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NO TAXPAYER FUNDING FOR ABORTION ACT 

HEARING 

BEFORE THE

SUBCOMMITTEE ON THE CONSTITUTION 

AND CIVIL JUSTICE 

OF THE

COMMITTEE ON THE JUDICIARY 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

ON

H.R. 7 

JANUARY 9, 2014 

Serial No. 113–57 

Printed for the use of the Committee on the Judiciary 

( 

Available via the World Wide Web: http://judiciary.house.gov 
(II) 

COMMITTEE ON THE JUDICIARY 

BOB GOODLATTE, Virginia, Chairman 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

HOWARD COBLE, North Carolina 

LAMAR SMITH, Texas 

STEVE CHABOT, Ohio 

SPENCER BACHUS, Alabama 

DARRELL E. ISSA, California 

J. RANDY FORBES, Virginia 

STEVE KING, Iowa 

TRENT FRANKS, Arizona 

LOUIE GOHMERT, Texas 

JIM JORDAN, Ohio 

TED POE, Texas 

JASON CHAFFETZ, Utah 

TOM MARINO, Pennsylvania 

TREY GOWDY, South Carolina 

MARK AMODEI, Nevada 

RAU ́ L LABRADOR, Idaho 

BLAKE FARENTHOLD, Texas 

GEORGE HOLDING, North Carolina 

DOUG COLLINS, Georgia 

RON DeSANTIS, Florida 

JASON T. SMITH, Missouri 

[Vacant] 

JOHN CONYERS, JR., Michigan 

JERROLD NADLER, New York 

ROBERT C. ‘‘BOBBY’’ SCOTT, Virginia 

ZOE LOFGREN, California 

SHEILA JACKSON LEE, Texas 

STEVE COHEN, Tennessee 

HENRY C. ‘‘HANK’’ JOHNSON, JR., 

Georgia 

PEDRO R. PIERLUISI, Puerto Rico 

JUDY CHU, California 

TED DEUTCH, Florida 

LUIS V. GUTIERREZ, Illinois 

KAREN BASS, California 

CEDRIC RICHMOND, Louisiana 

SUZAN DelBENE, Washington 

JOE GARCIA, Florida 

HAKEEM JEFFRIES, New York 

[Vacant] 

SHELLEY HUSBAND, Chief of Staff & General Counsel 

PERRY APELBAUM, Minority Staff Director & Chief Counsel 

SUBCOMMITTEE ON THE CONSTITUTION AND CIVIL JUSTICE

TRENT FRANKS, Arizona, Chairman 

JIM JORDAN, Ohio, Vice-Chairman 

STEVE CHABOT, Ohio 

J. RANDY FORBES, Virginia 

STEVE KING, Iowa 

LOUIE GOHMERT, Texas 

RON DeSANTIS, Florida 

JASON T. SMITH, Missouri 

JERROLD NADLER, New York 

JOHN CONYERS, JR., Michigan 

ROBERT C. ‘‘BOBBY’’ SCOTT, Virginia 

STEVE COHEN, Tennessee 

TED DEUTCH, Florida 

PAUL B. TAYLOR, Chief Counsel 

DAVID LACHMANN, Minority Staff Director 
(III) 

C O N T E N T S 

JANUARY 9, 2014 

Page 

THE BILL 

H.R. 7, the ‘‘No Taxpayer Funding for Abortion Act’’ ........................................... 3 

OPENING STATEMENTS 

The Honorable Trent Franks, a Representative in Congress from the State 

of Arizona, and Chairman, Subcommittee on the Constitution and Civil 

Justice ................................................................................................................... 1 

The Honorable Jerrold Nadler, a Representative in Congress from the State 

of New York, and Ranking Member, Subcommittee on the Constitution 

and Civil Justice ................................................................................................... 15 

The Honorable Bob Goodlatte, a Representative in Congress from the State 

of Virginia, and Chairman, Committee on the Judiciry ................................... 19 

The Honorable Steve Chabot, a Representative in Congress from the State 

of Ohio, and Member, Subcommittee on the Constitution and Civil Justice .. 20 

WITNESSES 

Helen M. Alvare ́, Professor of Law, George Mason University School of Law 

Oral Testimony ..................................................................................................... 27 

Prepared Statement ............................................................................................. 30 

Susan Franklin Wood, Associate Professor of Health Policy, Director, Jacobs 

Institute of Women’s Health, School of Public Health and Health Services, 

George Washington University 

Oral Testimony ..................................................................................................... 35 

Prepared Statement ............................................................................................. 38 

Richard M. Doerflinger, Associate Director, Secretariat of Pro-Life Activities, 

United States Conference of Catholic Bishops 

Oral Testimony ..................................................................................................... 42 

Prepared Statement ............................................................................................. 44 

LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING 

Material submitted by the Honorable Jerrold Nadler, a Representative in 

Congress from the State of New York, and Ranking Member, Subcommittee 

on the Constitution and Civil Justice 

Memo from the National Women’s Law Center ............................................. 17 

Prepared Statement of the Honorable Eleanor Holmes Norton, a Representative in Congress from the District Columbia ................................. 25 

APPENDIX 

MATERIAL SUBMITTED FOR THE HEARING RECORD

Prepared Statement of the Honorable John Conyers, Jr., a Representative 

in Congress from the State of Michigan, Ranking Member, Committee 

on the Judiciary, and Member, Subcommittee on the Constitution and 

Civil Justice .......................................................................................................... 72 
Page

IV 

Material submitted by the Honorable Jerrold Nadler, a Representative in 

Congress from the State of New York, and Ranking Member, Subcommittee 

on the Constitution and Civil Justice 

Prepared Statement of the Honorable Jerrold Nadler, a Representative 

in Congress from the State of New York, and Ranking Member, Subcommittee on the Constitution and Civil Justice ....................................... 74 

Response to Question for the Record from Susan Franklin Wood, Associate Professor of Health Policy, Director, Jacobs Institute of Women’s 

Health, School of Public Health and Health Services, George Washington University .......................................................................................... 85 

Prepared Statement of Sara Rosenbaum, Lara Cartwright-Smith, Ross 

Margulies, Susan Wood, and D. Richard Mauery, School of Public 

Health & Health Services, Department of Health Policy, the George 

Washington University Medical Center ...................................................... 86 

Coalition Letter ................................................................................................. 100 

Letter from Jon O’Brien, President, Catholics for Choice ............................. 103 

Letter from Vincent C. Gray, Mayor, Washington, D.C. ............................... 106 

Prepared Statement of Laura W. Murphy, Director, and Sarah LiptonLubet, Policy Counsel, ACLU Washington Legislative Office, the American Civil Liberties Union (ACLU) .............................................................. 107 

Prepared Statement of the American Congress of Obstetricians and Gynecologists (ACOG) ........................................................................................... 113 

Prepared Statement of the Center for Reproductive Rights ......................... 114 

Prepared Statement of Vicki Saporta, President and CEO, National Abortion Federal (NAF) ........................................................................................ 120 

Letter from Susan A. Cohen, Acting Vice President for Public Policy, 

the Guttmacher Institute ............................................................................. 124 

