Poor implementation of the ACA is threatening a longstanding détente between pro-life and pro-choice legislators. Ever since the 1976 Hyde amendment, federal legislation has forbidden federal funds from subsidizing abortion. When the ACA was first debated, this rule was extended to its new subsidies as a sop to pro-life Democrats who were essential to the law’s passage. The subsidies for plans bought on the exchanges couldn’t directly be used to pay for abortion. But now, in practice, it appears that compromise may be eroding. WaPo reports:
The Government Accountability Office said in a report released late Monday that only 1 of 18 insurers it reviewed was separately itemizing a charge for coverage of elective abortions on enrollees’ bills […][In the compromise] private health plans covering the procedure would collect a separate premium, which would be segregated from federal subsidies for other medical services. […]Abortion opponents said the [GAO] findings underscore their view that the compromise is an accounting gimmick.In a written response, the Health and Human Services Department said it “acknowledges that additional clarification may be needed” when it comes to the health law’s provisions on abortions.
This compromise was essential to bringing over pro-life Democrats in the face of fierce Republican opposition to the ACA, so its lapse is notable—and easily fixable. But it’s unsurprising that a compromise like this would be enforced poorly under an administration famous for its reliance on executive discretion to push preferred policy changes and preferences. This is just another chapter in this imperial presidency, where the dictates of executive bureaucrats overrule the wishes of democratically elected representatives.