Abortion roils GOP ObamaCare debate

Abortion roils GOP ObamaCare debate
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Tax credits under the House GOP’s ObamaCare repeal-and-replace bill meant to help people afford insurance could be largely unusable in some blue states because of a showdown over abortion rules.

The issue has largely flown under the radar, but it could have serious implications, potentially keeping people in California and New York from accessing assistance that helps them afford coverage under the bill.

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One GOP lawmaker, Rep. Dan Donovan (N.Y.), also says the issue is contributing to his opposition to the bill. Republican leaders are trying to round up enough votes to pass the measure as soon as this week.

The GOP bill prohibits its new tax credits from being used to purchase plans that cover abortion. The problem is that California and New York require essentially all insurance plans in the state to cover abortion, meaning that there might not be any options for people in those states receiving the tax credits.

The tax credits are one of the central features of the GOP bill, which is aimed at reducing premiums and helping people afford coverage. In New York, though, “the tax credits are unusable,” Donovan told MSNBC last week.

“The help that we’re going to give those hard-working people who don’t get their insurance from their employer or who don’t qualify for government assistance, who have to buy insurance themselves, we aren’t providing them the relief that they deserve,” Donovan added.

Asked how any Republican lawmaker representing California or New York could support the bill given this situation, Donovan replied: “I don’t know. I can only account for myself.”

A spokesman for the House Ways and Means Committee defended the provision.

“The legislation simply prohibits taxpayer dollars from being used to fund those services — consistent with existing bipartisan policies like the Hyde Amendment,” committee spokeswoman Lauren Aronson said in a statement. “As with any major legislation, it will be incumbent on states to adapt as federal law changes.”

It is possible that if the bill became law, California and New York could change their laws and regulations to try to find a workaround. But it is far from clear that they would want to. Both are liberal states that are strongly defensive of abortion rights.

As a result, they appear to be on a collision course with the House GOP’s legislation.

In fact, California’s insurance commissioner, Dave Jones, told The Hill that he would sue to stop the provision in the bill if it became law.

“I would sue the federal government to defend California’s determination,” Jones said.

He called the provision, which influences state regulation of abortion coverage, an “incredible expansion of federal overreach.” He also said the courts could strike it down under precedent from the 2012 ObamaCare Supreme Court case, where the court ruled that the federal government could not coerce states into expanding Medicaid.

Several House GOP lawmakers from New York and California did not respond by deadline to requests for comment on the provision.

One House GOP aide, though, said that their office had raised the issue as a problem with House GOP leadership but had been told that there was not an appetite to change the provision.

Allowing the tax credits to go to plans that cover abortion could run afoul of anti-abortion members of the House.

“This is a serious issue,” said Bill Hammond, health policy director of New York’s Empire Center for Public Policy. “It didn’t get a lot of attention until now, but it’s been there all along.

“It would force Albany and Sacramento either to deny their residents, their citizens, access to these tax credits, or swallow their pride and change their policy on abortion coverage.”

It would be particularly hard for California to find a workaround, given that its state Constitution protects abortion rights, and any plan that covers pregnancy must also cover abortions.

California and New York would be the main states affected by the provision, but experts say Massachusetts also could be affected.

Hammond said it is possible that a Catholic plan in New York, called Fidelis, could be exempted and able to offer plans without abortion coverage.

Jones, the California insurance commissioner, said he did not know of any exceptions in his state.

“I think people haven’t necessarily sort of seen this,” said Amy Chen, senior staff attorney at the National Health Law Program, which supports abortion rights. “It has huge implications for progressive states like California, New York.”

This story was updated at 4:58 p.m.