Prepared Statement of NARAL Pro-Choice American Foundation .............. 133 

Prepared Statement of Nancy Kaufman, Chief Executive Officer, the 

National Council of Jewish Women (NCJW) .............................................. 142 

Letter from Emily Spitzer, Executive Director, the National Health Law 

Program (NHeLP) ......................................................................................... 145 

Prepared Statement of the National Asian Pacific American Women’s 

Forum (NAPAWF) ........................................................................................ 148 

Prepared Statement of Debra Ness, President, and Andrea Friedman, 

Director of Reproductive Health Programs, the National Partnership 

for Women & Families .................................................................................. 151 

Prepared Statement of the Planned Parenthood Federation of America ..... 155 

Prepared Statement of Nancy Stanwood, MD, MPH, Board Chair, Physicians for Reproductive Health ..................................................................... 158 

Letter from Frank Knapp, Jr., President & CEO, South Carolina Small 

Business Chamber of Commerce ................................................................. 161 

Prepared Statement of Judy Waxman, Vice President for Health and 

Reproductive Rights, the National Women’s Law Center (NWLC) .......... 163 
(1) 

NO TAXPAYER FUNDING FOR ABORTION ACT 

THURSDAY, JANUARY 9, 2014 

HOUSE OF REPRESENTATIVES

SUBCOMMITTEE ON THE CONSTITUTION

AND CIVIL JUSTICE

COMMITTEE ON THE JUDICIARY

Washington, DC. 

The Subcommittee met, pursuant to call, at 10:05 a.m., in room 

2141, Rayburn House Office Building, the Honorable Trent Franks 

(Chairman of the Subcommittee) presiding. 

Present: Representatives Franks, Jordan, Chabot, Forbes, King, 

Gohmert, DeSantis, Smith, Nadler, Scott, Cohen, and Deutch. 

Staff Present: (Majority) Paul Taylor, Subcommittee Chief Counsel; Tricia White, Clerk; (Minority) Heather Sawyer, Counsel; and 

Veronica Eligan, Professional Staff Member. 

Mr. FRANKS. Committee will come to order. Want to welcome everyone to the Committee. Happy new year to you all. Welcome to 

the panelists, especially. And welcome back to my colleagues on 

both sides of this podium. 

For well over 30 years, Congress has prevented the Federal funding of abortions through a patchwork of amendments that are 

added to various appropriations bills during each budget cycle prohibiting the Federal funding of abortions through their funded programs. Now is the time to pass one piece of legislation that puts 

Members on record supporting a prohibition on any Federal funding of abortion no matter where in the Federal system that funding 

might occur. 

In poll after poll, the American people have overwhelmingly expressed their opposition to the Federal funding of abortions. H.R. 

7 will ensure that American taxpayers are not involved in funding 

the destruction of innocent human life through abortion on demand. The No Taxpayer Funding for Abortion Act will establish a 

government-wide statutory prohibition on abortion funding by making permanent the various policies Congress has implemented on 

a case-by-case basis, including: The Hyde Amendment, which prohibits funding for elective abortion coverage through any program 

funded through the annual Labor, Health and Human Services Appropriations Act; the Helms Amendment, which prohibits funding 

for abortions as a method of family planning overseas; the Smith 

Amendment, which prohibits funding for elective abortion coverage 

for Federal employees; the Dornan Amendment, which prohibits 

the use of Congressionally appropriated funds for abortion in the 
2 

District of Columbia, and other policies such as the restrictions on 

elective abortion funding through the Peace Corps and Federal 

prisons. 

Now, absolutely nothing in the Democrats’ unpopular health care 

law prevents the Federal funding of abortions under the program 

it creates. Representatives Joe Pitts and former Representative 

Bart Stupak offered an amendment to the bill during the 111th 

Congress that would have prohibited government funding of abortion, had it been included in the final Health Care Reform Act. But 

that provision was stripped out of the Senate bill the President 

signed into law. 

In the last-minute effort to work a face-saving political deal, the 

President said he would sign an executive order that claimed to 

limit Federal funding of abortions in some way. Then in an interview with the Chicago Tribune editorial board, former White House 

chief of staff Rahm Emanuel emphasized that the executive order 

signed by President Obama does not carry the force of law, and as 

such, was approved by the former House Speaker Nancy Pelosi and 

others who oppose a ban on taxpayer funding of abortion. Mr. 

Emanuel said, I quote, ‘‘Came up with the idea for an executive 

order to allow the Stupak Amendment not to exist in law.’’ 

There you have it. In the words of the President’s chief of staff 

at the time, ‘‘the Obamacare law provides for the Federal taxpayer 

funding of abortions.’’ Any Member who opposes that policy must 

support H.R. 7, which would at last put back into law the principle 

of the bipartisan Hyde Amendment and place a Federal Government-wide ban on the Federal funding of the destruction of innocent human life. 

Now, I am fully aware of the controversy surrounding the underlying issues here. And throughout history, there has often been 

great intensity surrounding the debates over protecting the innocent lives of those who, through no fault of their own, find themselves obscured in the shadows of humanity. It encourages me 

greatly that in nearly all of those cases, the collective conscience 

was finally moved in favor of the victims. The same thing is beginning to happen in this debate related to innocent, unborn children. 

We are beginning to ask ourselves the real question: Does abortion 

take the life of a child? And we are beginning to finally able to realize as a human family that it does. 

Ultrasound technology now demonstrates to all reasonable observers both the humanity of the victim and the inhumanity of 

what is being done to them. And we are beginning to realize as 

Americans that brutally taking the lives of the innocent unborn 

does not liberate anyone, and that 50 million dead children is 

enough. I look forward to hearing from the witnesses. 

And I now recognize the Ranking Member of the Subcommittee, 

Mr. Nadler, for his opening statement. 

[The bill, H.R. 7, follows:] 
3 

113'fTT CONCiRESS 

1ST SESSION H.R.7 

To prohibit taA1Jayer funded abortions. 

IN THE HOUSE OF REPRESENTATIVES 

IVL".y 1,!, 2013 

Mr. SMTTH of New .Jersey (for hirnself, Mr. T,IF'TNRKT, Mr. PITTS, }fr. FT,F;1\1-

lNG, Mrs. ROBY. Mrs. BLACKBul:ti\, Mr. ,JOi\H:S, }Ir. BUCHANAN, Mr. 

FRANKS of A.rizona, Mr. ROGERS of Alabama, lVh-. l1'LORES, Mr. 

FT,F.TR(:HMANN, Mr. ROTT8TANY, Mr. DUi\(:A'J of South Carolilla, Mr. 

FINCHH:l:t, Mr. CAl:tTEl:t, Mr. VVB;STlVlOl:tEL.;\.ND, Mr. GAl{gg','T, Mr. 

PF.AR.CF., Mr. R,oF; "f Tennessee, Mr. Nli:uGF.BAT~RR., Mr. POli: of Texa;;;, 

Mr. GOOHLATTE, Mr. BENTIVOLIO, }Ir. HAEPEE, Mr. SCH\'..-Em:EgT, Mr. 

