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Jennifer Klein's Files
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AUG 17 '94 18:06
PAGE. 001
SUBCOMMITTEE ON
HEALTH AND THE
ENVIRONMENT
FAX COVER SHEET
2415 Rayburn Building
2424 Rayburn Building
Washington, D.C. 20515
Washington, D.C. 20515
Phone: 202-225-4952
Phone: 202-225-0130
Fax: 202-225-3043
Fax: 202-225-7090
From the Desk of
From the Desk of
Debbie Finn
Ruth Katz
Mike Hash
Anne Lebbon
Alan Schlobohm
Karen Nelson
Andy Schneider
Tim Westmoreland
Attention:
Janifer Klein
Organization:
Phone:
Fax: 456-2878
Pages Following
Cover Sheet:
Message:
NOT for distribution but
FYI.
Crevision to follow)
AUG 17 '94 18:06
PAGE. 002
PUBLIC FUNDS
PRIVATE FUNDS FROM
PRIVATE FUNDS FROM
INDIVIDUALS
INDIVIDUALS WHO
WHO OBJEC TO
DO NOT OBJECT TO
ABORTION COVERAGE
ABORTION COVERAGE
PRIVATE FUNDS FROM
PRIVATE FUNDS FROM
RE GIOUSLY CONTROLLED
NON RELIGIOUSLY-
EMPLOYERS WHO OBJECT
CONTROLLED
TO ABORTION COVERAGE
EMPLOYERS
RESTRICTED
UNRESTRICTED
FUNDS
FUNDS
EXCESS
FUNDS
IF ANY
PAYMENT FOR GENERAL
PAYMENT FOR ABORTION
MEDICAL EXPENSES EXCEPT
SERVICES
ABORTION
No federal funds are used to pay for abortion.
Any individual who objects to abortion will not have abortion coverage and
their insurance premiums will not pay for other's abortions.
AUG-10-1994 00:05 FROM
TO
94562878 P.02
August 9
Note to Jen Klein
Here is the latest abortion language from Fran on the
individual/religious employer opt out and segregating funds.
The way I read this, only religious employers have the
opportunity to delete abortion coverage from the standard benefit
package for other people. Individuals also have the opportunity
to delete abortion coverage for their own policy. Coverage for
abortions that save the life of the mother can never be deleted.
Once these opt outs have been made, insurers are obligated to
maintain segregated accounts. Premium dollars from religious
employers and from individuals who have opted out, as well as
premium dollars from the subsidy pool go into an account that
cannot pay claims for abortions (other than for life of the
mother, rape and incest). All other premium dollars go into an
account that can pay for abortion services.
For subsidized individuals, the net result is that these low
income women may (at their own option) retain coverage for
abortion, even though premium contributions made on their behalf
are in the non-abortion pool.
I believe this will satisfy Rob and Susan. Robyn Lipner called
this morning and wants it, too.
Let me know what you think.
KP
Karen
PS- Pls feel free to share
with Lary, whomever -
AUG-10-1994 00:05 FROM
TO
94562878 P.03
SEC.
OPTION TO DECLINE COVERAGE OF ABORTION SERVICES;
SEPARATE ACCOUNTING FOR PREMIUMS.
(a) Individual Option.
(1) In General. An individual enrolled in a health
benefits plan may request the insurer, and the insurer shall
agree, to exclude coverage from such individual's policy for
abortion services if such service are contrary to the
religious beliefs or moral convictions of the individual.
(2) Method of Requesting. Each individual shall be
afforded an opportunity to file a request as provided in
paragraph (1) which shall be in writing, signed by the
individual, and delivered directly to the insurer (without
any employer receiving notice of such request).
(b) Option for Employers Affiliated with Religious
Organizations.
(1) In General. --A religious employer (as defined in
paragraph (3)) may offer one or more health benefits plans
that meet all the requirements of this Act except that the
plan or plans exclude abortion services if such services are
contrary to the religious beliefs or moral convictions of
the religious organization with which the employer is
affiliated.
(2) Notice to Prospective Enrollees. Each employer
exercising the option afforded under paragraph (1) shall
make information available to each employee, and to each
AUG-10-1994 00:05 FROM
TO
94562878 P.04
2
individual to whom an offer of employment is made, about the
exclusion of abortion services under one or more of the
health benefits plans provided by such employer.
(3) Definition. --As used in this section, the term
"religious employer" means an employer who is, in whole or
in substantial part, owned, supported, controlled, or
managed by a particular religion or by a particular
religious corporation, association, or society.
(c) Exception.--Nothing in this section shall be construed
as authorizing exclusion of coverage under a health benefits plan
of abortion services necessary to save the life of the mother.
(d) Insurer Obligation to Maintain Separate Account;
Prohibition
(1) Maintenance of Separate Accounts. Each insurer
providing a health benefits plan under the Act shall
maintain in a separate account--
(A) premiums paid by individuals who, in
accordance with subsection (a), have requested that
coverage of abortion services be excluded,
(B) premiums paid by employers who, in accordance
with subsection (b), have excluded abortion services
from the health plans they offer, and
(C) all subsidies provided under a Federal or
Federally-assisted program with respect to an
AUG-10-1994 00:06
FROM
TO
94562878 P.05
3
individual's share of the premium to obtain coverage
under a health benefits plan provided by the insurer.
(2) Prohibition. --No payment shall be made for
abortion services from the separate account required by
paragraph (1) (other than for an abortion necessary to save
the life of the mother or to terminate a pregnancy that is
the result of an act of rape or incest).
(3) Certification. -Each insurer shall certify
annually to the Secretary that no expenditure prohibited by
paragraph (2) was made from the separate account required
under paragraph (1) .
AUG 5 94 17:02
PAGE 002
1)
Rule of construction on State regulation of time, manner, and
circumstances.
2)
Rule of construction on no construction of abortion clinic facilities or
requirement for certification that abortion clinics be within the State.
3)
Exemption for religiously controlled employers.
4)
Someone (the Secretary?) is to calculate the actuarial value of having
abortion coverage in the minimum benefits package, if any. (First choice
is community-rated actuarial value (which may include offsets against
labor and delivery costs; second choice is community-rated amount,
which may not). If there is a cost, call this the Premium Amount. (If
there is no cost, all of this is academic.)
5)
In Medicare C:
(A) The minimum benefits package for all beneficiaries includes
abortion services to be paid for by private funds.
(B) All public funds go into an account that cannot pay for abortion
services.
(C) Except as provided below in F, all private funds (from employee
share of the premium and from any employers' share of the
premium) go into a separate account that can pay for abortion
services. A permanent appropriation is created in the HSA to
appropriate such sums as may be necessary to carry out this
purpose.
(D) All beneficiaries that are partially subsidized are to be offered the
opportunity to pay privately the pro rata share of the Premium
Amount out of pocket. (E.g., a 100% subsidized person could pay
100% of the Premium Amount; a low-wage person who is receiving
a 60% subsidy to reach their 20% share could pay 60% of 20% of
the Premium Amount; a small-business person whose company is
receiving a 60% premium to reach its 80% share could pay 60% of
the 80%; an unsubsidized person will have the Premium Amount
included in the basic premium.)
AUG 5 '94 17:03
PAGE 003
(E) All beneficiaries that are not subsidized are to be offered the full
benefits package.
(F) Any beneficiary that has any private payment associated with them
can forfeit abortion coverage and receive a pro rata rebate of their
unsubsidized premium costs. Premiums on behalf of such
beneficiary will be included in the public subsidy account and
treated as if they were public subsidies. Attach confidentiality
protections to the forfeiture; require aggregate refund of employer
share to employer.
6)
In private plans:
(A) Except in the case of religious employers, the minimum benefits
package for all beneficiaries includes abortion services to be paid
for by private funds.
(B) All public subsidy funds go into an account that cannot pay for
abortion services.
(C) Except as provided below in F, all private funds (from employee
share of the premium and from any employers' share of the
premium) go into a separate account that can pay for abortion
services.
(D) All beneficiaries that are partially subsidized are to be offered the
opportunity to pay privately the pro rata share of the Premium
Amount out of pocket. (E.g., a 100% subsidized person could pay
100% of the Premium Amount; a low-wage person who is receiving
a 60% subsidy to reach their 20% share could pay 60% of 20% of
the Premium Amount; a small-business person whose company is
receiving a 60% premium to reach its 80% share could pay 60% of
the 80%; an unsubsidized person will have the Premium Amount
included in the basic premium.)
(E) All beneficiaries that are not subsidized are to be offered the full
benefits package.
(F) Any beneficiary that has any private payment associated with them
can forfeit abortion coverage and receive a pro rata rebate of their
AUG 5 '94 17:03
PAGE. 004
unsubsidized premium costs. Premiums on behalf of such
beneficiary will be included in the public subsidy account and
treated as if they were public subsidies. Attach confidentiality
protections to the forfeiture; require aggregate refund of employer
share to employer.
SENT BY:Xerox Telecopier 7021 ; 8- 3-94 :11:52AM ;
94562878;# 1
HUMAN SERVICES USA
&
HEALTH
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE OF THE ASSISTANT SECRETARY FOR LEGISLATION
OF
DEPARTMENT
FROM:
KAREN L. POLLITZ
DEPUTY ASSISTANT SECRETARY FOR LEGISLATION
OFFICE OF HEALTH LEGISLATION
ROOM 405H, HHH BUILDING
PHONE: 690-7450
FAX: 690-8425
TO:
Jennita Kleen)
NAME:
Nan Hunter
OFFICE:
Judy Feder
ROOM:
PHONE:
456-2599
FAX:
456-2878
DATE:
8/3
11:15am.
PAGES:
4
(Including Cover)
REMARKS: description 9 Robign Lipner's 1 latest
request fn language.
SENT BY:Xerox Telecopier 7021 ; 8- 3-94 :11:52AM ;
94562878;# 2
August 3
Note to Judy Feder, Jennifer Klein, Nan Hunter, Fran White
There is a new request for draft language on abortion amendment
options from Robyn Lipner. Robyn continues to work closely with
Anita Jensen on Mitchell's staff. However, Sen. Mikulski would
like to see drafted her preferred option -- a very narrow
exemption from the standard benefits package for religious
employers only --- in addition to other fallback options. This
is OK with Anita.
