How Senator Mikulski Slipped an Abortion Mandate into the Health Care Bill
On Thursday, July 9, the Senate Health, Education, Labor and Pensions Committee met to consider amendments to the legislation it is drafting to rearrange the entire U.S. health care system.
While chairing the hearing, Mikulski offered an obscurely worded, two-part amendment.
The first part required literally all health insurance companies in America to provide unspecified “preventive care and screenings” for “pregnant women and individuals of child-bearing age.” The specific services involved would be determined later in guidelines approved by a federal agency called the Health Resources and Services Administration.
This part of the amendment said: “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for, and shall not impose any cost sharing requirements (other than minimal cost sharing in accordance with guidelines developed by the Secretary) for, with respect to women (including pregnant women and individuals of child bearing age), such additional preventive care and screenings not covered under section 2708 as provided for in guidelines supported by the Health Resources and Services Administration.”
The second part of the amendment applied to health insurers participating in government-run insurance networks—so-called “American Health Benefit Gateways”—that the bill directs each state to create. These “gateways,” consisting of a government-run insurance company plus “qualified” private insurance companies, would offer federally subsidized insurance to Americans earning less than 400 percent of the poverty level (currently $88,000 for a family of four).
In order to “qualify” to participate in these gateways, Mikulski’s amendment said, the secretary of health and human services must certify that the insurer includes “within health insurance plan networks those essential community providers, where available, that serve predominantly low-income, medically underserved individuals, such as health care providers defined in section 340B(a)(4) of the Public Health Service Act and providers described in section 1927 (c) (1)(D)(i)(IV) of the Social Security Act as set forth by section 21 of Public Law 111-8.”
Like many amendments offered in Congress these days, Mikulski’s was intentionally opaque. It did not plainly state that insurance companies must cover “abortion” and that taxpayers must pay for the abortions of people making up to $88,000 per year who are participating in federally subsidized insurance plans.
But Mikulski was outed anyway.
When she brought her amendment up, an exceedingly polite and understated—but nonetheless stunning—colloquy ensued.
Republican Sen. Orrin Hatch of Utah quietly asked the necessary questions. Pointing to the language mandating that health insurers participating in government “gateways” must include “essential community providers,” Hatch asked: “Would that include abortion providers? I mean it looks to me like you’re expanding it to where you—well, say for instance, like Planned Parenthood. Would that put them into this system?”
Mikulski was evasive.
“It would include women’s health clinics that provide comprehensive services, and under the definition of a women’s health clinic it would include Planned Parenthood clinics,” said Mikulski. “It does not in any way expand a service. In other words, it doesn’t expand, nor mandate an abortion service.”
“No,” said Hatch, “but it would provide for them.”
“It would provide for any service deemed medically necessary or medically appropriate,” said Mikulski.
In other words, “gateway” insurers would be required to cover Planned Parenthood services, which would include procedures deemed “medically appropriate,” which would include abortions.
“Well, I would have a rough time supporting it on that basis,” said Hatch. “But I just wanted to get that clarified.”
At this point, Democratic Sen. Bob Casey Jr. of Pennsylvania had a go-around with Mikulski.
“You and I had a discussion about it,” Casey said to Mikulski. “The way it is written—and I don’t believe this is the intent—the way it is written, I believe it is too broad. And the way it could be interpreted down the road might include something like abortion. And I am concerned about that, the breadth of it and the scope of it. And for that reason I will oppose it.”
To eliminate any ambiguity that Mikulski’s amendment was intended to mandate abortion coverage in the proposed health-care reform, Hatch asked her a final question.
“Madame Chairman, would you be willing to put some language in that says, ‘Not including abortion services’?” Hatch asked. “Then I think you would have more support.”
Mikulski concluded with a convoluted response, saying, “So, no, I would not be willing to do that at this time.” Mikulski’s amendment passed.
On Monday, Hatch offered his own amendment in the committee to prohibit any funding of abortion through federally funded health insurance programs except in cases of rape, incest or to save the life of the mother. The amendment was defeated.