WILSON of South Carolina, lVir. SCALISE, Mr. WOODALL, Iv1r. STrTz::\L".i\, 

Mr. Hm7.F.NGA of }fiehigan, Mr. vVENRTm~p, Mrs. RA(:HMANi\, Mr. 

A . .YIASH, Mr. SHllVlKUS, Mr. LAJl.:1ALi<'A, Mr. VVAl,BE1W, Mr. Bl:'.ADY of 

TexaR, Mrs. Bld,CK, MI'. HUELSE:..'u'V[P, Mr. CASSIDY, }Ir. GO\Vl)Y, Mr. 

MEADOWS, Mr. FOgTENB:EImy, Mr. VVOLF, Mr. BRIDENSTI'JE, Mr. 

SAL:\ION, IVlr. KING of Iowa, Mr. GINGREY of Georgia, .lVIr. HOLDING, 

Mrs ET,L1mR.R, }fr. T,ON'T, Mr. Sli:SRTONS, Mr. MAR.iNO, Ms. RosLgHTINli:'J, Mr. CONAWAY, Mr. POMPgO, Mr. LASIBOl{N, Mr. KELLY of 

PenIlsylvania, Mr . .JOHNSON of Ohio, Mr .. JORDAN, Mr. GUTHRIE, Ms. 

Foxx, Mr. Hl~LTGREN, Mr. }lli;SSER, Mr. B.oyCE, }Ir. BROUi\ of Georgia, lVlr. GIBBS, lVIr. 'l'HORi\BTIlRRY, .lVIr . .ADERHOLT, .lVIr. RAHALL, lVir. 

R.OGRRR of Michigan, Mr. Mm,YANF;Y, Mrs. HARTZLRR, Mrs. WAGNiijR., 

Mr. ALBXAND b;l:t, Mr. LA.KKl<'OHD, lVIr. llARms, lVIrs. \V ALOl:tSKl, lVIr. 

OLSOl', 111'. ROTHFFS, lVIr. RillTON, lVIr. DrFFY, lVIr. SMITH of Nebraska, }lr. Nl~GENT, Mr. BiTRGESS, Mr. 'IVOMACK, lVIr. ROD.KEY DAVIS 

of Illinois, :VII'. BACHUS, Mr. KlINE, Mr. BENISHEI{:, Mr. SOUTHERLAND, 

Mr. Mn,LF.R of Florida, Mr. STF.WART, Mr. McKT'JT,F.Y, and Mr. YODRR) 

introduced the foll01ving bill; which was referred to the Committee on 

\Vays alld lVIeans, and in additioll Lo the Committees Oll the Judiciary 

and Energy and Commeree, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jUl'iRdj(~lioll of the eommi1.Lee (~()Jlcerned 
4 

2 

A BILL 

To prohibit tU:XlJuyer funded abortions. 

Be it enacted the Senate and House 

2 tives United States 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 SHOR.1' TnT,Eo-This Act may be cited as tllC 

5 ''::--Jo Taxpayer Funding for Abortion Ad". 

6 (b) T~illLE OF COKTENTS.-The table of contents for 

7 this Aet is as follows: 

Sec. 1. Sho!'t title; table of conLellts. 

TITLE I-PROHIBITING FEDERALLY FUNDED ABORTIOKS 

Sec. 101. Prohibiting taxpayer funded abortions. 

Sec. 102 .• 'unendmcnt to table of chapters. 

TITLE II-ELIMINATION OF CERTAIK T.'lX BENEFITS RELATING 

TO llilORTION 

Sec. 201. 

Sec. 202. 

Sec. 203. 

8ee. 204. 

Deduction for medical expenses not allowed for abortiom;. 

Di,mllowflnce of refumlable credit for coverag'e ullder qualified health 

plan which provides coverag'e for abortion. 

Disallowallce of slllall cmploye!' health insurance expense crcdit [or 

plan which ineludes coverage for abortion. 

Distributions for abortion expenses from eel'tain account.s and arrangements ineluded in gTOSS im:orne. 

8 TITLE I-PROHIBITING FEDER9 ALLY FUNDED ABORTIONS 

10 SEC. 101. PROHIBITING TAXPAYER FUNDED ABORTIONS. 

11 Title 1 ~ Ullited States Code is amended by adding 

12 at the end the following new chapter: 

13 "CHAPTER 4-PROHIBITING TAXPAYER 

14 FUNDED ABORTIONS 

":301. Prohibit.ion on fumling for abort.ions. 

"302. Prohibition on funding for health benefits plans that eover abortion . 

• HR 7 HI 
5 

"80B. Limitation on Federal faeilit.ie, and employees. 

"304. Con~truetion relat.ing to 8eparate eov(erage. 

"305. Con~t.ruction relat.ing to the use of non-Federal funds for health coverage. 

";306. Non-preemption of other Federal laws. 

"807. Const.mction relat.ing in complicat.ions arising from ahort.ioll. 

";308. Treatment of abortion" related to rape, ineeiit, or prt'8erving the life of 

the mother. 

"309. Application t.o District of Coillmhia. 

"§ 301. Prohibition on funding for abortions 

2 "No funds authoriz-:ed ot' appropriated by Federal 

3 law, and none of the funds in any trust fund to which 

4 funds are authorized or appropriated by Federal law, shall 

5 be eApended for any ahortion. 

6 "§ 302. Prohibition on funding for health benefits 

7 plans that cover abortion 

8 "None of the funds authorized or appropriated by 

9 Federal law, and none of the funds in any trust fund to 

10 which funds [Ire authorized or appropriated by l"ederal 

11 shall be expended for health benefits eoverage that 

12 includes eoverage of abortion. 

13 "§ 303. Limitation on Federal facilities and employees 

14 "No hcaltl1 care service furnisl1ed15 "(1) or in a health eare faeility owned or op16 erated the Federal Government: or 

17 any physician or other individual em18 ployed by tllC Federal Government to provide health 

19 care services vvithin the scope of the physician's or 

20 individual's employment, 

21 may include abortion . 

• HR 7 III 
6 

4 

"§ 304. Construction relating to separate coverage 

2 "N othing in this chapter shall he construed as pro3 hibiting any individual, entity, or State or locality from 

4 purchasing separate abortion coverage or health benefits 

5 coverage that includes abortion so long as such coverage 

6 is paid for entirely using only funds not authorized or 11p7 propriated Federal law and tmeh eoverage shall not be 

8 purchased using matching funds required for a federally 

9 subsidized prognun, including a State's or locality's con10 tribution of Medicaid matclLlng funds. 

11 "§ 305. Construction relating to the use of non-Fed12 eral funds for health coverage 

13 "Nothing in this chapter shall he construed as 1'e14 stricting the ability of any non-Federal health benefits cov15 erage provider from offering abortion coverage, or the abil16 ity of a State or locality to contract separately with such 

17 a provider for such coverage, so long as only funds not 

18 authorized or appropriated by Federal 1a,,- are used and 

19 such coverage shall not be purchased using matching 

20 funds required for a federally subsidized program, includ21 ing a State's or locality's contribution of Medicaid mateh22 iug funds. 

