House Democrats have pushed forward in their reconciliation bill with creating a new “Medicaid-like” program that lacks the Hyde amendment, a measure that generally prohibits federal funding of abortion. But West Virginia senator Joe Manchin, a pro-life Democrat, says reconciliation is “dead on arrival” in the Senate if it doesn’t include the longstanding pro-life protection.
Outside of the U.S. Capitol building on Wednesday evening, Manchin briefly spoke to National Review:
National Review: Senator, you’ve been very firm on keeping the Hyde amendment on the appropriations bills. Are you concerned about that issue at all in reconciliation—
Manchin: Certainly—
NR: —with this new Medicaid program?
Manchin: Yeah, we’re not taking the Hyde amendment off. Hyde’s going to be on.
National Review: In the new Medicaid program?
Manchin: It has to be. It has to be. That’s dead on arrival if that’s gone.
The traditional Medicaid program is funded by appropriations bills that are subject to a 60-vote hurdle in the Senate, so efforts by House Democrats to kill off the Hyde amendment entirely this year are doomed.
But in their reconciliation bill, which only needs a simple majority to pass the Senate, House Democrats propose creating a new Medicaid-like program administered entirely by the federal government for low-income residents in the twelve states that chose not to expand Medicaid under the Affordable Care Act. The new Medicaid-like program lacks the Hyde amendment and would therefore fund abortions for beneficiaries. If Manchin wants to close the so-called Medicaid gap without funding elective abortion, there appears to be an obvious path to accomplish that:
Politico reports that another option under consideration is “allowing low-income adults to get free private coverage through Obamacare’s insurance marketplaces.”
When Obamacare passed in 2010, it subsidized insurance plans that cover elective abortions (and still does), but it also gave states the ability to pass laws applying the Hyde amendment to all of the health-insurance plans offered on respective Obamacare exchanges. None of the twelve states that declined to expand Medicaid offers elective-abortion coverage in their taxpayer-subsidized Obamacare exchanges. So expanding Obamacare coverage in only those states would not result in taxpayer funding of elective abortion.
The House Energy & Commerce bill actually takes this approach to closing the Medicaid gap in 2022 and 2023 but then appears to add abortion funding in the Obamacare exchanges in those twelve states in 2024. As National Review reported earlier this month:
Because the new Medicaid program in these twelve states wouldn’t be up and running until 2025, the bill would, starting in 2022, make these low-income individuals eligible for Obamacare plans that the government would subsidize to the tune of 99 percent of the actuarial value of medical expenses (up from 94 percent under current law).
Obamacare plans in these twelve states do not currently cover taxpayer funding of abortion — the Affordable Care Act allowed states to prohibit elective abortion coverage in their exchanges — but the House Democrats’ bill appears to do an end run around that prohibition, too, starting in 2024.
The language in the House Energy and Commerce bill is convoluted, but it is hard to see how it isn’t designed to fund abortions in the Obamacare exchanges in the twelve states that didn’t expand Medicaid. The House reconciliation bill would require funding for family-planning services “which are not otherwise provided under such plan[s]” in Obamacare. The Affordable Care Act already requires plans to cover all FDA-approved contraceptives with no co-pay or cost-sharing, but as HealthCare.gov notes: “Plans aren’t required to cover drugs to induce abortions.” So family-planning services “not otherwise provided” means abortion.
These aren’t the only ways the House Energy and Commerce Committee bill would fund abortion. It also includes funding starting in 2024 for “non-emergency medical transportation services,” which could mean that enrollees could be transported at taxpayer expense for an abortion at any point in pregnancy. And it includes “public health” funding that could be used to train doulas and others to assist or perform elective abortions.
In June, Manchin said that he’s going to support the Hyde amendment “in every way possible.”