Here Are Religious Liberty and Church-State Issues From Senate's Health Care Reform Bill

Last week, the Chairman of the Senate Finance Committee, Sen. Max Baucus, introduced his detailed proposal for comprehensive health care reform, the America's Healthy Future Act of 2009. (Press release.) The committee has posted a 223 page document (the Chairman's Mark) describing the bill and a 348-page document summarizing a large number of proposed amendments from other Finance Committee members. Several items covered in the bill and proposed amendments are of particular interest to those following religious liberty and church-state matters-- abortion, conscience provisions, spiritual health care, faith-based grants and abstinence education.

Extensive attention has been given to issues relating to abortion services. A lengthy summary of the abortion provisions in the bill are in the Chairman's Mark at pp. 28-30 of that document. The provisions would:

• ensure that state laws prohibiting or requiring coverage or funding for abortions, and state laws involving abortion-related procedural requirements, are not preempted. The provision similarly provides that Federal conscience protections and abortion-related antidiscrimination laws would not be affected by the bill.
  
• abortions (beyond those for which federal funds can already be used) cannot be a mandated benefit as part of a minimum benefits package but a qualified health plan would not be prohibited from providing additional coverage. Federal funds continue to be prohibited from being used to pay for abortions unless the pregnancy is due to rape, incest, or if the life of the mother is in danger.


• no tax credit or cost-sharing credits may be used to pay for abortions beyond those for which federal funds may already be used. Insurers participating in any state-based exchange that offer additional abortion coverage must segregate from any premium and cost-sharing credits an amount of each enrollee's private premium dollars that is determined to be sufficient to cover the provision of those services.


• in each state exchange, at least one plan must provide additional abortion coverage and at least one plan must not provide such coverage.


• health benefits plans participating in state exchanges would be prohibited from discriminating against any individual health care provider or health care facility because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions.

Other provisions of interest in the Chairman's Mark are:

• Pg. 31: Exemptions from the requirement to have health coverage would be allowed for religious objections that are consistent with those allowed under Medicare.
  
• Pg. 32: Exemptions from the excise tax on those who do not purchase health insurance policies will be made for any health arrangement provided by established religious organizations comprised of individuals with sincerely held beliefs (such as those participating in Health Sharing Ministries),.
  
• Pg. 76: states can apply for funds to provide incentives to Medicaid enrollees who successfully complete healthy lifestyle programs. In designing plans, States may collaborate with community-based programs, non-profit organizations, providers, and faith-based groups, among others.

Many of the proposed amendments are also of interest to those concerned with religious liberty and church-state issues. Here is a summary with an indication of the pages at which they appear:

• Pg. 36: Rockefeller Amendment #C22: $80 million annually would go to non-profit, community-based, and faith-based organizations as well as to states to cover the administrative costs of system and policy improvements that expedite enrollment and retention in the Children's Health Insurance Program.
  
• Pg. 79: Kerry-Hatch Amendment #C-14 (pg. 79): No qualified health plan offered through a State Exchange may deny benefits for religious or spiritual health care.
  
• Pg. 201: Hatch Amendment #C-10: Restores funding for abstinence education.
  
• Pg. 203: Hatch Amendment #C-12: Prohibits federal funds from being used to pay for assisted suicide and offers conscience protections to providers or plans refusing to offer assisted suicide services.
  
• Pg. 204: Hatch Amendment #C13: Non-discrimination on abortion and respect for right of conscience.
  
• Pg. 205: Hatch Amendment #C14: Prohibits federal funds under the Act from being used for elective abortions and plans that cover such abortions.
  
• Pg. 310: Enzi Amendment #C12: Prohibits requirement that a health plan cover abortions except in the case where the mother‘s life is in danger or the pregnancy is the result of rape or incest.
  
• Pg. 311: Enzi Amendment #C13: Prohibits federal funds to be used to pay for any abortion or cover any part of the cost of any health plan that includes coverage of abortion, except in the case where the mother‘s life is in danger or the pregnancy is the result of rape or incest. But individuals may purchase supplemental abortion coverage with non-federal funds.
  
• Pg. 312: Enzi Amendment #C14: Prohibits any provision in the bill from overturning or preempting constitutionally permissible laws or regulations of a State, that place limitations or procedural requirements on abortions, including any state law requiring parental notification or consent for the performance of an abortion on a minor.
  
• Pg. 313: Enzi Amendment #C15: Prohibits the federal, state or local governments, health care providers or plans that receives federal funds from discriminating against an individual or institution on the basis that they do not perform or participate in specific surgical or medical procedures or prescribe certain pharmaceuticals in violation of the moral, ethical, or religious beliefs of the individual or entity.

Yesterday the Interfaith Alliance released letters it sent to Sen. Orrin Hatch objecting to his Amendment #C-10 and to Sen. Michael Enzi objecting to his Amendment #C-15.