Executive
Order

– –
– – – – –

ensuring
enforcement and implementation of abortion restrictions in the patient
protection and affordable care act

By the authority vested in me as President by the
Constitution and the laws of the United States of America, including the
“Patient Protection and Affordable Care Act” (approved March ­­__,
2010), I hereby order as follows:

Section
1.  Policy. 

Following
the recent passage of the Patient Protection and Affordable Care Act
(“the Act”), it is necessary to establish an adequate enforcement
mechanism to ensure that Federal funds are not used for abortion services
(except in cases of rape or incest, or when the life of the woman would be
endangered), consistent with a longstanding Federal statutory restriction that
is commonly known as the Hyde Amendment.   The purpose of this
Executive Order is to establish a comprehensive, government-wide set of
policies and procedures to achieve this goal and to make certain that all relevant
actors—Federal officials, state officials (including insurance
regulators) and health care providers—are aware of their
responsibilities, new and old. 

The
Act maintains current Hyde Amendment restrictions governing abortion policy and
extends those restrictions to the newly-created health insurance
exchanges.  Under the Act, longstanding Federal laws to protect
conscience (such as the Church Amendment, 42 U.S.C. §300a-7, and the Weldon
Amendment, Pub. L. No. 111-8, §508(d)(1) (2009)) remain intact and new protections
prohibit discrimination against health care facilities and health care
providers because of an unwillingness to provide, pay for, provide coverage of,
or refer for abortions.

Numerous executive agencies have a role in ensuring
that these restrictions are enforced, including the Department of Health and
Human Services (HHS), the Office of Management and Budget (OMB), and the Office
of Personnel Management (OPM).  

Section 2.  Strict Compliance with
Prohibitions on Abortion Funding in Health Insurance Exchanges.  The Act specifically
prohibits the use of tax credits and cost-sharing reduction payments to pay for
abortion services (except in cases of rape or incest, or when the life of the
woman would be endangered) in the health insurance exchanges that will be
operational in 2014.  The Act also imposes strict payment and accounting
requirements to ensure that Federal funds are not used for abortion services in
exchange plans (except in cases of rape or incest, or when the life of the
woman would be endangered) and requires state health insurance commissioners to
ensure that exchange plan funds are segregated by insurance companies in
accordance with generally accepted accounting principles, OMB funds management
circulars, and accounting guidance provided by the Government Accountability
Office. 

I hereby direct the Director of OMB and the
Secretary of HHS to develop, within 180 days of the date of this Executive
Order, a model set of segregation guidelines for state health insurance
commissioners to use when determining whether exchange plans are complying with
the Act’s segregation requirements, established in Section 1303 of the
Act, for enrollees receiving Federal financial assistance.  The guidelines
shall also offer technical information that states should follow to conduct
independent regular audits of insurance companies that participate in the
health insurance exchanges.  In developing these model guidelines, the
Director of OMB and the Secretary of HHS shall consult with executive agencies
and offices that have relevant expertise in accounting principles, including,
but not limited to, the Department of the Treasury, and with the Government
Accountability Office.  Upon completion of those model guidelines, the
Secretary of HHS should promptly initiate a rulemaking to issue regulations,
which will have the force of law, to interpret the Act’s segregation
requirements, and shall provide guidance to state health insurance
commissioners on how to comply with the model guidelines.

Section 3.  Community Health Center
Program.  

The Act establishes a new Community Health Center
(CHC) Fund within HHS, which provides additional Federal funds for the
community health center program.  Existing law prohibits these centers
from using federal funds to provide abortion services (except in cases of rape
or incest, or when the life of the woman would be endangered), as a result of
both the Hyde Amendment and longstanding regulations containing the Hyde
language.  Under the Act, the Hyde language shall apply to the
authorization and appropriations of funds for Community Health Centers under
section 10503 and all other relevant provisions.  I hereby direct the
Secretary of HHS to ensure that program administrators and recipients of
Federal funds are aware of and comply with the limitations on abortion services
imposed on CHCs by existing law.  Such actions should include, but are not
limited to, updating Grant Policy Statements that accompany CHC grants and
issuing new interpretive rules.

Section
4.  General Provisions.  

(a)
Nothing in this Executive Order shall be construed to impair or otherwise
affect:  (i) authority granted by law or presidential directive to an
agency, or the head thereof; or (ii) functions of the Director of the Office of
Management and Budget relating to budgetary, administrative, or legislative
proposals.

(b) This Executive Order
shall be implemented consistent with applicable law and subject to the
availability of appropriations.

(c)
This Executive Order is not intended to, and does not, create any right or
benefit, substantive or procedural, enforceable at law or in equity against the
United States, its departments, agencies, entities, officers, employees or
agents, or any other person.

THE
WHITE HOUSE,