By the end of today, Robyn would like language that accomplishes
the following:
1. Mikulski preference: narrow religious employer opt out
*
The definition of religious employers would rely on
language from Title VII. Mikulski and the abortion
rights groups, apparently, feel most comfortable with
this definition.
A religious employer would have the option of buying a
standard benefits package that supresses coverage for
abortion only for the people covered under that
employer's plan. There would be no such thing as a
"religous plan" option to not provide abortion
coverage.
The religious employer exemption would be limited
specifically to abortion. No other exception would be
made for other services to which an employer objects on
religious or moral grounds.
Religious employers making this election would see no
change in the premium they or their employees pay.
There would be no opportunity for individuals covered
under the religious employer's plan to buy back
coverage for abortion.
The employer would be required to disclose to its
employees that it has elected not to provide abortion
coverage. No discrimination against employees based on
their preference for abortion coverage would be
permitted.
[Note, much of this is already drafted. Some
rearranging needed]
SENT BY:Xerox Telecopier 7021 ; 8- 3-94 :11:53AM ;
94562878:# 3
2. Fallback option: plan conscience clause
*
Health plans would have the option of refusing to cover
abortion. This option would not be limited to
"religious plans."
Plans exercising the option to not include abortion in
the standard benefits package would be required to
disclose this in its enrollment materials.
change in premium?
[Much of this is already drafted, along with religious
plan opt-out, below)
3.
Fallback option: plan conscience clause for religious plans
[Already drafted]
4. Fallback option: non-religious employer exemption
*
Assuming that an exemption for religious employers only
might not pass, the fallback would be to extend the
option to not cover abortion to a broader, yet limited
class of closely held businesses whose owner (s) have a
religious or moral objection to covering abortion.
A "closely held business" would be distinct from other
corporate entities because it is owned and controlled
largely by one individual or by a limited group of
individuals, VS. owned by many stockholders and
governed by a hired board of directors. The closely
held business owner, it could be argued, might hold
strong religious or moral beliefs that would lead
him/her to oppose purchasing insurance coverage
including abortion for workers. By contrast, it would
be more difficult to argue a conscientious objection by
a corporation, whose multiple owners and directors
could hold widely varying religious and moral beliefs.
IRS has advised us that language defining closely held
businesses could read something like this: A closely
held business is (1) a non-corporate entity that is not
publicly held; and (2) that meets the definition of
businesses described in Sec. 1361(b) or Sec. 542 (a) (2)
of the Internal Revenue Code; or (3) whose ownership
structure is similar to those in (2) above, as
described by rules to be promulgated by the Secretary.
[note, Sec. 1361 (b) defines subchapter S corporations,
for which there can be no more than 35 U.S. individual
SENT BY:Xerox Telecopier 7021 ; 8- 3-94 :11:53AM ;
94562878:# 4
shareholders. Sec. 542 (a) (2) defines a personal
holding company, in which no more than 5 individuals
must hold a majority of the stock. Other definitions
of similar business entities -- general partnerships,
limited partnerships, limited liability companies, and
sole proprietorships -- are recognized by the IRS but
defined according to state statutes and would need to
be picked up in federal regulations.]
5. Fallback option: subsidy limitation
[Already drafted]
Laren
SENT BY:Xerox Telecopier 7021 ; 8- 1-94 ; 8:28AM ;
94562878:# 1
HUMAN SERVICES. USA
&
HEALTH
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE OF THE ASSISTANT SECRETARY FOR LEGISLATION
OF
DEPARTMENT
Nan Fax
690-7998
FROM:
KAREN L. POLLITZ
DEPUTY ASSISTANT SECRETARY FOR LEGISLATION
OFFICE OF HEALTH LEGISLATION
ROOM 405H, HHH BUILDING
PHONE: 690-7450 or 7414
FAX: 690-8425
668-7317-beeper
TO:
JK-
NAME:
JEN KLEIN
Here is is the corrected
OFFICE:
language i sent
ROOM:
to Ro 6yn + Anita
PHONE:
456-2599
Am S having up nan
FAX:
454-2878
& from & terdy for
cleanup, as well
DATE:
-7-29-94 8-1-94
- KP
PAGES:
X 10
(Including Cover)
REMARKS: draft abnhm language. 1 quore my scrib ble-
but 1 think it needs some work. we
only have our drawn until 5:30 to day- -
00 call beep when you get this Thanks- -
Kare
SENT BY:Xerox Telecopier 7021 ; 8- 1-94 ; 8:28AM ;
94562878:# 2
Sec.
Exclusion of Benefits Because of Religious Beliefs.
(a) Special Rule for Religious Insurer or Religious
Employer.
(1) Religious Insurer. (A) Notwithstanding any other
provision of this Act, a religious insurer (as defined in
subsection (e)) may provide a health plan that meets the
requirements of this Act, except that it does not cover
health benefits that are contrary to the religious beliefs
or moral convictions of the religious organization with
which the insurer is affiliated.
(B) Any plan provided pursuant to the authority in
subparagraph (A) must clearly advise each prospective
enrollee, through its explanatory literature or other
effective means, of the otherwise required health benefits
that are excluded pursuant to subparagraph (A).
(2) Religious Employer. (A) A religious employer (as
F
defined in subsection (c)) may offer one or more health plans
that meet all the requirements of this Act except that the
plan or plans exclude health benefits that are contrary to
the religious beliefs or moral convictions of the religious
organization with which the employer is affiliated.
(B) Each employer exercising the option afforded under
subparagraph (A) shall make information available to each
employee, and to each individual to whom an offer of
employment is made, about the exclusion of health benefits
SENT BY:Xerox Telecopier 7021 ; 8- 1-94 ; 8:29AM ;
94562878:# 3
2
under one or more of the health plans provided by such
employer.
(3) Nothing in this section shall be construed as
authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother.
(b) Deletion from Existing Plans of Certain Health
Benefits. --A religious employer may provide a health plan offered
by a religious insurer or may request any other insurer, and the
insurer shall agree, to exclude from its plan that otherwise
meets the requirements of this Act those health benefits which
are contrary to the religious beliefs or moral convictions of the
religious organization with which the employer is affiliated.
(c) Premium Adjustment Prohibited. An insurer providing a
plan that meets the requirements of this Act, shall make no
adjustment in the premium amount by reason of the exercise by a
religious employer of the option afforded by this section to
exclude certain health benefits.
[Alternative:
(c) Employer and Employee Options with Respect to Excluded
Services.
(1) Employer Option. --A religious employer offering a
plan (other than a plan provided by a religious insurer)
that excludes health benefits pursuant to the option
afforded by subsection (b) may deduct from the premium
SENT BY:Xerox Telecopier 7021 ; 8- 1-94 ; 8:29AM ;
94562878:# 4
3
amount otherwise payable with respect to each employee
electing to enroll in such plan the employer's share of the
community rated amount attributable to coverage of the
excluded benefits (as determined in accordance with
paragraph (3)), and the employee's share of the premium
shall be reduced accordingly.
(2) Employee Option. -- An employee of a religious
employer who has enrolled in a health benefits plan that
excludes health benefits pursuant to the provisions of
subsection (b), other than a health plan offered by a
religious insurer, may request the insurer, and the insurer
shall agree, to restore the excluded health benefits with
respect to individuals covered by that employee's enrollment
upon the employee's payment of an amount equal to the
community-rated amount attributable to coverage of the
excluded benefits.]
(d) No religious employer shall discriminate in the hiring
of an individual because of the individual's expressed preference
for or interest in any particular health plan provided by the
employer, nor shall such employer discriminate in any way in the
terms or conditions of employment because an employee has chosen
to enroll in any particular health plan. Action prohibited by
this subsection shall constitute a violation of the general
nondiscrimination provisions of this Act.
SENT BY:Xerox Telecopier 7021 ; 8- 1-94 ; 8:30AM ;
94562878:# 5
(e) AS used in this section, the term
"religious insurer" means an insurer
who (1) satisfies the definition of
"church plan" under section 3(33)CA) )
the Employee Retirement Income Security
Act, and (2) is, in whole or in substantial
part, owned, supported, controlled, or
managed by a particular religion or
by a particular religions corporation,
association or society-
[ note- ERISA language on
"church plan" follows]
SENT BY:Xerox Telecopier 7021 ; 8- 1-94 ; 8:30AM ;
94562878;# 6
13
ERISA
Sec. 3
tained age normal cost method, and the frozen initial liability cost
method. The terminal funding cost method and the current funding
(pay-as-you-go) cost method are not acceptable actuarial cost meth-
ods. The Secretary of the Treasury shall issue regulations to fur-
ther define acceptable actuarial cost methods.
(32) The term "governmental plan" means a plan established or
maintained for its employees by the Government of the United
States, by the government of any State or political subdivision
thereof, or by any agency or instrumentality of any of the forego-
ing. The term "governmental plan" also includes any plan to which
the Railroad Retirement Act of 1985 [(45 U.S.C. 215 note)] or 1987
[Railroad Retirement Act of 1974 (45 U.S.C. 231 et seq.)] 3-2 applies,
and which is financed by contributions required under that Act
and any plan of an international organization which is exempt
from taxation under the provisions of the International Organiza-
tions Immunities Act (59 Stat. 669) [(22 U.S.C. 288 et seq.)].
(33)(A) The term "church plan" means a plan established and
maintained (to the extent required in clause (ii) of subparagraph
(B)) for its employees (or their beneficiaries) by a church or by a
convention or association of churches which is exempt from tax
under section 501 of the Internal Revenue Code of 1986.
(B) The term "church plan" does not include a plan-
(i) which is established and maintained primarily for the
benefit of employees (or their beneficiaries) of such church or
convention or association of churches who are employed in con-
nection with one or more unrelated trades or businesses
(within the meaning of section 513 of the Internal Revenue
Code of 1986), or
(ii) if less than substantially all of the individuals included in
the plan are individuals described in subparagraph (A) or in
clause (ii) of subparagraph (C) (or their beneficiaries).
(C) For purposes of this paragraph--
(i) A plan established and maintained for its employees (or
their beneficiaries) by a church or by a convention or associa-
tion of churches includes a plan maintained by an organiza-
tion, whether a civil law corporation or otherwise, the princi-
pal purpose or function of which is the administration or fund-
ing of a plan or program for the provision of retirement bene-
fits or welfare benefits, or both, for the employees of a church
or a convention or association of churches, if such organization
is controlled by or associated with a church or a convention or
association of churches.