23 "§ 306. Non-preemption of other Federal laws 

24 "Nothing ill this chaptcr s11a11 rcpeal, amend, or have 

25 any effect on any other Pederal law to the ex-tent such 

26 law any limitation on the use of funds for abortion 

.UR 7 HI 
7 

;) 

or for health benefits coverage that includes coverage of 

2 abortion, beyond the limitations set forth in this chapter. 

3 "§ 307. Construction relating to complications arising 

4 from abortion 

5 "Nothing in this chapter shall be construed to apply 

6 to the treatment of any infection, injury, Ui~),,;a."'IJ, or rus7 order that llas been caused by or exacerbated by the per8 forrna.nce of an abortion. This rule of construction shall 

9 be applicable v\Jjthout regard to whether the abortion ,vas 

10 performed in accord with Federal or State and vvith11 out regard to whether funding for the abortion is perm1s12 sible under sertion 308. 

13 "§ 308. Treatment of abortions related to rape, incest, 

14 or preserving the life of the mother 

15 "The limitations established in seetions 301, 302, 

16 and 303 shall not apply to an abortion17 "( 1) if the pregnancy is the result of an act of 

18 rape or ineest; or 

19 "( 2) in the ease where a woman suffers from a 

20 physical disorder, physical iIljury, or physical illness 

21 tl1at would, as certified by a physician, place tllC 

22 woman in dang'er of death unleHs an abortion is per23 formed, including a life-endang'ering physical condi24 tion caused by or arising from the pregnancy itself . 

• HR 7 III 
8 

() 

"§ 309. Application to District of Columbia 

2 "In this chapter: 

3 "(1) Any referenee to fund8 appropriated by 

4 Federal law shall be treated as including any 

5 amounts vvithin the budget of the District of Co1um6 bin that have been approved by Act of Congress pur7 ~uant to 8t'(-tion :146 of the Di8tri(:t of Columbia 

8 Home Rule Act (01' any applicable successor Federal 

9 law). 

10 "(2) The term 'Federal Governmenf includes 

11 the government of the District of Columbia.". 

12 SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 

13 The table of chapters for title 1, l~nited States Code, 

14 is amended by adding at the end the following new item: 

"4. Prohibiting taxpayer funded abortions ............................. 301". 

15 TITLE II-ELIMINATION OF CER16 TAIN TAX BENEFITS RELAT17 ING TO ABORTION 

18 SEC. 201. DEDUCTION FOR MEDICAL EXPENSES NOT AL19 

20 

LOWED FOR ABORTIONS. 

I:\[ GENERAI..-Section 213 of the Internal Rev21 enue Code of 19Hfi i8 amended adding at the end the 

22 following nevv 8ub8ection: 

23 AlVI01JNTS PAID FOR ABORTIO:\[ XOT TAKEN 

24 INTO ACCOUKT.-

.UR 7 IH 
9 

7 

"(1) IN GENEEAL.-An amount paid during the 

2 taxable year for an abortion shall not be taken into 

3 account undcr subsection 

4 "(2) EXCEPTIOKS.-ParagTClph (1) shall not 

5 

6 

apply toan abortion7 "(i) in the case of a pregnancy t11at is 

8 the result of an act of rape or incest, or 

9 "(ii) in the case where a woman suf10 fers from a physical disorder, physical in11 jUlY, or physical illness that would, as cer12 tincd by a physician, placc tllC woman in 

13 danger of death unless an abortion is per14 formed, including a life-endangering phys15 ical condition caused by or arising from 

16 thc prcgnancy, and 

17 "(B) the treatment of any infection, injury, 

18 disease, or disorder that has been caused by or 

19 exacerbated by the performance of an abor20 tion.". 

21 (b) EFFECTTVE DATE.-Thc amcndmcnt madc by 

22 this se(~ti()n shall apply to taxable years beginning after 

23 the date of the enactment of this Act . 

• HR 7 HI 
10 

H 

SEC. 202. DISALLOWANCE OF REFUNDABLE CREDIT FOR 

2 COVERAGE UNDER QUALIFIED HEALTH PLAN 

3 WHICH PROVIDES COVERAGE FOR ABOR4 TION. 

5 (a) IN GRl\IiJR.AL.-Subparagraph (A) of section 

6 36B(e)(3) of the Internal Revenue Code of 1986 i8 amend7 ed by inserting before the period at the end the follmving: 

8 "or any health plan that includes coverage for abortions 

9 (otl1er tlla11 ~my abortion or treatment described in section 

10 213(g)(2))". 

11 (b) OPTION To PL-RCHASE OR OFFER SEPARATE 

12 OJVl£HAGl£ em PLili"i.-Paragraph of section 36B(c) 

13 of such Code is amended by adding at the end the fo1-

14 lm\~ng new subparagrapll: 

15 SEPARATE ABORTION COVERAGE OR 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

• HR 7 III 

PLAN ALLOI'v'ED.-

"(i) OPTlO.:.I TO PUHCIUSB SEPM?A'TE 

C0l71~RAGR OR PT,A"T.-:\othing ill subparagraph (A) shall be construed as prohibiting 

any individual from pureha8ing 8eparate 

coverage for abortions described in such 

subparagraph, or a health plan that includes suell abortions, so long as 110 credit 

is allowed under this sedion vvith respeet 

to the premiums for such coverag'e or plan . 
11 

9 

"(ii) OPTION '1'0 Ob'PE:H COVEEAGE OE 

2 PI.AN.-Nothing in subparagraph (A) shall 

3 rcstrict any non-I,lcc\cra] 11caHh insurancc 

4 issuer offering a health plan from offering 

5 separate coverage for abortions described 

6 in such subparagTaph, or a plan that in7 cludes such abortions, so long as premiums 

8 for tmch separate coverage or plan are not 

9 paid for with any amount attributable to 

10 the credit allowed under Hus section (or 

11 the amount of any advance pa:vrnent of the 

12 credit uuder section 1412 of the Patient 

13 Protection and Affordable Care Act).". 

14 (c) EFFECTIVE DATE.-The amendment made by 

15 this section shall apply to taxable years ending after De16 ccmbcr 31,2013. 

17 SEC. 203. DISALLOWANCE OF SMALL EMPLOYER HEALTH 

18 INSURANCE EXPENSE CREDIT FOR PLAN 

19 WHICH INCLUDES COVERAGE FOR ABOR20 TION. 

21 (a) T~ (lBJNERAh-Subsection (11) of section 45R of 

22 the Internal Hevenue Code of 19f)() is amended23 (1) by striking "L~U'y term" and illser·ting the 

24 following: 

25 "(1) IN GENERAL.-Any term", and 

.HR 7 III 
12 

10 

by adding at the end the following new 

2 paragTaph: 

3 EXCU~STON OF HEAT/rH Phi\NS l'·JCTjl~DTNG 

4 CUVERAGE FOR ABORTION.-The terms 'qualified 

5 health plan' and 'health insurance shall 

6 not include any health plan or benefit that includes 

7 coverage for abortions (otl1er thml any abortion or 

8 treatment described in section 213(g)(2)).". 

9 Cb) EFFECTIVE DATE.-The amendments made 

10 this section shall to taxable years beginning after 

11 the date of the enactment of this Act. 

