of services described in subparagraph
(B)(ii) by the community health insurance option. Services described in
subparagraph (B)(ii) shall be covered to the same extent as such services
are covered under title XIX of the Social Security Act.
D) ASSURED AVAILABILITY OF VARIED COVERAGE THROUGH EXCHANGES.-
(i) In General.-The Secretary shall assure that with
respect to qualified health plans offered in any Exchange established
pursuant to this title-
(I) there is at least one such plan that provides coverage
of services described in clauses (i) and (ii) of subparagraph (B); and
(II) there is at least one such plan that does not provide
coverage of services described in subparagraph (B)(i).
(ii) Special Rules.-For purposes of clause (i)-(I) a plan
shall be treated as described in clause (i)(II) if the plan does not provide
coverage of services described in either subparagraph (B)(i) or (B)(ii);
and(II) if a State has one Exchange covering more than 1 insurance market,
the Secretary shall meet the requirements of clause (i) separately with
respect to each such market.
(2) PROHIBITION ON THE USE OF FEDERAL FUNDS.-
(A) IN GENERAL.-If a qualified health plan provides
coverage of services described in paragraph (1)(B)(i), the issuer of the
plan shall not use any amount attributable to any of the following for
purposes of paying for such services:
(i) The credit under section 36B of the Internal Revenue
Code of 1986 (and the amount (if any) of the advance payment of the credit
under section 1412 of the Patient Protection and Affordable Care Act).
(ii) Any cost-sharing reduction under section 1402 of the
Patient Protection and Affordable Care Act (and the amount (if any) of the
advance payment of the reduction under section 1412 of the Patient
Protection and Affordable Care Act).
(B) SEGREGATION OF FUNDS.-In the case of a plan to which
subparagraph (A) applies, the issuer of the plan shall, out of amounts not
described in subparagraph (A), segregate an amount equal to the actuarial
amounts determined under subparagraph (C) for all enrollees from the amounts
described in subparagraph(A).
(C) ACTUARIAL VALUE OF OPTIONAL SERVICE COVERAGE.-
(i) In General.-The Secretary shall estimate the basic
per enrollee, per month cost, determined on an average actuarial basis, for
including coverage under a qualified health plan of the services described
in paragraph (1)(B)(i).
(ii) Considerations.-In making such estimate, the
Secretary-(I) may take into account the impact on overall costs of the
inclusion of such coverage, but may not take into account any cost reduction
estimated to result from such services, including prenatal care, delivery,
or postnatal care; (II) shall estimate such costs as if such coverage were
included for the entire population covered; and (III) may not estimate such
a cost at less than $1 per enrollee, per month.
No individual health care provider or health care facility may be
discriminated against because of a willingness or an unwillingness, if doing
so is contrary to the religious or moral beliefs of the provider or
facility, to provide, pay for, provide coverage of, or refer for abortions.
(b) APPLICATION OF STATE AND FEDERAL LAWS REGARDING ABORTION.-
(1) NO PREEMPTION OF STATE LAWS REGARDING ABORTION.-
Nothing in this Act shall be construed to preempt or otherwise have any
effect on State laws regarding the prohibition of (or requirement of)
coverage, funding, or procedural requirements on abortions, including
parental notification or consent for the performance of an abortion on a
minor.
(2) NO EFFECT ON FEDERAL LAWS REGARDING ABORTION.-
(A) IN GENERAL.-Nothing
in this Act shall be construed to have any effect on Federal laws regarding-
(i) conscience protection;
(ii) willingness or refusal to provide abortion; and
(iii) discrimination on the basis of the willingness or
refusal to provide, pay for, cover, or refer for abortion or to provide or
participate in training to provide abortion