(ii) The term employee of a church or a convention or asso-
ciation of churches includes-
(I) a duly ordained, commissioned, or licensed minister of
a church in the exercise of his ministry, regardless of the
source of his compensation;
(II) an employee of an organization, whether a civil law
corporation or otherwise, which is exempt from tax under
The Railroad Retirement Act of 1985 was amended in its entirety and completely revised
by the Railroad Retirement Act of 1897. Effective January 1, 1975, the Railroad Retirement Act
C
1987 was itself amended in its entirety by, completely revised by, and redesignated as the
allroad Retirement Act of 1974 (Public Law 98-445; 88 Stat. 1305).
SENT.BY:Xerox Telecopier 7021 ; 8- 1-94 ; 8:31AM :
94562878;# 7
Sec. 3
ERISA
14
section 501 of the Internal Revenue Code of 1986 and
which is controlled by or associated with a church or a
convention or association of churches; and
(III) an individual described in clause (v).
(iii) A church or a convention or association of churches
which is exempt from tax under section 501 of the Internal
Revenue Code of 1986 shall be deemed the employer of any in-
dividual included as an employee under clause (ii).
(iv) An organization, whether a civil law corporation or oth-
erwise, is associated with a church or a convention or associa-
tion of churches if it shares common religious bonds and con-
victions with that church or convention or association of
churches.
(v) If an employee who is included in a church plan separates
from the service of a church or a convention or association of
churches or an organization, whether a civil law corporation or
otherwise, which is exempt from tax under section 501 of the
Internal Revenue Code of 1986 and which is controlled by or
associated with a church or a convention or association of
churches, the church plan shall not fail to meet the require-
ments of this paragraph merely because the plan-
(I) retains the employee's accrued benefit or account for
the payment of benefits to the employee or his benefici-
aries pursuant to the terms of the plan; or
(II) receives contributions on the employee's behalf after
the employee's separation from such service, but only for a
period of 5 years after such separation, unless the employ-
ee is disabled (within the meaning of the disability provi-
sions of the church plan or, if there are no such provisions
in the church plan, within the meaning of section 72(m)(7)
of the Internal Revenue Code of 1986) at the time of such
separation from service.
(D)(i) If a plan established and maintained for its employees (or
their beneficiaries) by a church or by a convention or association of
churches which is exempt from tax under section 501 of the Inter-
nal Revenue Code of 1986 fails to meet one or more of the require-
ments of this paragraph and corrects its failure to meet such re-
quirements within the correction period, the plan shall be deemed
to meet the requirements of this paragraph for the year in which
the correction was made and for all prior years.
(ii) If a correction is not made within the correction period, the
plan shall be deemed not to meet the requirements of this para-
graph beginning with the date on which the earliest failure to meet
one or more of such requirements occurred.
(iii) For purposes of this subparagraph, the term "correction
period" means-
(I) the period ending 270 days after the date of mailing by
the Secretary of the Treasury of a notice of default with re-
spect to the plan's failure to meet one or more of the require-
ments of this paragraph; or
(II) any period set by a court of competent jurisdiction after
a final determination that the plan fails to meet such require-
ments, or, if the court does not specify such period, any reason-
SENT BY:Xerox Telecopier 7021 ; 8- 1-94 ; 8:31AM ;
94562878:# 8
15
ERISA
Sec. 3
able period determined by the Secretary of the Treasury on the
basis of all the facts and circumstances, but in any event not
less than 270 days after the determination has become final; or
(III) any additional period which the Secretary of the Treas-
ury determines is reasonable or necessary for the correction of
the default,
whichever has the latest ending date.
(84) The term "individual account plan" or "defined contribution
plan" means a pension plan which provides for an individual ac-
count for each participant and for benefits based solely upon the
amount contributed to the participant's account, and any income,
expenses, gains and losses, and any forfeitures of accounts of other
participants which may be allocated to such participant's account.
(35) The term "defined benefit plan" means a pension plan other
than an individual account plan; except that a pension plan which
is not an individual account plan and which provides a benefit de-
rived from employer contributions which is based partly on the bal-
ance of the separate account of a participant-
(A) for the purposes of section 202, shall be treated as an in-
dividual account plan, and
(B) for the purposes of paragraph (23) of this section and sec-
tion 204, shall be treated as an individual account plan to the
extent benefits are based upon the separate account of a par-
ticipant and as a defined benefit plan with respect to the re-
maining portion of benefits under the plan.
(36) The term "excess banefit plan" means a plan maintained by
in employer solely for the purpose of providing benefits for certain
employees in excess of the limitations on contributions and benefits
imposed by section 415 of the Internal Revenue Code of 1986 on
plans to which that section applies, without regard to whether the
plan is funded. To the extent that a separable part of a plan (as
determined by the Secretary of Labor) maintained by an employer
is maintained for such purpose, that part shall be treated as a sep-
arate plan which is an excess benefit plan.
(37)(A) The term "multiemployer plan" means a plan-
(i) to which more than one employer is required to contrib-
ute,
(ii) which is maintained pursuant to one or more collective
bargaining agreements between one or more employee organi-
zations and more than one employer, and
(iii) which satisfles such other requirements as the Secretary
may prescribe by regulation.
(B) For purposes of this paragraph, all trades or businesses
(whether or not incorporated) which are under common control
within the meaning of section 4001(b)(1) are considered a single em-
ployer.
(C) Notwithstanding subparagraph (A), a plan is a multiemployer
plan on and after its termination date if the plan was a multiem-
ployer plan under this paragraph for the plan year preceding its
termination date.
(D) For purposes of this title, notwithstanding the preceding pro-
visions of this paragraph, for any plan year which began before the
late of the enactment of the Multiemployer Pension Plan Amend-
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(e) see insert
4
F
(d) As used in this section, the term "religious employer"
or "religious insurer" means an employer, or an insurer
whichever may be applicable, who (1) is exempted from taxation by
section 501 (a) of the Internal Revenue Code of 1986 by reason of
the applicability of section 501 (c) (3) thereof on the basis of
the employer's religious purposes, and (2) is, in whole or in
substantial part, owned, supported, controlled, or managed by a
particular religion or by a particular religious corporation,
association, or society.
g
(f) Reduction of Federal or Federally assisted Subsidies.
(1) If a subsidy is being provided under any Federal or
Federally-assisted program with respect to an individual's share
of the premium to obtain coverage under a health benefits plan
(ether than such a plan offered by a religious insurer) that
excludes INCLUDES abortion services enother convices, or both) puesuant
to the provisions of subsection (b) such subsidy shall be
reduced by an amount equal to the product of (1) the community-
rated amount attributable to abortion coverage or the community
rated amount attributable to such other excluded services, or
both as may be applicable, (11) the ratio of the individual's
share of the premium to the total amount of the premium
applicable to such plan, and (iii) the ratio of the subsidy
(before any reduction) to the employee's share of the premium
(before application of the subsidy).
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5
(2) For purposes of this section, the Secretary shall
determine the community-rated amount attributable to abortion
coverage based on the ratio of --
(A) the total amounts expended for health benefits
that may be excluded pursuant to this section (but not
necessary to save the life of the mother OR to terminate a
including amounts expended for abortions, if the pregnancy is
that
the result of an act of rape or incest), to
(B) the total amount expended for all health benefits
required to be covered pursuant to the provisions of this
Act (without application of this section),
and the Secretary shall determine the community-rated amount
attributable to services that may be excluded other than
abortions in accordance with the same methodology.
(3) Notwithstanding paragraph (1), no reduction shall be
made in the subsidy payable with respect to an individual
enrolled in a plan provided by a religious insurer, and RO
reduction shall be made in the subsidy with respect to an
employee of an employer who has exercised the option under
subsection (b) and with respect to whom the premium has been
reduced under subsection (c). that does not cover abortion.
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HUMAN SERVICES ,USA
HEALTH
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE OF THE ASSISTANT SECRETARY FOR LEGISLATION
OF
DEPARTMENT
FROM:
KAREN L. POLLITZ
DEPUTY ASSISTANT SECRETARY FOR LEGISLATION
OFFICE OF HEALTH LEGISLATION
ROOM 405H, HHH BUILDING
PHONE: 690-7450
FAX: 690-8425
TO:
NAME:
Jen Klein
OFFICE:
ROOM:
PHONE:
FAX:
456- 2878
DATE:
PAGES:
14
(Including Cover)
REMARKS:
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94562878:# 2
August 4
Note to Robyn Lipner
Per your request, we have drafted language on a series of
possible abortion amendments. Based on Finance action in
committee, a series of amendments could be anticipated providing
for "conscience clause" opt outs for employers, health plans, and
individuals who choose not to cover abortion. Also anticipated
would be an amendment to restrict federal subsidy dollars in so
taxpayers do not fund insurance coverage for abortion.
Employer options - On the employer opt out, we have drafted
your preferred amendment (#1) which would permit only religious
employers (as defined in Title VII) to opt not to cover abortion.
Such employers would be required to disclose this lack of
coverage to their employees and prospective employees, and would
be prohibited against discriminating against individuals based on
their preference for abortion coverage.
In the event a religious-employer-only amendment does not
prevail, we have also drafted a broader, though not total,
employer opt out amendment (#2) as a fallback. Added to the
religious employer amendment, this would permit secular employers
who have religious/moral views to elect not to cover abortion.
This broader class of employers would be limited to closely held
businesses that are owned and operated by a small number of
individuals who, arguably, could hold like religious and moral
views on abortion. Not included in this class would be
corporations owned and governed by many stockholders and
directors who, arguably, would hold divergent religious and moral
views.
Premium changes due to opt out - Under either employer opt-
out, you would face the question about whether the dropping
coverage for abortion triggers a change in the plan premium. We
have discussed two possibilities in this regard. The law could
direct that there is no change in a premium when an employer
elects not to purchase abortion coverage. Alternatively, the law
could direct that there is a change in the premium, but that the
changed amount is limited to a small amount, essentially
reflecting the ratio of spending for abortion to spending for all
covered services under the standard benefits package. Neither of
these options appear in the employer amendments attached,
although they are drafted in the language we sent you a few days
ago.
The advantage of permitting no change in premium when
employers opt to drop abortion coverage is that the financial
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incentive to do so is neutralized. The advantage of permitting a
small change in premium is that employees can have the
opportunity of "buying back" the abortion coverage by replacing
the small premium reduction. (See individual options, below.)