12 SEC. 204. DISTRIBUTIONS FOR ABORTION EXPENSES FROM 

13 

14 

15 

CERTAIN ACCOUNTS AND ARRANGEMENTS 

INCLUDED IN GROSS INCOME. 

FLEXIBLE SPENDH\G AlU\UCL'\JGElVLENTS U.'IJDEU 

16 C~~ETERIA PLA:'-JS.-Section 125 of the Internal Revenue 

17 Code of 19KG is amended by recieslgrlatlmg suhsections (k) 

18 and (1) as subsections (1) and (m), respectively, and by 

19 inserting after subsection (j) the following new subsection: 

20 _ABORTIOK RmMBURSElVIENT FROM FLEXIBLE 

21 SPB:'-JDTNG AHRANGR1VrENT TNCTjUDBD TN G:ROSS TN22 cOl\fE.-Not,vitlli:,tanding seetion 105(b), gTOI:-;S ineome 

23 shall include any reimbursement for expenses ineuI'['ed for 

24 an abortion (other than any abortion or treatment de25 scribed in section 213(g)(2)) from a health flexible spend-

.HR 7 IH 
13 

11 

ing arrangement provided under a cafeteria plan. Such re2 imbursement shall not fail to be a qualified benefit for 

3 purposes of this section merely as a result of such inclu4 sion in gross income. . 

5 (b) A1WHE:R MSAs.-Paragraph (1) of section 220(f) 

6 of such Code is amended by inserting before the period 

7 at the end the follov'~llg: ", tllat any such amount 

8 used to pay for an abortion (other than any abortion or 

9 treatment described in seetion 213(g)(2)) shall be induded 

10 in the gross income of such holder". 

11 (e) IISAs.-Paragraph (1) of section 223(£) of such 

12 Code is amellded by inserting before the periocl at tl1e end 

13 the follovving: ", exeept that any such amount used to pay 

14 for an abortion (other than any abortion or treatment de15 scribed in section 213(g)(2)) shall be included in the gross 

16 income of such beneficiar;/'. 

17 (el) EFFEGTIVE DATES.-

18 (1) FSA REIlVIBURSElVIEKTS.-The amendment 

19 made subsection (a) shall apply to e}q)enses in20 curred ,vith respect to taxable years beginning after 

21 tllC date of the enactment oftllis Act. 

22 (2) DrSTR.IBUTIONS FROM SAI7INGS AC23 

24 

COL"NTS.-Tbe amendments made subsection (b) 

and shall apply to amounts paid vvith respect to 

.HR 7 In 
14 

12 

taxable years beginning after the date of the enact2 ment of this Act. 

.HR 7 III 

n 

u 
15 

Mr. NADLER. Thank you, Mr. Chairman. Today’s hearing concerns what may be the most difficult and divisive issue we will 

have the opportunity to consider: A woman’s right to make decisions about her own body. The right of a woman to decide whether 

to become pregnant and whether to continue or terminate her pregnancy is protected by the Constitution. Whether or not you think 

that is a good idea or a fair reading of the Constitution, it remains 

the law of the land. The Supreme Court has also determined that 

neither Congress nor a State may place an undue burden on that 

right. 

Now comes H.R. 7, the ‘‘No Taxpayer Funding for Abortion Act,’’ 

which is misleading and misnamed because the bill seeks to burden 

all women’s health care choices in a variety of ways that have in 

nothing to do with Federal funds. Contrary to the assertions of its 

supporters, H.R. 7 is not the mere codification of existing law. This 

bill seeks to extend current funding restrictions in the Hyde 

Amendment that are limited in time and scope and to apply them 

to all Federal laws without any effort to determine how such a 

sweeping and permanent expansion would impact American women 

and their families. 

If this were all, that would still be enough reason to oppose it. 

But H.R. 7 actually goes much further. This bill, for the first time 

ever, denies tax deductions and credits for women who use their 

own money to pay for an abortion or to purchase insurance that 

covers abortion, and in so doing, increases taxes for women and 

families with respect to one of the most personal, private decisions 

that they may face. So in effect, it imposes a tax increase on 

women who choose to use their own money for abortions, under 

certain circumstances. In particular,H.R. 7 denies the itemized tax 

deduction that otherwise is available for medical expenses if the expense is an abortion and treats as taxable income any distribution 

from a flexible spending account or health savings account that is 

used to pay for abortion expenses. 

H.R. 7 denies small employers the ability to use tax credits to 

provide health coverage if that coverage includes abortion. The bill 

also denies income-eligible women the use of premium tax credits 

available under the Affordable Care Act if selected insurance coverage includes abortion. In first opposing and then voting to repeal 

the Affordable Care Act—not once, not twice, but I think we are 

up to 47 times now—my Republican colleagues have complained 

that government should not meddle in the private insurance market or in private health care choices. But this legislation obviously 

is designed to do just that. 

It seems that many Republicans believe in freedom, provided no 

one uses that freedom in a way that they do not approve of. That 

is a strange understanding of freedom. Even more stunning, this 

bill increases taxes on families, businesses, and the self-employed 

if they spend their own money—let me repeat that, their own 

money, not Federal money—on abortion coverage or services. As we 

know, the power to tax is the power to destroy. And here the taxing 

power is being used to destroy the right of every woman to make 

private health care decisions free from government interference. 

This tax increase is being championed by Republicans, almost all 
16 

of whom have taken a pledge not to raise taxes on individuals or 

businesses, except here. 

I am equally surprised to find out that my Republican colleagues 

think that a tax exemption or a tax credit is a form of government 

funding. Should we now consider every tax exemption or credit as 

a form of government funding for the recipient? I am sure there 

will be many businesses, charities, and religious denominations 

that will be alarmed to discover this. 

I also join many other Americans in being absolutely horrified 

that the majority of this Committee seems to not know what rape 

is. When this bill was introduced in the last Congress, its sponsors 

sought to limit the Hyde Amendment rape exception to instances 

of ‘‘forcible’’ rape. Many in Congress and across America were outraged. According to the bill’s champions, date rape drugs, and sex 

with minors were not really rape. 

In the face of public outcry, the majority removed the term ‘‘forcible’’ from the bill before this Committee marked it up in the last 

Congress. But let no one misunderstand or be fooled by that 

change. My colleagues still seek to narrow the rape exception, as 

they made clear in the Committee report accompanying H.R. 3 in 

the last Congress, where they explained, ‘‘Reverting to the original 

Hyde Amendment language should not change longstanding policy. 

H.R. 3 with the Hyde Amendment language would still appropriately not allow the Federal Government to subsidize abortions 

in cases of statutory rape. The Hyde Amendment has not been construed to permit Federal funding of abortion based solely on the 

youth of the mother, nor has the Federal funding of abortions in 

such cases ever been the practice.’’ 

The majority’s assertion, as explained in a memo from the National Women’s Law Center is false. In fact, a 1978 regulation 

clarified that funding is required for all cases of rape, whether statutory or forcible. Nothing in the language of the Hyde Amendment 

qualifies the term ‘‘rape,’’ and Congress rejected a proposal to limit 

the amendments to cases of forcible rape. It rejected it then, but 

this Committee would seek to change it now. 

