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Conscience Protections and the Affordable Care Act

Last month’s report from the Government Accountability Office (GAO) — the independent government agency that investigates the use of federal funds — cast suspicion over President Obama’s promise that the Affordable Care Act would not undo conscience laws prohibiting the use of federal dollars to fund abortions.

The GAO reported that many plans offered through the state exchanges include abortion coverage.  A large percentage of consumers — both low – and middle – income families — who purchase insurance through these exchanges will receive federal subsidies for their coverage, but of the eighteen insurance providers surveyed by the GAO, not one was collecting a separate fee for abortion insurance.

In our state, the Washington Health Benefit Exchange is the online marketplace where residents purchase health insurance conforming to the requirements of the ACA.  If you qualify for federal subsidies, they will be sent directly to the insurance company on your behalf.

So how does Washington State ensure that taxpayers like you and I are not paying for abortions?  While the topic of abortion rights and funding was a point of strong contention in passing the ACA, it is oddly absent on the Washington Health Benefit Exchange website (  On this site, consumers can enter information about themselves to get price estimates for insurance plans.  There is no question about abortion coverage.  It is also missing on the website of the Washington State Office of the Insurance Commissioner (  A prominent page on the Insurance Commissioner’s site is titled “What determines how much you’ll pay in premiums.”  Listed below are seven factors, including whether you smoke and whether you qualify for federal subsidies.  Not a word about abortion.

Those who direct the Washington Health Benefit Exchange say that abortion coverage fees required by the ACA will be collected by the IRS.  This is their plan for the tax years 2014 and 2015.  By 2016 they hope to implement a system that collects this fee in a more direct manner.

If you are still following me, you are probably wondering a few things:  Why are they collecting the abortion insurance premiums in such a roundabout way?  And why aren’t they informing women that they will pay extra for abortion coverage?  Won’t these women be surprised and frustrated when, come tax season, they find out they must pay for something they thought was included in the original price?

Or maybe you’re thinking, “Did I unwittingly purchase a plan that includes abortion coverage?  Am I going to be charged for something I never wanted?”  Since most plans include abortion coverage, presumably some women who would never consider getting an abortion may purchase a plan that covers abortion because it has other features that are desirable.  They probably do not know that they will be charged an additional fee for this insurance.

Bill Hinkle is a former state legislator, a pro-life Republican and one of eleven board members of the Washington Health Benefit Exchange.  He insists that our state’s apparent negligence on this front is the result of technical issues.

The state’s website was already designed when the laws regarding abortion coverage were passed, he explained.  “The way our system was set up, we didn’t have any way to do it,” he said.  “I wish it was just some simple accounting thing, but it’s not.”

Hinkle added, “It doesn’t mean that we are not in keeping with the spirit of the law.  There’s nothing political about it.”

That may be the case.  A year after it began to take effect, still no one seems to fully understand the Affordable Care Act or what its final implementation will be.  For concerned citizens, it’s more important than ever to wade through tedious details to stay informed and hold government accountable.   We are living in a new era: Government of the experts, by the experts and perhaps for the experts.  Which makes our task clear—become an expert.

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