Health plan options - Employers could exercise their
abortion opt out in several ways, depending on what you
accomplish with respect to an insurance plan opt out. First,
they could elect to purchase insurance through a relgious plan
which also has chosen not to cover abortion due to a moral
objection (Amendment #3). If only religious plans had the option
to drop abortion coverage, their market would effectively be
limited to those employers/individuals who are permitted to not
purchase abortion coverage. Second, employers could purchase
insurance through any plan which has decided not to cover
abortion. (Amendment #4). Permitting any insurer to decline to
cover abortion leaves the biggest potential gap in available
abortion coverage. Finally, the employer could purchase coverage
through any secular plan and require that plan to suppress
coverage for abortion. Health plans would be required to cover
abortion for all other employers who did not make this election.
This option is not drafted as a separate amendment. However,
language to accomplish this was included in amendment we sent you
a few days ago.
Individual options - A third area of amendments would
involve individual opt outs and opt ins. (Amendment #5) We have
drafted for you a straight individual election to drop abortion
coverage. It is important to note that, as drafted, this
amendment is silent on what happens to individuals enrolled in
family policies. For example, can a husband elect to drop
abortion coverage from his families policy altogether, or does
the wife need to concur in writing? The amendment also is silent
on whether individuals are required to formally certify their
moral objection to abortion in order to drop coverage. For
example, a person might be required to present a notarized
statement of their moral objection to their insurer before the
policy can be changed.
If individuals face an option to drop abortion coverage, you
would again face the question about impact on premiums. You
could direct that premiums are the same, regardless of the
individual election. Alternatively, you could direct that the
individual's share of the premium be reduced by the community
rated amount attributable to abortion.
If individuals can opt out of abortion, they could also be
extended the right to restore coverage for abortion if their
employer opts to drop coverage. Similarly, individuals could be
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permitted to restore any reduction in premium subsidies if Hyde-
type language is adopted. (see below)
Subsidies - As we discussed, a way to limit the impact of
Hyde-like restrictions on subsidies is to restrict the amount of
reduction applied. You would use the same methodology as used in
premium reductions for employers/individuals who opt out of
abortion coverage. We estimate this methodology would produce a
subsidy reduction would be approximately $8.67 per policy per
year for a full subsidy and smaller, prorated amounts for partial
subsidies.
Please let me know if you have any questions.
Enclosures
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Amendment #1 - Religious Employers
SEC.
OPTION FOR EMPLOYERS AFFILIATED WITH RELIGIOUS
ORGANIZATIONS.
(a) In General. --A religious employer (as defined in
subsection (e)) may offer one or more health plans that meet all
the requirements of this Act except that the plan or plans
exclude abortion services if such services are contrary to the
religious beliefs or moral convictions of the religious
organization with which the employer is affiliated.
(b) Notice to Prospective Enrollees. Each employer
exercising the option afforded under subsection (a) shall make
information available to each employee, and to each individual to
whom an offer of employment is made, about the exclusion of
abortion services under one or more of the health plans provided
by such employer.
(c) Exception. Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother.
(d) Nondiscrimination. --No religious employer shall
discriminate in the hiring of an individual because of the
individual's expressed preference for or interest in any
particular health plan provided by the employer, nor shall such
employer discriminate in any way in the terms or conditions of
employment because an employee has chosen to enroll in any
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94562878;# 6
particular health plan. Action prohibited by this subsection
shall constitute a violation of the general nondiscrimination
provisions of this Act.
(a) Definition. --As used in this section, the term
"religious employer" means an employer who is, in whole or in
substantial part, owned, supported, controlled, or managed by a
particular religion or by a particular religious corporation,
association, or society.
- 2 -
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Amendment #2 - Secular employers with religious objections
SEC.
.
EMPLOYER OPTION BASED ON RELIGIOUS OBJECTION OR MORAL
CONVICTION.
(a) In General. --A employer that is a closely held business
(as defined in subsection (e)) may offer one or more health plans
that meet all the requirements of this Act except that the plan
or plans exclude abortion services if such services are contrary
to the religious beliefs or moral convictions of the employer.
(b) Notice to Prospective Enrollees. Any plan provided
pursuant to the authority in subsection (a) must clearly advise
each prospective enrollee, through its enrollment literature or
other effective means, that abortions services are excluded
pursuant to subsection (a).
(c) Exception. -Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother or to
terminate a pregnancy that is the result of an act of rape or
incest.
(d) Nondiscrimination.--No employer shall discriminate in
the hiring of an individual because of the individual's expressed
preference for or interest in any particular health plan provided
by the employer, nor shall such employer discriminate in any way
in the terms or conditions of employment because an employee has
chosen to enroll in any particular health plan. Action
- 3 -
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prohibited by this subsection shall constitute a violation of the
general nondiscrimination provisions of this Act.
(e) Definition. -As used in this section, the term "closely
held business" means an organization or other business entity,
whether or not incorporated, that --
(1) is a personal holding company within the meaning
of section 542 of the Internal Revenue Code of 1986,
(2) is a so-called "subchapter S corporation" as
defined in section 1361 of such Code, or
(3) is organized in accordance with the laws of a
State that recognize an ownership structure that is limited
or defined (by number, personal relationships among the
owners, or other specified connections) and with respect to
which it is therefore reasonable to conclude, as determined
in accordance with regulations of the Secretary, that there
is a commonality of religious belief or moral conviction
among a majority of the owners.
- 4-
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Amendment 3 - Religious plans
SEC.
. OPTION FOR PLANS PROVIDED BY INSURERS AFFILIATED WITH
RELIGIOUS ORGANIZATIONS.
(a) General Rule. -- Notwithstanding any other provision of
this Act, a religious insurer (as defined in subsection (d)) may
provide a health plan that meets the requirements of this Act,
except that it does not cover abortion services contrary to the
religious beliefs or moral convictions of the religious
organization with which the insurer is affiliated.
(b) Notice to Prospective Enrollees. Any plan provided
pursuant to the authority in subsection (a) must clearly advise
each prospective enrollee, through its enrollment literature or
other effective means, that abortion services are excluded
pursuant to subparagraph (A).
(c) Exception.--Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother.
(d) Definition. -- As used in this section, the term
"religious insurer" means an insurer who (1) satisfies the
definition of "church plan" under section 3 (33) the Employee
Retirement Income Security Act of 1974, and (2) is, in whole or
in substantial part, owned, supported, controlled, or managed by
a particular religion or by a particular religious corporation,
association, or society.
- S -
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Amendment 4 - All insurer opt-out
SEC.
.
INSURER OPTION TO COVER ABORTION.
(a) In General. Notwithstanding any other provision of
this Act, an insurer may provide a health plan that meets the
requirements of this Act except that it does not cover abortion
services.
(b) Notice to Prospective Enrollees. Any plan provided
pursuant to the authority in subsection (a) must clearly advise
each prospective enrollee, through its enrollment literature or
other effective means, that abortion services are excluded
pursuant to subparagraph (A).
(c) Exception.--Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother or to
terminate a pregnancy that is the result of an act of rape or
incest.
6
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Amendment 5 - Individual options
SEC.
INDIVIDUAL OPTION. [Could accompany option with
respect to employers or subsidies.]
(a) Option to Decline Coverage of Abortion Services.--
(1) An individual who is enrolled in a health benefits
plan may request the insurer, and the insurer shall agree,
to exclude coverage for the abortion services if such
services are contrary to the religious beliefs or moral
convictions of the individual.
(2) A health plan shall make no change in the premium
for individuals making an election under paragraph (1).
[Alternative (2) A health plan shall reduce the premium
for an individual electing the option under paragraph (1) by
an amount equal to the individual's share of the community-
rated amount attributable to the excluded benefits.]
(b) Option to Restore Coverage.-- An employee who has
enrolled in a health benefits plan that excludes abortion
services at the option of the employer pursuant to the provisions
of
section , may request the insurer, and the insurer shall
agree, to restore the excluded abortion services with respect to
individuals covered by that employee's enrollment upon the
employee's payment of an amount equal to the community-rated
amount attributable to coverage of the excluded benefits.
- 7 -
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(c) Option to Replace Subsidy Reduction. -- An individual
whose subsidy has been reduced under section
shall have the
option to replace the reduced subsidy (by increasing by an equal
amount the portion of the premium paid by the individual) and
upon payment of such increased share of the premium, coverage of
the abortion services that would have been excluded shall be
restored.
- 8 -
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Amendment 6 - Subsidies
SEC.
REDUCTION OF FEDERAL OR FEDERALLY ASSISTED SUBSIDIES.
(a) If a subsidy is being provided under any Federal or
Federally-assisted program with respect to an individual's share
of the premium to obtain coverage under a health benefits plan
under this Act that includes abortion services, such subsidy
shall be reduced by an amount equal to the product of--
(1) the community-rated amount attributable to
abortion coverage,
(2) the ratio of the individual's share of the premium
to the total amount of the premium applicable to such plan,
and
(3) the ratio of the subsidy (before any reduction) to
the employee's share of the premium (before application of
the subsidy).
(b) For purposes of this section, the Secretary shall
determine the community-rated amount attributable to abortion
coverage based on the ratio of --
(1) the total amounts expended for abortion services
(other than amounts expended for abortions necessary to save
the life of the mother or to terminate a pregnancy that is
the result of an act of rape or incest), to
- 4- -
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(2) the total amount expended for all health benefits
required to be covered pursuant to the provisions of this
Act (without application of this section).
(c) Notwithstanding subsection (a), no reduction shall be
made in the subsidy payable with respect to an individual
enrolled in a plan that does not cover abortion services in
addition to abortions necessary to save the life of the mother or
to terminate a pregnancy that is the result of an act of rape or
incest.
10
August 4
Note to Robyn Lipner
Per your request, we have drafted language on a series of
possible abortion amendments. Based on Finance action in
committee, a series of amendments could be anticipated providing
for "conscience clause" opt outs for employers, health plans, and
individuals who choose not to cover abortion. Also anticipated
would be an amendment to restrict federal subsidy dollars so
taxpayers do not support insurance coverage for abortion.
Employer options - On the employer opt-out, we have drafted
your preferred amendment (#1) which would permit only religious
employers (as defined in Title VII) to elect not to cover
abortion. Such employers would be required to disclose this lack
of coverage to their employees and prospective employees, and
would be prohibited against discriminating against individuals
based on their preference for abortion coverage.