I ask unanimous consent that the National Women’s Law Center 

memo be entered into the record. 

Mr. FRANKS. Without objection. 

Mr. NADLER. Thank you. 

[The information referred to follows:] 
17 

NATIONAL 

WOMEN'S 

LAWCENHR 

TO: Interested Parties 

FR National Women's Law Center 

MEMORANDUM 

RE The House Judiciary Committee Report on HR 3 Reflects an Attempt to Narrow the Rape 

Exception Even Though the Statutory Term "Forcible" Was Removed and Misrepresents 

Longstanding Policy on the Rape Exception 

Tn January, Representative Chris Smith introduced H.R. 3, a bill that punishes private health 

decisions by raising taxes on individuals and small businesses with insurance plans that include 

coverage of abortion and makes permanent the ban on federal funding for abortion, often known 

as the Hyde Amendment. H.R. 3, as introduced, modified the longstanding rape exception to the 

Hyde Amendment by adding the term "forcible" before the word rape, thereby excluding rape 

that results from non-consent, or when a womanjust says no, and, depending on how broadly or 

narrowly the term is construed, rape accomplished through threats of non-physical harm; 

previous violence coercing a woman to have sex, such as a serial abuser who demands sex; rape 

committed against an individual under the influence of drugs or alcohol at the time of the rape; 

and statutory rape, among others. In response to public outcry over this attempt to narrow the 

rape exception, the term "forcible" was deleted from the bill's text. 

However, despite the fact that the tenn "forcible" was dropped from the bill's text, proponents of 

the bill still intend the term "rape" to exclude victims who were not raped "forcibly." The House 

Judiciary Committee Report states that "reverting to the original Hyde Amendment language 

should not change longstanding policy." According to proponents ofH.R. 3, the intent of the bill 

is to narrow the rape exception to apply only to victims of "forcible" rape, whether or not the 

"forcible" modifier is in the bill's text 

Moreover, the House Judiciary Committee Report misrepresents the "longstanding policy" it 

specifically cites. According to the Report, the Hyde Amendment language does "not allow the 

Federal Government to subsidize abortions in cases of statutory rape. The Hyde Amendment has 

not been construed to permit Federal funding of abortion based solely on the youth of the mother 

. ·,1 This is false. A 1978 regulation implementing the Hyde Amendment made clear that the 

term "rape" included statutory rape 2 In addition, states include statutory rape in their 

interpretations ofthe "rape" exception] Every state that cites to a specific part of its criminal 

code to identify which crime victims are entitled to Medicaid funding for pregnancy termination 

speCifically includes victims of statutory rape 4 And in the states that just use the term "rape" or 

"sexual assault" and do not include explicit statutory references in their State Medicaid manuals, 

statutes or administrative codes to define rape for Medicaid purposes, the terms can be 

interpreted as being coterminous with state criminal code, and "most states have statutory rape 

and other sex offense statutes which criminalize sexual activity with minors who fall within a 

specified age range or are under a specified age'" 

In sum, though the proponeuts of H.R. 3 deleted the term "forcible" from the bill's text, the 

House Judiciary Committee Report restores the proponents' intended meaning: that only 

victims of "forcible" rape can be included in the bill's rape exception, thereby narrowing 

longstanding policy and excluding some ofthe most vulnerable victims from the abortion 

care they need. 
18 

1 RR. Rep. No. 112-38, at 28, availahle at http://demoerats.m1cs.house.gov/112/te).1/112_hr3_rpt.pdf. 

~ A 1978 regulation implementing the Hyde Amendment included discussion in the Federal Register about whether 

statutory rape is included in the tenn "rape." In its response to COlmnents, the Department of Health. Education and 

Welfare addressed comments that "criticized the regulations for including statutory rape \vithin the exception 

pemritting Federal funding of abortions for victims of rape."' The Department, in relevant part, responded 

This interpretation ,,,as clearly mandated by section 101. Nothing in these vilOrds limits such funcling 

to victims offorccd rapc. In addition. Congrcss considered, and failcd to cnaet a proposal that ""'ould 

have expressly limited the availability of Federal funding of abortions to victims of "forced" rape 

Thus, the failure to use the word "forced" in section 101 when referring to rape is conclusive evidence 

that Congress intended funding to be available for \ictims of statutory, as \\ell as forced, rape 

,I.,'ee Federal Financial Participation in State Claims for Abortions, .. 1-3 Fed. Reg. 31,873 (Jul! 21. 1978). 

1 The Health Care Financing Administration (HCF A) issued guidance to State Medicaid Directors, shortly after the 

rape and incest exceptions were restored to the Hyde Amendment in 1993, that 'The deflllition of rape and incest 

should be detenrrined in accordance with each State's own law" in the Medicaid prognml. Letter from Sally K 

Richardson, Director. Meclicaid Bureau, Dep 't Health & Human Sen·s. to State Medicaid Director 2 (Dec. 28. 

1993). As such. state interpretations of "rape" in lmvs and regulations implementing bans on public funding for 

abortion and in Mcdicaid provider manuals govcrn here 

4 There are four states that refer to specific criminal statutes to define ,,·hich rape \ lctims are entitled to Medicaid 

funding for abortion. Each state includes those 'who are victims due to their age. Alaska's regulations state that 

medical assistance funding is available ",here pregnancy resulted from "a crime of sexual abuse of a minor under 

AS-lIA1A3+-lIAIA+0:· Alaska Admin. Code tit. 7. § +7.290 (2010). Arkmsass Medicaid m,mual states that 

coverage is available "for victims of rape. defined lUlder Ark. Code Ann. ~ 5-14-103.·' Memorandum from the 

Diy. of Med. Servs., Ark. Dep't Human Sen's. to Ark. Medicaid Provider 3 (Aug. 1, 200-1-). The Arkansas code 

referenced by the Medicaid manual defines rape as including se:\.'llal intercourse with <mother person ,vho is less than 

14 years of age. Ark. Code Ann. ~ 5-1-1--103 (20 10). Florida's Medicaid manual states that Medicaid reimburses 

"When the prcgnancy is the result of rape as defincd in section 79-1-.01 L F.S.'· Fl. Medicaid. Agency for Health 

Care Admin .. Hospital Serdccs Coveragc and Limitations Handbook 2-3 (June 20(5). 11le Florida statute 

referenced by the manual includes penetration by a person 18 years of age or older of a person less than 12 years of 

age. Fla. StaL § 79 .. 1-.011 (2011). \Vyoming's statute provides funding when the pregnanc} is the result of "sexual 

assault as defined by W. S. 6-2-301:· Wyo. Stat. Ann. § 35-6-117 (2011). The staMe defines sexual assault as 

including "sexual abuse of a minor·' crimes. Wyo. Stat. Ann. § 6-2-30 I (2010) (""'Sexual assault' means any act 

made criminal pursuantto W.S. 6-2-302 through 6-2-319·'); Wyo. Stat. AtUl. ~ 6-2-314 through 317 (degrees of 

"Sc\":ual abuse of a minor.") 

