Efforts to correct the abortion funding and conscience protection defects in the Affordable Care Act (ACA) and related rules continue in 2017. Early in the year the House again passed the No Taxpayer Funding for Abortion Act (H.R. 7). The latest version of conscience legislation, the Conscience Protection Act of 2017, was introduced in both House and Senate (H.R. 644, S. 301).
The House also began consideration of health care reform legislation to revamp the ACA and set health care reform on a new course. A new bill includes provisions restricting or prohibiting abortion funding.
On March 8, 2017, the Committee on Energy and Commerce and the Committee on Ways and Means marked up their sections of the new bill. On March 16, 2017, the Committee on the Budget incorporated the work of the other two House committees into one bill. All amendments in committee to strike pro-life provisions in the proposed text were rejected.
On March 20, 2017, the House Committee on the Budget reported as a reconciliation bill the American Health Care Act of 2017 (AHCA) (H.R. 1628), with House Report 115-52. The bill was placed on the House calendar.
On review, the U.S. bishops found some provisions of the AHCA commendable, for example those restricting or prohibiting abortion funding: “Laudably, the AHCA proposes to include critical life protections for the most vulnerable among us. By restricting funding which flows to providers that promote abortion and prohibiting federal funding for abortion or the purchase of plans that provide abortion—including with current and future tax credits—the legislation honors a key moral requirement for our nation’s health care policy.”
Other provisions present “grave challenges that must be addressed before passage.” The latter included the lack of conscience protection against health care mandates: “Absent in the AHCA are any changes to afford conscience protection against mandates to provide coverage or services, such as the regulatory interpretation of “preventive services” requiring contraception and sterilization coverage in almost all private health plans nationwide, which has been the subject of large-scale litigation especially involving religious entities like the Little Sisters of the Poor.”
The bishops expressed concern that efforts to improve deficiencies in the ACA should not create other problems, “particularly for those who struggle on the margins of our society.” In this respect the bishops state that the AHCA “must be modified” to correct specific serious flaws in the Medicaid-related provisions.
On March 24, 2017, the House approved a rule for consideration of H.R. 1628, but later in the day further consideration of H.R. 1628 was postponed.
The AHCA was further modified. First on April 6, 2017 and then a second time on May 3, 2017, the Rules Committee reported rules to the House for consideration of the AHCA with modifications. On May 4, 2017, the House passed the modified AHCA, 217-yes, 213-no (Roll Call 256).
In a May 4, 2017 statement, Bishop Frank J. Dewane of Venice, FL, Chairman of the U.S. Bishops’ Committee on Domestic Justice and Human Development, recognized that the AHCA “does offer critical life protections, and our health care system desperately needs these safeguards.” Despite efforts to improve the bill, Bishop Dewane stated that the AHCA “still contains major defects” and the Senate “must act decisively to remove the harmful proposals from the bill that will affect low-income people—including immigrants—as well as add vital conscience protections, or begin reform efforts anew.” See: www.usccb.org/news/2017/17-078.cfm.
The ACHA now moves to the Senate.
On May 4, 2017, President Donald Trump issued an Executive Order on Free Speech and Religious Liberty. For more details, see “Promoting Free Speech and Religious Liberty: Executive Order” elsewhere in this Legislative Report.
In 2010, after months of debate starting in 2009, Congress passed health care reform legislation, the Patient Protection and Affordable Care Act (H.R. 3590)—generally called the Affordable Care Act (ACA)—and a follow-up bill, the Health Care and Education Affordability Reconciliation Act (H.R. 4872). Thereafter President Obama signed these measures into law on, respectively, March 23 (PL 111-148) and March 30 (PL 111-152).
The late Cardinal Francis George, then President of the U. S. Bishops’ conference, opposed the ACA as passed. Along with other problems, the law “would expand the role of the federal government in funding and facilitating abortion and plans that cover abortion” and failed to include “essential conscience protections (both within and beyond the abortion context).”
General language in the ACA became the basis on which the Obama Administration in 2011 issued a rule—commonly called the HHS [Department of Health and Human Services] Mandate—requiring coverage in most private health plans of sterilization and abortion-inducing drugs and devices, as well as contraception. The Administration rule also required “counseling and education” to promote the coverage among all “women of reproductive capacity,” thereby including even minor girls.
In succeeding years, legislative efforts to correct the abortion funding and conscience protection defects in the ACA and related rules have not been successful. Court challenges have achieved some good results. In 2014 the U.S. Supreme Court ruled in its Hobby Lobby decision that the HHS mandate did not apply to closely held for-profit corporations. In 2016 the Court vacated lower court decisions against the Little Sisters of the Poor and other non-profit entities, urging accommodation for their religious beliefs.
For a full history, see HLA Legislative Reports from 2010 to 2016.