In the event a religious-employer-only amendment does not
prevail, we have also drafted a broader, though not total,
employer opt-out amendment (#2) as a fallback. Added to the
religious employer amendment, this would permit secular employers
who have religious/moral views to elect not to cover abortion.
This broader class of employers would be limited to closely held
businesses that are owned and operated by a small number of
individuals who, arguably, could hold like religious and moral
views on abortion. Not included in this class would be
corporations owned and governed by many stockholders and
directors who, arguably, would hold divergent religious and moral
views.
Premium changes due to opt out - Under either employer opt-
out, you would face the question about whether dropping coverage
for abortion triggers a change in the plan premium. We have
discussed two possibilities in this regard. The law could direct
that there is no change in premium when an employer elects not to
purchase abortion coverage. Alternatively, the law could direct
that there is a change in the premium, but that the change is
limited to a small amount, essentially reflecting the the cost of
abortion services per policy, assuming universal coverage for
abortion. The option to hold premiums unchanged is not included
in the employer amendments attached, although they are drafted in
the language we sent you a few days ago. The language to limit
the change in premiums is reflected in Amendment #6.
The advantage of permitting no change in premium when
employers elect to drop abortion coverage is that the financial
incentive to do so is neutralized. The advantage of permitting a
small change in premium is that employees can have the
opportunity of "buying back" abortion coverage by replacing the
small premium reduction. (See individual options, below.)
Health plan options - Employers could exercise their
abortion opt-out in several ways, depending on what happens with
respect to an insurance plan opt-out.
First, they could elect to purchase insurance through a
religious plan which also has chosen not to cover abortion due to
a moral objection (Amendment #3). The market for religious plans
would effectively be limited to those employers/individuals who
are permitted to not purchase abortion coverage.
Second, the employer could purchase coverage through any
secular plan and require that plan to suppress coverage for
abortion. Health plans would continue to cover abortion for all
other employers who did not make this election. This option is
not drafted as a separate amendment. However, language to
accomplish this was included in amendment we sent you a few days
ago.
Finally, any plan could elect to drop coverage for abortion
and employers could choose coverage under those plans.
(Amendment #4). Permitting any insurer to decline to cover
abortion leaves the biggest potential gap in available abortion
coverage.
Individual options - A third area of amendments would
involve individual opt-outs and opt-ins. (Amendment #5) We have
drafted a straight individual election to drop abortion coverage.
It is important to note that, as drafted, this amendment is
silent on what happens to individuals enrolled in family
policies. For example, can a husband elect to drop abortion
coverage from his family's policy altogether, or does the wife
need to concur in writing? The amendment also is silent on
whether individuals are required to formally certify their moral
objection to abortion in order to drop coverage. For example, a
person might be required to present a notarized statement of
their moral objection to their insurer before the policy can be
changed.
If individuals have an option to drop abortion coverage, you
would again face the question about impact on premiums. You
could direct that premiums are the same, regardless of the
individual election. Alternatively, you could direct that the
individual's share of the premium be reduced by the community
rated amount attributable to abortion.
If individuals can opt out of abortion, they could also be
extended the right to restore coverage for abortion if their
employer elects to drop coverage. Similarly, individuals could
be permitted to restore any reduction in premium subsidies if
Hyde- type language is adopted. (see below)
Subsidies - As we discussed, a way to limit the impact of
Hyde-like restrictions on subsidies is to restrict the amount of
reduction applied. (Amendment #6) You would use the same
methodology used in premium reductions for employers/individuals
who opt out of abortion coverage. We estimate this methodology
would produce a subsidy reduction of approximately $8.67 per
policy per year for a full subsidy, with prorated reductions for
partial subsidies.
For administrative purposes, it would be simpler to apply
any subsidy reduction only to individual premium contributions.
Because the amount of subsidy reduction involved is so small, the
difficulty of tracing the employer and individual subsidies for
each policy in order to apportion the reduction would render the
effort not cost effective.
Please let me know if you have any questions.
Enclosures
Amendment #1 - Religious Employers
SEC.
.
OPTION FOR EMPLOYERS AFFILIATED WITH RELIGIOUS
ORGANIZATIONS.
(a) In General. --A religious employer (as defined in
subsection (e)) may offer one or more health plans that meet all
the requirements of this Act except that the plan or plans
exclude abortion services if such services are contrary to the
religious beliefs or moral convictions of the religious
organization with which the employer is affiliated.
(b) Notice to Prospective Enrollees. Each employer
exercising the option afforded under subsection (a) shall make
information available to each employee, and to each individual to
whom an offer of employment is made, about the exclusion of
abortion services under one or more of the health plans provided
by such employer.
(c) Exception. - Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother.
(d) Nondiscrimination. No religious employer shall
discriminate in the hiring of an individual because of the
individual's expressed preference for or interest in any
particular health plan provided by the employer, nor shall such
employer discriminate in any way in the terms or conditions of
employment because an employee has chosen to enroll in any
particular health plan. Action prohibited by this subsection
shall constitute a violation of the general nondiscrimination
provisions of this Act.
(e) Definition. -- As used in this section, the term
"religious employer" means an employer who is, in whole or in
substantial part, owned, supported, controlled, or managed by a
particular religion or by a particular religious corporation,
association, or society.
- 2 -
Amendment #2 - Secular employers with religious objections
SEC.
.
EMPLOYER OPTION BASED ON RELIGIOUS OBJECTION OR MORAL
CONVICTION.
(a) In General. An employer that is a closely held
business (as defined in subsection (e)) may offer one or more
health plans that meet all the requirements of this Act except
that the plan or plans exclude abortion services if such services
are contrary to the religious beliefs or moral convictions of the
employer.
(b) Notice to Prospective Enrollees. Any plan provided
pursuant to the authority in subsection (a) must clearly advise
each prospective enrollee, through its enrollment literature or
other effective means, that abortions services are excluded
pursuant to subsection (a).
(c) Exception. - -Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother or to
terminate a pregnancy that is the result of an act of rape or
incest.
(d) Nondiscrimination. --No employer shall discriminate in
the hiring of an individual because of the individual's expressed
preference for or interest in any particular health plan provided
by the employer, nor shall such employer discriminate in any way
in the terms or conditions of employment because an employee has
- 3 -
chosen to enroll in any particular health plan. Action
prohibited by this subsection shall constitute a violation of the
general nondiscrimination provisions of this Act.
(e) Definition. As used in this section, the term "closely
held business" means an organization or other business entity,
whether or not incorporated, that --
(1) is a personal holding company within the meaning
of section 542 of the Internal Revenue Code of 1986,
(2) is a so-called "subchapter S corporation" as
defined in section 1361 of such Code, or
(3) is organized in accordance with the laws of a
State that recognize an ownership structure that is limited
or defined (by number, personal relationships among the
owners, or other specified connections) and with respect to
which it is therefore reasonable to conclude, as determined
in accordance with regulations of the Secretary, that there
is a commonality of religious belief or moral conviction
among a majority of the owners.
- 4
Amendment 3 - Religious plans
SEC.
.
OPTION FOR PLANS PROVIDED BY INSURERS AFFILIATED WITH
RELIGIOUS ORGANIZATIONS.
(a) General Rule. -- Notwithstanding any other provision of
this Act, a religious insurer (as defined in subsection (d)) may
provide a health plan that meets the requirements of this Act,
except that it does not cover abortion services contrary to the
religious beliefs or moral convictions of the religious
organization with which the insurer is affiliated.
(b) Notice to Prospective Enrollees. Any plan provided
pursuant to the authority in subsection (a) must clearly advise
each prospective enrollee, through its enrollment literature or
other effective means, that abortion services are excluded
pursuant to subparagraph (A).
(c) Exception. - Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother.
(d) Definition. -- As used in this section, the term
"religious insurer" means an insurer who (1) satisfies the
definition of "church plan" under section 3 (33) the Employee
Retirement Income Security Act of 1974, and (2) is, in whole or
in 'substantial part, owned, supported, controlled, or managed by
a particular religion or by a particular religious corporation,
association, or society.
- 5 -
Amendment 4 - All insurer opt-out
SEC.
.
INSURER OPTION TO COVER ABORTION.
(a) In General. Notwithstanding any other provision of
this Act, an insurer may provide a health plan that meets the
requirements of this Act except that it does not cover abortion
services.
(b) Notice to Prospective Enrollees. Any plan provided
pursuant to the authority in subsection (a) must clearly advise
each prospective enrollee, through its enrollment literature or
other effective means, that abortion services are excluded
pursuant to subparagraph (A)
(c) Exception. - Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother or to
terminate a pregnancy that is the result of an act of rape or
incest.
- 6 -
Amendment 5 - Individual options
SEC.
.
INDIVIDUAL OPTION. [Could accompany option with
respect to employers or subsidies.]
(a) Option to Decline Coverage of Abortion Services. --
(1) An individual who is enrolled in a health benefits
plan may request the insurer, and the insurer shall agree,
to exclude coverage for the abortion services if such
services are contrary to the religious beliefs or moral
convictions of the individual.
(2) A health plan shall make no change in the premium
for individuals making an election under paragraph (1).
[Alternative (2) A health plan shall reduce the premium
for an individual electing the option under paragraph (1) by
an amount equal to the individual's share of the community-
rated amount attributable to the excluded benefits.]
(b) Option to Restore Coverage. --- An employee who has
enrolled in a health benefits plan that excludes abortion
services at the option of the employer pursuant to the provisions
of section
, may request the insurer, and the insurer shall
agree, to restore the excluded abortion services with respect to
individuals covered by that employee's enrollment upon the
employee's payment of an amount equal to the community-rated
amount attributable to coverage of the excluded benefits.
- 7 -
(c) Option to Replace Subsidy Reduction. -- An individual
whose subsidy has been reduced under section
shall have the
option to replace the reduced subsidy (by increasing by an equal
amount the portion of the premium paid by the individual) and
upon payment of such increased share of the premium, coverage of
the abortion services that would have been excluded shall be
restored.
- 8 -
Amendment 6 - Subsidies
SEC.
.
REDUCTION OF FEDERAL OR FEDERALLY ASSISTED SUBSIDIES.
