Friday, October 14, 2011

HR 358: Let Women Die Act

The US House of Representatives voted to advance HR 358, which amends the Patient Protection and Affordable Care Act passed last year (this is the big health insurance reform bill). This amendment, introduced by Pennsylvania's own Rep. Joe Pitts, makes double sure that not only are no federal funds used to pay for abortions but that women can't use their own money to purchase separate abortion insurance through federal exchanges.

Independent fact check group Politifact specifically referenced Pennsylvania when it debunked the myth that federal funds would be used for elective abortions. National political newspaper The Hill discusses the particulars of HR 358 ("House votes to advance abortion bill," by Pete Kasperowicz, 10/13/2011).

Among the requirements of the bill are:

any such non-Federal health insurance issuer that offers a qualified health plan through an Exchange that includes coverage for abortions for which funding is prohibited under this sub section also offers a qualified health plan through the Exchange that is identical in every respect except that it does not cover abortions for which funding is prohibited under this subsection.’’;
So private companies that do offer plans including abortion must also offer plans that are identical except that they don't cover abortions. And the plans that do cover abortion can't be offered through a federal exchange. That's a lot of extra paperwork for the insurance companies. That section also notes that: "administrative costs and all services offered through such coverage or plan are paid for using only premiums collected for such coverage or plan;" Does that mean offices have to keep track of the administrative costs of processing those claims and charge separately for them?

Another wording choice I noted was the exceptions clause:
‘‘(A) if the pregnancy is the result of an act of rape or incest; or
‘‘(B) in the case where a pregnant female suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the female in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself.
That removes any mental health issues. It also creates a gray area for women who discover they have a serious illness while pregnant and want to undergo aggressive treatment for it, which might impact or be impacted by the pregnancy.

One other clause that is of concern is this one:
20 ‘‘(g) NONDISCRIMINATION ON ABORTION.— ‘‘(1) NONDISCRIMINATION.—A Federal agency or program, and any State or local government that receives Federal financial assistance under this Act (or an amendment made by this Act), may not subject any institutional or individual health care entity to discrimination, or require any health plan created or regulated under this Act (or an amendment made by this Act) to subject any institutional or individual health care entity to discrimination, on the basis that the health care entity refuses to— ‘‘(A) undergo training in the performance of induced abortions; ‘‘(B) require or provide such training; ‘‘(C) perform, participate in, provide coverage of, or pay for induced abortions; or ‘‘(D) provide referrals for such training or such abortions.
‘‘(2) DEFINITION.—In this subsection, the term ‘health care entity’ includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.

As noted by the VeracityStew blog:
Currently, all hospitals in the U.S. that receive funds from Medicare or Medicaid, are required under EMTALA, the Emergency Medical Treatment and Labor Act, to perform emergency procedures on all patients, including emergency abortion procedures, regardless of their ability to pay. If the hospital is a religious-run hospital, like a Catholic hospital, and are opposed to abortion, they are still required to arrange transfer of the patient to a suitable hospital where the procedure can be performed.

HB 358 would exempt any hospital that opposes abortion from performing emergency procedures, and would also abolish the requirement of arranging transport to another hospital, leaving women completely helpless and without care.

In other words, left to die.

This is also pointed out in the House Report, 112-040
Subsection (a), paragraph (5) adjusts the current statutory language regarding preemption of state or federal laws to close loopholes. The state nonpreemption language currently contained in (c)(1) [redesignated at (e)(1) in the Protect Life Act] does not protect state conscience protection laws, and instead protects state laws requiring the provision of abortion and abortion funding. The Protect Life Act changes this language by removing protections for laws favoring abortion and instead ensures nonpreemption of State laws `protecting conscience rights, restricting or prohibiting abortion or coverage or funding of abortion, or establishing procedural requirements on abortion.' For the provision regarding Federal laws, a technical reference (`subject to subsection (g)') is added to ensure there is no conflict between this provision and the `Hyde-Weldon' conscience provision added in subsection (g).

Subsection (a), paragraph (6) inserts `Subject to subsection (g)' before the clause regarding emergency services including the Emergency Medical Treatment and Active Labor Act (EMTALA). There is not a conflict between the conscience clause and EMTALA because EMTALA references stabilizing the woman and her `unborn child.' The language clarifies that the general reference to `emergency services as required by State or Federal law' should not be construed to allow states to override conscience protections by labeling broad abortion mandates as `emergency service' requirements.

As I understand it, and I am neither a doctor not a lawyer, this means a doctor / hospital would be required to treat someone who had mowed down an entire Lamaze class of pregnant women, or a group of children, but would not be required to treat a woman who would die without an abortion. There's something very strange in that. (Yes, the does say "stabilize" but the bill takes out the requirement to refer the family to another facility or doctor who would do the procedure. In an emergency that kind of means she's likely to die.)

A Pennsylvania congressman introduced the bill and a number of other Pennsylvania congressmen co-sponsored it: Rep Critz, Mark, [PA- ]
Rep Kelly, Mike [PA-3]
Rep Marino, Tom [PA-10]
Rep Murphy, Tim [PA-18]
Rep Platts, Todd Russell [PA-19]
Rep Shuster, Bill [PA-9]
Rep Thompson, Glenn [PA-5]

The article in the Hill stated that all Republicans in the House and 11 Democrats voted for the bill. Something to remember come election time.

The entire text of the bill is available at:
You can find more information, a summary and voting records on the bill at (search for hr 358); this also links to the House Report.

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