~ Susan M. Kale. Statute Protecting Minors in a Specified Age Range from Rape or Other Sexual Acti'i'ity as 

Applicable to Defendant Minor WithinProtccted Age GrouP. l~ AL.R.5th ~56 (l99~). 

With tne 'aw on ylllJf' SHie-, great thfng" em,} p055/bil;' 
19 

Mr. NADLER. In their Committee report, my colleagues displayed 

their true intent with regard to the exception for rape, which is to 

remove Federal assistance to children and teenagers who are the 

victims of predators. They have not been as transparent about the 

overall intent behind this bill, but it is nonetheless clear: it is to 

end insurance coverage for medically indicated abortions for all 

women, whether or not they obtain their insurance on an exchange, 

and even if they use their own money to purchase the insurance. 

My colleagues in the majority believe that if you like your insurance coverage you should get to keep it, unless it is for choices that 

they don’t like. Then they have no qualms about taking your coverage away. That is the intended and likely result of this bill. Currently, the vast majority of insurance products cover abortion services. But as Professor Sara Rosenbaum of GWU’s School of Public 

Health testified in the last Congress, insurance companies will respond to the tax penalties this bill imposes by dropping coverage 

for abortions from all of their plans. This will have a significant effect on all women, not just lower-income women, who have long felt 

the brunt of Federal restrictions on their health care choices. 

My colleagues blithely assert that coverage will be available if in 

no other way through supplemental insurance policies. But, as Professor Wood, the witness invited by the minority, can explain, there 

is no evidence that such product lines are being developed. H.R. 7 

is not codification of existing law, nor is it just another attempt to 

enact the approach taken in the Stupak-Pitts Amendment to the 

House-passed Affordable Care Act. H.R. 7 is a radical departure 

from current tax treatment of medical expenses and insurance coverage. And it is neither justifiable nor necessary to prevent Federal 

funding of abortion. 

I yield back the balance of my time, and I look forward to hearing from our witnesses today. 

Mr. FRANKS. I thank the gentleman. And now I yield to the 

Chairman of the Committee, Mr. Goodlatte from Virginia, for an 

opening statement. 

Mr. GOODLATTE. Thank you, Mr. Chairman, for holding this 

hearing. However stark Americans’ differences of opinion can be on 

the matter of abortion generally, there has been long bipartisan 

agreement that Federal taxpayer funds should not be used to destroy innocent life. The Hyde Amendment, named for its chief sponsor, former House Judiciary Committee Chairman Henry Hyde, has 

prohibited the Federal funding of abortion since 1976, when it 

passed a House and Senate that was composed overwhelmingly of 

Democratic Members. It has been renewed each appropriations 

cycle with few changes over the last 38 years, supported by Congresses controlled by both parties and presidents from both parties. 

It is probably the most bipartisan, pro-life proposal sustained 

over a longer period of time than any other. As such, it warrants 

codification in the United States Code. H.R. 7, the No Taxpayer 

Funding for Abortion Act, would do just that by codifying the two 

core principles of the Hyde Amendment throughout the operations 

of the Federal Government, namely, a ban on Federal funding for 

abortions and a ban on the use of Federal funds for health benefits 

coverage that includes coverage of abortion. 
20 

During the time the Hyde Amendment has been in place, probably millions and millions of innocent children and their mothers 

have been spared the horrors of abortion. The Congressional Budget Office has estimated that the Hyde Amendment has led to as 

many as 675,000 fewer abortions each year. Let that sink in for a 

few precious moments. The policy we are discussing today has likely given America the gift of millions more children and consequently millions more mothers and millions more fathers, millions more lifetimes, and trillions more loving gestures and other 

human gifts in all their diverse forms. What a stunningly wondrous 

legacy. 

Thank you, Chairman Franks, for convening this hearing and 

thanks also to representative Chris Smith for sponsoring this vital 

legislation. I look forward to hearing from our witnesses today. 

However, I wanted to say just one more thing, Mr. Chairman. The 

gentleman from New York made reference to it being a radical departure from insurance policies. But the real radical departure here 

is the fact that now we will have, for the first time, Federal subsidies of health insurance policies in America. So that is the radical 

departure that we are facing, and that is why legislation is needed 

to address the fact that this will be a major substantial breach in 

the Hyde Amendment, the policy of the United States of America 

since 1976. 

And I thank you and yield back. 

Mr. FRANKS. And I thank the gentleman. 

Are there any other opening statements? 

Then I would now yield to Mr. Chabot, the gentleman from Ohio, 

for an opening statement. 

Mr. NADLER. Mr. Chairman. 

Mr. FRANKS. When he finishes his opening statement, we will 

consider unanimous consent. 

Mr. NADLER. I’m sorry. 

Mr. CHABOT. Thank you, Mr. Chairman. And thank you for your 

leadership on this issue for many years now. 

Protection of the most vulnerable among us, the unborn, is one 

of the most important and most solemn duties that we, I believe, 

as elected officials, undertake. Since Roe versus Wade was decided 

almost 41 years ago, this Subcommittee in particular has been the 

focal point in the effort to curb abortions nationally. Most notably, 

it was this Subcommittee that first considered and approved the 

Partial Birth Abortion Ban Act of 2003, which I had the honor to 

introduce, which later passed both Houses of Congress, was signed 

into the law by President Bush, and upheld as constitutional by the 

United States Supreme Court. But as thousands of Americans prepare to head to Washington in about 2 weeks for the annual March 

for Life in remembrance of the approximately 50 million American 

lives lost to abortions since Roe was decided back on January 22, 

1973, much more remains to be done. It is appropriate then that 

this Subcommittee again take the lead on legislation that will further limit the number of abortions performed in this country, especially with taxpayer dollars. 

The No Taxpayer Funding for Abortion Act introduced by our colleague, Chris Smith of New Jersey, would prevent any Federal 

funding of abortion, whether channeled through insurance plans or 
21 

paid directly to abortion providers. The bill reaches back through 

history and seeks to make the Hyde Amendment, as has been mentioned a number of times already, and the Hyde/Weldon Conscience 

Protection clause and several other pro-life amendments permanent under Federal law. I would note that this bill is a legislative 

effort to actually implement Executive Order 13535 that President 

Obama issued back on March 24 of 2010. And that order stated, 

in part, ‘‘It is necessary to establish an adequate enforcement 

mechanism to ensure that Federal funds are not used for abortion 

services, consistent with the longstanding Federal statutory restriction that is commonly known as the Hyde Amendment.’’ 

Mr. Chairman, the No Taxpayer Funding for Abortion Act provides that enforcement mechanism and it has overwhelming public 

support. 2011 CNN poll found 61 percent of the respondents opposed public funding for abortion. And a 2010 Quinnipiac poll 

showed 67 percent of the respondents opposed Federal funding of 

abortion. 

For these reasons, I would urge my colleagues to support this 

legislation. I thank you for holding this hearing today. Yield back. 

Mr. FRANKS. And I thank the gentleman. 

And I understand—go ahead. 

Mr. NADLER. Mr. Chairman, may I be recognized for a unanimous consent request? 

Mr. FRANKS. Without objection. 