(a) If a subsidy is being provided under any Federal or
Federally-assisted program with respect to an individual's share
of the premium to obtain coverage under a health benefits plan
under this Act that includes abortion services, such subsidy
shall be reduced by an amount equal to the product of--
(1) the community-rated amount attributable to
abortion coverage,
(2) the ratio of the individual's share of the premium
to the total amount of the premium applicable to such plan,
and
(3) the ratio of the subsidy (before any reduction) to
the employee's share of the premium (before application of
the subsidy).
(b) For purposes of this section, the Secretary shall
determine the community-rated amount attributable to abortion
coverage based on --
(1) the total amounts expended for abortion services
(other than amounts expended for abortions necessary to save
the life of the mother or to terminate a pregnancy that is
the result of an act of rape or incest), divided by
(2) the total number of health insurance policies.
- 9 -
(c) Notwithstanding subsection (a), no reduction shall be
made in the subsidy payable with respect to an individual
enrolled in a plan that does not cover abortion services in
addition to abortions necessary to save the life of the mother or
to terminate a pregnancy that is the result of an act of rape or
incest.
- 10 -
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Who has
enrolled in Family?
SEC.
.
INDIVIDUAL OPTION. [Could accompany option with
respect to employers or subsidies.]
(a) Option to Decline Coverage of Abortion Services.-
(1) An individual who has enrolled in a health benefits
plan may request the insurer, and the insurer shall agree,
to exclude coverage for the abortion services if such
services are contrary to the religious beliefs or moral
convictions of the individual.
(2) A health plan shall reduce the premium for an
individual electing the option under paragraph (1) by an
amount equal to the individual's share of the community-
rated amount attributable to the excluded benefits.
(b) Option to Restore Coverage. An employee who has
enrolled in a health benefits plan that excludes abortion
services at the option of the employer pursuant to the provisions
of
section , may request the insurer, and the insurer shall
agree, to restore the excluded abortion services with respect to
individuals covered by that employee's enrollment upon the
employee's payment of an amount equal to the community-rated
amount attributable to coverage of the excluded benefits.
(c) option to Replace Subsidy Reduction. -- An individual
whose subsidy has been reduced under section shall have the
option to replace the reduced subsidy (by increasing by an equal
amount the portion of the premium paid by the individual) and
upon payment of such increased share of the premium, coverage of
1
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2
the abortion services that would have been excluded shall be
restored.
Z
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SEC.
.
OPTION FOR PLANS PROVIDED BY INSURERS AFFILIATED WITH
RELIGIOUS ORGANIZATIONS.
(a) General Rule. Notwithstanding any other provision of
this Act, a religious insurer (as defined in subsection (d)) may
provide a health plan that meets the requirements of this Act,
except that it does not cover services if such services are
contrary to the religious beliefs or moral convictions of the
religious organization with which the insurer is affiliated.
(b) Notice to Prospective Enrollees. Any plan provided
pursuant to the authority in subsection (a) must clearly advise
each prospective enrollee, through its enrollment literature or
other effective means, that abortion services are excluded
pursuant to subparagraph (A).
(c) Exception. -Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother.
(d) Definition. -- As used in this section, the term
"religious insurer" means an insurer who (1) satisfies the
definition of "church plan" under section 3 (33) the Employee
Retirement Income Security Act of 1974, and (2) is, in whole or
in substantial part, owned, supported, controlled, or managed by
a particular religion or by a particular religious corporation,
association, or society.
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SEC.
EMPLOYER OPTION BASED ON RELIGIOUS OBJECTION OR MORAL
CONVICTION.
(a) In General.--A employer that is a closely held business
(as defined in subsection (e)) may offer one or more health plans
that meet all the requirements of this Act except that the plan
or plans exclude abortion services if such services are contrary
to the religious beliefs or moral convictions of the employer.
(b) Notice to Prospective Enrollees. Any plan provided
pursuant to the authority in subsection (a) must clearly advise
each prospective enrollee, through its enrollment literature or
other effective means, that abortions services are excluded
pursuant to subsection (a).
(c) Exception.--Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother or to
terminate a pregnancy that is the result of an act of rape or
incest.
(d) Nondiscrimination. No employer shall discriminate in
the hiring of an individual because of the individual's expressed
preference for or interest in any particular health plan provided
by the employer, nor shall such employer discriminate in any way
in the terms or conditions of employment because an employee has
chosen to enroll in any particular health plan. Action
prohibited by this subsection shall constitute a violation of the
general nondiscrimination provisions of this Act.
(4)
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2
(e) Definition. --As used in this section, the term "closely
held business" means an organization or other business entity,
whether or not incorporated, that --
(1) is a personal holding company within the meaning
of section 542 of the Internal Revenue Code of 1986,
(2) is a so-called "subchapter S corporation" as
defined in section 1361 of such Code, or
(3) is organized in accordance with the laws of a
State that recognize an ownership structure that is limited
or defined (by number, personal relationships among the
owners, or other specified connections) and with respect to
which it is therefore reasonable to conclude, as determined
in accordance with regulations of the Secretary, that there
is a commonality of religious belief or moral conviction
among a majority of the owners.
5
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SEC.
INSURER OPTION BASED ON RELIGIOUS OBJECTION OR MORAL
CONVICTION.
(a) In General. -Notwithstanding any other provision of
this Act, an insurer may provide a health plan that meets the
Religious
0
Moral
requirements of this Act except that it does not cover abortion
reason
services.
(b) Notice to Prospective Enrollees. Any plan provided
pursuant to the authority in subsection (a) must clearly advise
each prospective enrollee, through its enrollment literature or
other effective means, that abortion services are excluded
pursuant to subparagraph (A).
(c) Exception. Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother or to
terminate a pregnancy that is the result of an act of rape or
incest.
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Plans shall certify that it had suff.
non-subsidy As to cover costs of abortion
services
SEC.
.
REDUCTION OF FEDERAL OR FEDERALLY ASSISTED SUBSIDIES.
(a) If a subsidy is being provided under any Federal or
Federally-assisted program with respect to an individual's share
of the premium to obtain coverage under a health benefits plan
under this Act that includes abortion services, such subsidy
shall be reduced by an amount equal to the product of--
(1) the community-rated amount attributable to
abortion coverage,
(2) the ratio of the individual's share of the premium
to the total amount of the premium applicable to such plan,
and
(3) the ratio of the subsidy (before any reduction) to
the employee's share of the premium (before application of
the subsidy).
(b) For purposes of this section, the Secretary shall
determine the community-rated amount attributable to
abortion knevsons all 65 FLA
resender legal
coverage based on the ratio of --
(1) the total amounts expended for abortion services
(other than amounts expended for abortions necessary to save
the life of the mother or to terminate a pregnancy that is
This is
the result of an act of rape or incest), to
nhow figured
(2) the total amount expended for all health benefits
required to be covered pursuant to the provisions of this
Act (without application of this section).
7
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2
(c) Notwithstanding subsection (a), no reduction shall be
made in the subsidy payable with respect to an individual
enrolled in a plan that does not cover abortion services in
addition to abortions necessary to save the life of the mother or
to terminate a pregnancy that is the result of an act of rape or
incest.
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SEC.
OPTION FOR EMPLOYERS AFFILIATED WITH RELIGIOUS
ORGANIZATIONS.
(a) In General. --A religious employer (as defined in
subsection (e)) may offer one or more health plans that meet all
the requirements of this Act except that the plan or plans
exclude abortion services if such services are contrary to the
religious beliefs or moral convictions of the religious
organization with which the employer is affiliated.
(b) Notice to Prospective Enrollees. Each employer
exercising the option afforded under subsection (a) shall make
information available to each employee, and to each individual to
whom an offer of employment is made, about the exclusion of
abortion services under one or more of the health plans provided
by such employer.
(c) Exception.--Nothing in this section shall be construed
as authorizing exclusion of coverage under a health plan of
NH
abortion services necessary to save the life of the mother.
OH,
(d) Nondiscrimination. No religious employer shall
discriminate in the hiring of an individual because of the
individual's expressed preference for or interest in any
particular health plan provided by the employer, nor shall such
employer discriminate in any way in the terms or conditions of
employment because an employee has chosen to enroll in any
particular health plan. Action prohibited by this subsection
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2
shall constitute a violation of the general nondiscrimination
provisions of this Act.
(e) Definition. --As used in this section, the term
"religious employer" means an employer who is, in whole or in
substantial part, owned, supported, controlled, or managed by a
particular religion or by a particular religious corporation,
association, or society.
(10
SENT BY:
8- 3-94 : 16:04 :OGC IMMEDIATE OFFICE-
94562878:# 1/ 2
DEPARTMENT OF HEALTH & HUMAN SERVICES
OFFICE OF THE GENERAL COUNSEL
ROOM 707-F
PHONE: (202) 690-7780
FAX: (202) 690-7998
"
DATE:
8/2
Telephone No.
Fax No.
TO :
Jennifer Klein
456-2878
:
FROM:
Nan Hunter
OFFICE: OS/Immediate Office
PHONE NO.
690-7780
FAX NO.
690-7998
COMMENTS: Tim requested language on the "no construction
of abortn chhics required" issue, 80 I combined
Senate Finance amement w/ text of HSA (406(a).
Any thoughts?
No. of Pages (including cover) 2
SENT BY
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"() Nothing in this Act shall be construed--
"(1) to require the creation or maintenance of
abortion clinics or other abortion providers within any
state or region of a state, or
"(2) to authorize any federal agency or State--
"(A) to require the creation or maintenance of
abortion clinics or abortion providers, or
" (B) to deny certification or any other benefit
granted by this Act to a health plan based on the
number of or the presence or absence of abortion
clinics or other abortion providers in or affiliated
with the plan so long as the health plan enters into
such agreements or other arrangements with health care
providers as may be necessary to assure the provision
of all services covered by the comprehensive benefit
package to eligible individuals enrolled with the
plan. "
94562878;# 2
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Sen. Hatch
AMENDMENT NO
Purpose: To exclude abortions from the comprehensive
benefit package except in certain circumstances
In the Committee on Finance, United States Senate, 103d
Cong., 2nd Sess.
AMENDMENT intended to be proposed by Senator Hatch.
Viz:
At the end of subpart IV.B on page 21, after item 16, add:
"Notwithstanding the foregoing, abortion shall not be a covered
service under this Act, except where (a) a woman suffers from a
physical disorder, illness, or injury that would, as certified by
a physician, place the woman in danger of death if the fetus were
carried to term; or (b) the pregnancy is the result of rape or
incest. This exclusion shall not be construed to remove or
diminish coverage of any reproductive health service, family
planning service, or service for pregnant women otherwise
provided for under this Act, except abortions."
At the appropriate place, add: "Notwithstanding any other
provision of this Act, the National Health Benefits Board may not
expand any benefit package provided for under this Act to include
any abortion that is excluded under the covered services
provisions of this Act."
failed 11-9.
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Sen.
AMENDMENT NO.
regarding abortions
Purpose: To preserve constitutional State authority
Cong., 2nd Sess.
In the Committee on Finance, United States Senate, 103d
AMENDMENT intended to be proposed by Senator
Grassley
Viz:
At the appropriate place, add: "Nothing in this Act shall be
construed to conflict with any constitutionally permissible
regulation of abortion by a State."
11-9
got
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AMENDMENT NO.
Ex:
Calendar No.
Purpose:
IN THE SENATE OF THE UNITED STATES-103rd Cong., 2nd Sess.
S.
(or TREATY
)
H.R.
short title
(title)
( ) Referred to the Committee on
and ordered to be printed
( ) Ordered to lie on the table and to be printed
INTENDED to be proposed by Senator Danforth
Viz: At the appropriate place, insert the following:
"Nothing in this Act shall be construed to require the
creation or maintenance of abortion clinics or other abortion
providers within any state or region of a state; nor shall
anything in this Act be construed to authorize any federal
agency or State to require the creation or maintenance of
abortion clinics or abortion providers or to deny
certification or any other benefit granted by this Act to a
health plan based on the number of or the presence or absence
of abortion clinics or other abortion providers in or
affiliated with the plan
Subject to Kuai req to provide
ail services in benefit package.
passiz-8
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AMENDMENT NO.
Ex.
Calendar No.
Purpose:
IN THE SENATE OF THE UNITED STATES-103rd Cong., 2nd Sess.
S.
(or TREATY
)
H.R.
short title
(title)
( ) Referred to the Committee on
and ordered to be printed
( ) Ordered to lie on the table and to be printed
INTENDED to be proposed by Senator Danforth
Viz: At the appropriate place, insert the following:
"Nothing in this Act shall be construed to:
1. prevent any individual from purchasing a standard benefits
package excluding coverage of abortion, if the individual
objects to abortion on the basis of a religious belief or
moral conviction;
2. prevent any employer from contributing to the purchase of
a standard benefits package excluding abortion or other
services, if the employer objects to doing so on the basis of
a religious belief or moral conviction;
3. require any health professional or health facility to
perform or assist in the performance of any benefit or
service, if the health professional or health facility
objects to doing so on the basis of a religious belief or
moral conviction; and
4. require any commercial insurance company, Blue Cross Plan,
integrated health plan or any other organization that assumes
health insurance risk to offer a package including abortion
or other services, if the plan objects to doing so on the
basis of a religious belief or moral conviction.
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AMENDMENT TO PREVENT FORCED SUBSIDIZATION OF ABORTIONS BY
Danfath
2
: SE WITH STRONG MORAL OBJECTIONS
fail
Present Law: Because there is no federally defined benefits
package, there is no provision on whether abortion must be
included or excluded from a federally- defined benefits
package. The Hyde Amendment insures that Medicaid dollars
are not spent for abortions, unless the life of the mother
would be endangered if the child were carried to term or the
pregnancy resulted from rape or incest. Other federal
programs, including the Federal Employees Health Benefits
Plan, Department of Defense, Veterans, the Peace Corp have
been interpreted to include coverage of abortions, but the
procedure is now excluded in some of these programs through
annual appropriation riders. Subscribers are free to choose
a health plan which offers abortion under the Federal
Employees Health Benefits Plan.
Amendment Proposal:
Under the Chairman's mark, "[h]ealth plans would be
required to offer a standardized set of covered services.
Categories of covered services would be specified in
statute." This amendment would require that if "abortion"
were interpreted to be a covered service under the categories
set in statute, each plan offering the standard benefits
package would be required to offer a package which would
explicitly exclude coverage for abortion, except when the
life of the mother would be endangered if the child were
carried to term or the pregnancy resulted from rape or
incest. The same requirement would apply if changes were
made to the benefits package by the Benefits Commission.
Each purchaser of insurance would then be given the
option of choosing the benefit package which excludes
coverage of abortion, except when the life of the mother
would be endangered if the child were carried to term or the
pregnancy resulted from rape or incest. No plan is required
to include coverage of abortion, but if the plan chooses to
cover that service, it must offer the plan which explicitly
excludes coverage of abortion, except when the life of the
mother would be endangered if the child were carried to term
or the pregnancy resulted from rape or incest.
Packages must be priced by the plan using actuarial
principles, and proof of the actuarial methodology must be
given to the state before certification. Health plans must
charge the same premium for both packages, except for the
differential in cost for covering abortions.
Under the Chairman's mark, subsidies for health
insurance will be given to those below 200% of poverty. A
full subsidy will be given to those below 100% of poverty.
The full subsidy must equal the average cost of the premium
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2
for a certified standard health plan in the community rating
area which excludes coverage of abortion, except when the
life of the mother would be endangered if the child were
carried to term or the pregnancy resulted from rape or
incest.
The agency administering the subsidies will only be
permitted to pay a subsidy for which an individual or family
qualifies directly to a plan for a package which does not
cover abortions, except when the life of the mother would be
endangered if the child were carried to term or the pregnancy
resulted from rape or incest.
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Sec.
.
Exclusion of Benefits Because of Religious Beliefs.
(a) Special Rule for Religious Insurer or Religious
Employer.
(1) Religious Insurer. -- (A) Notwithstanding any other
provision of this Act, a religious insurer (as defined in
subsection (e)) may provide a health plan that meets the
requirements of this Act, except that it does not cover
health benefits that are contrary to the religious beliefs
or moral convictions of the religious organization with
which the insurer is affiliated.
(B) Any plan provided pursuant to the authority in
subparagraph (A) must clearly advise each prospective
enrollee, through its explanatory literature or other
effective means, of the otherwise required health benefits
that are excluded pursuant to subparagraph (A).
(2) Religious Employer -- (A) A religious employer (as
defined in subsection (e)) may offer one or more health plans
that meet all the requirements of this Act except that the
plan or plans exclude health benefits that are contrary to
the religious beliefs or moral convictions of the religious
organization with which the employer is affiliated.
(B) Each employer exercising the option afforded under
subparagraph (A) shall make information available to each
employee, and to each individual to whom an offer of
employment is made, about the exclusion of health benefits
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2
under one or more of the health plans provided by such
employer.
(3) Nothing in this section shall be construed as
authorizing exclusion of coverage under a health plan of
abortion services necessary to save the life of the mother.
(b) Deletion from Existing Plans of Certain Health
Benefits. --A religious employer may provide a health plan offered
by a religious insurer or may request any other insurer, and the
insurer shall agree, to exclude from its plan that otherwise
meets the requirements of this Act those health benefits which
are contrary to the religious beliefs or moral convictions of the
religious organization with which the employer is affiliated.
(c) Premium Adjustment Prohibited. --An insurer providing a
plan that meets the requirements of this Act, shall make no
adjustment in the premium amount by reason of the exercise by a
religious employer of the option afforded by this section to
exclude certain health benefits.
[Alternative:
(c) Employer and Employee Options with Respect to Excluded
Services.
(1) Employer Option. --A religious employer offering a
plan (other than a plan provided by a religious insurer)
that excludes health benefits pursuant to the option
afforded by subsection (b) may deduct from the premium
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3
amount otherwise payable with respect to each employee
electing to enroll in such plan the employer's share of the
community rated amount attributable to coverage of the
excluded benefits (as determined in accordance with
paragraph (3)), and the employee's share of the premium
shall be reduced accordingly.
(2) Employee Option. -- An employee of a religious
employer who has enrolled in a health benefits plan that
excludes health benefits pursuant to the provisions of
subsection (b), other than a health plan offered by a
religious insurer, may request the insurer, and the insurer
shall agree, to restore the excluded health benefits with
respect to individuals covered by that employee's enrollment
upon the employee's payment of an amount equal to the
community-rated amount attributable to coverage of the
excluded benefits.]
(d) No religious employer shall discriminate in the hiring
of an individual because of the individual's expressed preference
for or interest in any particular health plan provided by the
employer, nor shall such employer discriminate in any way in the
terms or conditions of employment because an employee has chosen
to enroll in any particular health plan. Action prohibited by
this subsection shall constitute a violation of the general
nondiscrimination provisions of this Act.
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4
(e) As used in this section, the term "religious employer"
or "religious insurer" means an employer, or an insurer,
whichever may be applicable, who (1) is exempted from taxation by
section 501 (a) of the Internal Revenue Code of 1986 by reason of
the applicability of section 501 (c) (3) thereof on the basis of
the employer's religious purposes, and (2) is, in whole or in
substantial part, owned, supported, controlled, or managed by a
particular religion or by a particular religious corporation,
association, or society.
(f) Reduction of Federal or Federally assisted Subsidies.
(1) If a subsidy is being provided under any Federal or
Federally-assisted program with respect to an individual's share
of the premium to obtain coverage under a health benefits plan
(other than such a plan offered by a religious insurer) that
excludes abortion services or other services, or both, pursuant
to the provisions of subsection (b), such subsidy shall be
reduced by an amount equal to the product of (1) the community-
rated amount attributable to abortion coverage or the community-
rated amount attributable to such other excluded services, or
both as may be applicable, (ii) the ratio of the individual's
share of the premium to the total amount of the premium
applicable to such plan, and (iii) the ratio of the subsidy
(before any reduction) to the employee's share of the premium
(before application of the subsidy).
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5
(2) For purposes of this section, the Secretary shall
determine the community-rated amount attributable to abortion
coverage based on the ratio of --
(A) the total amounts expended for health benefits
that may be excluded pursuant to this section (but not
including amounts expended for abortions if the pregnancy is
the result of an act of rape or incest), to
(B) the total amount expended for all health benefits
required to be covered pursuant to the provisions of this
Act (without application of this section),
and the Secretary shall determine the community-rated amount
attributable to services that may be excluded other than
abortions in accordance with the same methodology.
(3) Notwithstanding paragraph (1), no reduction shall be
made in the subsidy payable with respect to an individual
enrolled in a plan provided by a religious insurer, and no
reduction shall be made in the subsidy with respect to an
employee of an employer who has exercised the option under
subsection (b) and with respect to whom the premium has been
reduced under subsection (c).
DATE:
TIME:
THE WHITE HOUSE
WASHINGTON
FAX COVER SHEET
TO:
Anita Jenson
PHONE: ( )
FAX:
( ) 778-4538
FROM:
Jennifer Klein
PHONE: (202) 456- 2599
PAGES FOLLOWING COVER SHEET:
Coverage for Abortion Services
Cost:
The cost of abortion coverage is $8.67 per policy, based on
the estimated community rate required to fund abortions.
Therefore, if a religious employer chooses for moral or
religious reasons to purchase the comprehensive benefit
package without abortion coverage, the premium payment is
reduced by the appropriate share of $8.67.
Religious Employers:
All policies include coverage for abortions that are necessary
to save the woman's life or as a result of rape or incest.
A religious employer may choose not to pay for abortion
coverage other than abortions that are necessary to save the
woman's life or as a result of rape or incest. If the
employer chooses not to pay for abortion coverage, the
employer's premium contribution is reduced by the employer
share of the community-rated amount attributable to abortion
coverage. An employee may elect not to pay the difference.
A religious employer is an employer that: (1) qualifies for
tax exemption (under 501 (c) (3) or ERISA "church plan"
definitions) i and (2) is, in whole or in substantial part,
owned, supported, controlled, or managed by a particular
religion or by a particular religion or by a particular
religious corporation, association or society.
Religious Plans:
A religious plan sponsor may decline to include abortion
services other than abortions that are necessary to save a
woman's life or as a result of rape or incest. A religious
plan sponsor is a sponsor that meets the definition above.
Subsidies:
Subsidies are reduced by the appropriate share of the
community-rated amount attributable to abortion coverage.
F:\HSAVEDLABOR\FULL\DEM\AB.001
H.L.C.
[DISCUSSION DRAFT]
AMENDMENT To COMMITTEE PRINT (H.R. 3600)
OFFERED By
(Page & line nos. refer to Committee Print of June 8, 1994)
Page 509, after line 2, insert the following (and con-
form the table of contents of title I accordingly):
1 SEC. 1913. PRESERVATION OF STATE AUTHORITY REGARD-
2
ING ABORTIONS.
3
Nothing in this Act shall be construed to preempt any
4 constitutionally permissible regulation by a State of the
5 time, place, and circumstances under which abortions may
6 be performed, that applies regardless of the source of pay-
7 ment for an abortion.
June 15, 1994
F:\HSA\WM\FULL\AB.002
[DISCUSSION DRAFT]
AMENDMENT OFFERED By
TO MR. KLECZKA'S AMENDMENT
Limit the application of the Kleczka amendment to
plans that are sponsored by a religious organization.
If an employer that is not a religious organization
offers its employees a plan the sponsor of which is a reli-
gious organization that exercises the conscience clause,
the employer must also offer a plan that is at or below
the average weighted premium and the sponsor of which
has not exercised that clause.
"Religious organization" would be either a church
(as defined in section 7611(h) of the IRC) or a 501(c)(3)
religious, educational, or charitable organization that is
controlled by such a church.
June 15, 1994
001/002
07/19/94 16:26
202 401 7321
HHS ASPE/HP
OPTIONAL FORM 99 (7-90)
FAX TRANSMITTAL
# of pages
2
To Jennifer Klein
From
Sharman
Dept./Agency
Phone *
Fax #
Fax #
NSN 7540-01-317-7368
5099-101
GENERAL SERVICES ADMINISTRATION
Per your request +
07/19/94
16:26
202 401 7321
HHS ASPE/HP
002/002
It is also important to consider how close the patient may be to
the planned end of his rehabilitation hospital stay when further
progress becomes unlikely. If a patient is within a few days of
discharge, it would usually not be appropriate to transfer him to
a less intensive setting in another facility even though further
progress in the hospital setting is unlikely. However, it could
be appropriate to utilize a "swing bed" arrangement, if it exists
in the same facility, for rendering necessary services to the
patient pending discharge.
When discharge or transfer to another facility is appropriate,
the cut-off point for coverage should not be the last day on
which improvement actually occurred. Rather, coverage should
continue through the time it would have been reasonable for the
physician, in consultation with the rehabilitation team, to have
concluded that further improvement would not occur and to
initiate the patient's discharge.
Since discharge planning is an integral part of any
rehabilitation program and should begin upon the patient's
admittance to the facility, an extended period of time for
discharge action would not be reasonable after established goals
have been reached, or a determination made that further progress
is unlikely, or that care in a less intensive setting would be
appropriate.
Pregnancy
3101.12 Health Care Associated with Pregnancy Reasonable and
necessary services associated with pregnancy are covered and
reimbursable under the Medicare program. Because pregnancy is a
condition which is sufficiently at variance with the usual state
of health, it is appropriate for a pregnant woman to seek medical
care. The increased possibility of illness or injury which
accompanies this condition is well recognized, and medical
supervision is required throughout pregnancy and for a brief
period beyond. Skilled medical management is appropriate
throughout the events of pregnancy, beginning with diagnosis of
the condition, continuing through delivery, and ending after the
necessary postnatal care. Similarly, in the event of termination
of pregnancy, regardless of whether terminated spontaneously or
for therapeutic reasons (i.e., where the life of the mother would
be endangered If the fetus were brought to term), the need for
skilled medical management and/or medical services is equally as
important as in those cases carried to full term. After the
infant is delivered items and services furnished to the infant
cannot be covered and reimbursed under the program on the basis
of the mother's eligibility.
Infertility
40
7-13-94 : 12:40 :OGC IMMEDIATE OFFICE-
94562878:# 2/ 3
SENT BY:
7/13/94
Summary
*
Premium differential established to reflect cost of full abortion services as part of
premium.
*
Individuals and employers can opt out and premium differential is deducted.
*
Government funds subsidize individual premiums only up to amount without the
differential.
* Individuals with subsidies or with opt-out employers who wish full abortion
coverage can pay differential.
*
All plans except religious plans required to offer coverage of full abortion services.
"Full abortion services" means all medically necessary or appropriate abortions.
"Restricted abortion coverage" means only abortions necessary to save woman's life or as a
result of rape or incest.
Individual Conscience Clause
1. Individuals can elect to waive full abortion coverage.
2. Amount of check-off would be set by Board to reflect value of abortion services as a
portion of total premium amount. We estimate $5 to $10.
3. In enrollment unit consisting of married couple, both signatures required to waive.
Subsidized individuals
1. Subsidy for low-income persons would be available to purchase only restricted abortion
coverage.
DOES THIS APPLY REGARDLESS OF HOW SMALL THE SUBSIDY?
2. Individual would have to pay premium differential in order to secure full abortion
coverage.
THIS COULD CREATE WINDFALL FOR PLANS. DOES GOV'T DEDUCT UP FRONT THE
AMOUNT OF THE DIFFERENTIAL? IF NOT, PLANS GET PAID TWICE IF THE INDIVIDUAL
OPTS IN.
Employers
1. Employer could elect not to pay for full abortion services in premium contribution, and
premium differential would be deducted.
THIS CREATES ENORMOUS FINANCIAL INCENTIVE TO OPT OUT, ESPECIALLY FOR BIG
EMPLOYERS. TO WHOM WOULD THE REBATE GO? IF EMPLOYER IS PAYING LESS THAN
100% OF PREMIUM, WOULD EMPLOYER AND EMPLOYEE SPLIT THE REBATE?
7-13-94 : 12:41 :OGC IMMEDIATE OFFICE-
94562878:#
SENT BY:
2. Preservation of individual choice - Individual employee could pay the premium differential
to secure full abortion coverage.
Plan Conscience Clause
1. Religious exemption
a) Religious plan sponsor could decline to include abortion services beyond restricted
abortion coverage.
b) Definition of religious:
i) 501(c)(3) and ERISA "church plan" - entity that qualifies for tax exemption.
ii) Title VII: if entity is, in whole or in substantial part, owned, supported,
controlled, or managed by a particular religion or by a particular religious corporation,
association or society.
2. Premiums to be set by market
a) Plans with and without abortion coverage are priced out actuarially and individuals
choose among them. Plan with abortion coverage may cost less.
7/6/94
Summary
*
All plans except religious plans required to offer full abortion services.
*
Allow individuals with religious or moral objection to abortion to opt out.
*
Allow religious employers and religious plans to decline to offer full abortion
services.
*
Structure so that federal government funds do not purchase full abortion services.
Individual Conscience Clause
1. Option A: Waiver of abortion coverage
a) Individuals can elect to waive abortion coverage on basis of religious or moral
belief:
i) by voluntarily dropping that coverage, which would not affect the premium cost,
or
ii) by selecting a religious plan, if one is available.
b) In households with married couple, both signatures required to waive.
c) Individual could waive all coverage except for abortions necessary to save woman's
life or as a result of rape or incest.
2. Option B: Check-off
a) Household waiver would lead to re-allocation of specified amount to another
service paid for by premium.
b) Amount of check-off would be set by Board to reflect value of abortion services as
a portion of total premium amount. We estimate $5.
c) No difference in premium costs because of check-off.
d) Same as 1(b) and (c).
3. Either option: Subsidized individuals
a) Subsidy substituting for Medicaid would be available only to purchase only
coverage excluding full abortion services (subject to minimum coverage requirement as stated
in 1(c)).
b) Board shall set an amount as in 2(b). Individual would have to pay this amount in
order to secure full abortion coverage.
Employer Conscience Clause
1. Religious exemption
a) Religious entity could decline to offer any plans that include full abortion coverage.
b) Definition of religious employer:
i) 501(c)(3) and ERISA "church plan" - entity that qualifies for tax exemption.
ii) Title VII: if entity is, in whole or in substantial part, owned, supported,
controlled, or managed by a particular religion or by a particular religious corporation,
association or society.
2. Preservation of individual choice
a) If a non-religious employer offers a religious plan (see below), that employer must
also offer at least one plan that does cover full range of abortion services and that is priced at
or below the weighted average premium, the premium for a religious plan, or a comparable
price level.
Plan Conscience Clause
1. Religious exemption
a) Religious plan sponsor could decline to include abortion services beyond minimum.
b) Definition of "religious" for plan same as in employer section.
2. Premiums to be set by market
a) Plans with and without abortion coverage are priced out actuarially and individuals
choose among them. Plan with abortion coverage may cost less.