Mr. NADLER. Thank you, Mr. Chairman. This Subcommittee received a request from the delegate from the District of Columbia, 

Eleanor Holmes Norton, to be allowed to testify on this bill. I understand that she has been told that her request would not be accommodated. I ask unanimous consent that our colleague be given 

5 minutes to address the Subcommittee on the matter that uniquely affects her constituents and only her constituents. That has been 

the common practice in the House. 

Mr. FRANKS. I would have to have raise objection. 

Mr. NADLER. I regret that the Chairman objects. I would hope 

that he would reconsider what is normally a fairly pedestrian request. This bill contains a provision that singles out the District of 

Columbia for additional restrictions on how it may spend its own 

local tax funds, not Federal funds. This is the equivalent of barring 

a State from making its own choices about how it wants to spend 

its own State funds. No Member would tolerate Congress telling 

their State or their town how to spend their own tax dollars, yet 

this bill would do just that to the citizens of our Nation’s capital. 

The exclusion of Delegate Norton, who is relegated to sitting in 

the audience today—and I want to welcome her and apologize for 

the manner in which she is being treated—is yet another example 

of an abuse of power. As I have said in the past, never in more 

than 20 years as a Member of this body have I seen a colleague 

treated as contemptuously as our colleague from the District of Columbia is being treated today. The gentlewoman from the District 

of Columbia is a Member of this body, and the people she represents are taxpaying American citizens. And yet this Committee 

can’t be bothered to take 5 minutes to hear our colleague, who will 

not even be permitted to vote on the bill. The District of Columbia 

is not a colony, it is part of the United States, and its people are 
22 

entitled to be treated with the same respect that we demand for 

the people we represent. 

Now, I know that it will be said by the Chairman, because he 

has said it to me, and there is no secret, that while the Democrats 

get one witness and if we want Eleanor—or the delegate from the 

District of Columbia to be our witness—we are free to do that. That 

is true. But that gives us a Hobson’s choice. Because Eleanor’s testimony would be only about the specifics of how this affects her district in a way unique to that district. And that would leave us no 

witness on the basic, broad import of the bill. On the other hand, 

if we have a witness on the basic, broad import of the bill, we don’t 

have the opportunity, or Eleanor doesn’t have the opportunity, to 

present the specifics of her district. 

It is a common courtesy. There is no rule in the House that prevents this. And again, I ask that this be reconsidered. And that the 

common practice that has normally been common practice in this 

House that when a matter specifically affects a Member’s district, 

she or he is given the opportunity to testify, be implemented here. 

Mr. FRANKS. I would join the gentleman in recognizing and welcoming Mrs. Norton, Ms. Norton to the audience today. And would 

remind the gentleman that it does indeed remain true that the minority was entirely free to invite Ms. Norton as their witness. In 

fact, I extended that invitation personally both to the Chairman 

and to the Subcommittee Chairman, Mr. Nadler. But they declined. 

Now, since the bill that is the subject of the hearing today only 

mentions the District of Columbia to make clear that funds appropriated by Congress for the District of Columbia shall be, of course, 

considered Federal funds, just like all other Federal funds, there 

was no reason for the majority to call Ms. Norton as a witness. Ms. 

Norton is, of course, welcome to submit any materials she would 

like for the hearing record, which will be made part of the record 

without objection. 

Mr. NADLER. Mr. Chairman. Mr. Chairman. With respect—what 

you just said is not completely accurate. This bill applies in a way 

that it applies nowhere else, to funds raised locally, by local tax 

funds in the District of Columbia. It does not apply to local tax 

funds raised in New Jersey, by the State of New Jersey, or anywhere else. Now, it does that by sleight of hand. It says, ‘‘The term 

’Federal government’ includes the government of the District of Columbia,’ for the purposes of this bill. For most purposes, the term 

’Federal Government’ never includes the District of Columbia.’’ So 

this bill has the unique effect of—for the District of Columbia 

only—telling them how they may use local funds raised by local 

sales taxes or income taxes or property tax in a way that is not 

done anywhere else. And, therefore, it is a unique application. And 

the common courtesy of the House demands that Ms. Norton be 

able to testify—not as our one witness but as a specific witness 

with respect to the application to her district. A courtesy that I 

have seen granted many, many times in this House. And in this 

Committee, for that matter. 

Mr. FRANKS. The gentleman’s objection is duly noted. And would 

just remind the gentleman that the District of Columbia is the seat 

of this government, according to the Constitution, and not a State. 

And consequently we will proceed. 
23 

Mr. NADLER. Mr. Chairman. 

Mr. FRANKS. Now let me introduce our witnesses. 

Mr. NADLER. Mr. Chairman, Mr. Chairman, Mr. Chairman. Mr. 

Chairman, you stated to me that the rules of the House are the 

rules of the Committee do not permit the seating of Ms. Norton as 

a witness other than our one witness. Could you please point out 

to me the rules of the House, the rules of the Committee that so 

indicate? 

Mr. GOODLATTE. Would the gentleman yield? 

Mr. FRANKS. Yes. 

Mr. NADLER. Would I yield? 

Mr. GOODLATTE. Mr. Chairman, I appreciate the circumstances, 

and I, too, welcome Ms. Norton’s presence here. But, last year, at 

the beginning of this Congress, I announced to the full Committee 

our policy regarding the participation of Members who are not a 

Member of the Judiciary Committee or its Subcommittees, and 

here is what I announced. 

‘‘I want to take the opportunity of this full Committee gathering 

to make Members aware of our new policy regarding participation 

in Subcommittee hearings. At the beginning of the Congress, I was 

asked whether Members who are not a Member of a Subcommittee 

would be allowed to participate in Subcommittee hearings. After 

giving it some thought, I have come up with what I think to be a 

reasonable solution that will allow our Members some level of participation without overly burdening the Subcommittees. A Member 

of the Judiciary Committee who is not a Member of a Subcommittee may attend a hearing and sit on the dais. That Member 

may also ask questions of the witnesses. But only if yielded time 

by an actual Member of the Subcommittee who is present at the 

hearing. I would ask that Members who intend to participate in 

this fashion let the majority staff know as far in advance of the 

hearing as possible so that we may prepare accordingly. It will remain the policy of the Committee that we do not allow Members 

to participate in our hearings if they are not Members of the Judiciary Committee.’’ Thank you, Mr. Chairman. 

Mr. NADLER. Would the gentleman yield? 

Mr. FRANKS. Gentleman from New Jersey has the time. There is 

really no time. At this point, I think—— 

Mr. NADLER. Gentleman from New Jersey? 

Mr. FRANKS. I’m sorry. Wherever you are from. New York. 

Mr. GOODLATTE. You mentioned New Jersey a couple times in 

your statements. 

Mr. FRANKS. I apologize to people in both the States. 

Mr. NADLER. Mr. Chairman, I would like to point out that that 

policy statement, A, is not a rule, but, B, refers to participation as 

a Member of the Committee or Subcommittee in asking questions. 

It does not refer to testifying before the Committee. And again it 

has been the practice in the House that we afford the courtesy— 

we would have been well finished with this by now if you had done 

that, by the way—to a Member whose district is uniquely affected 

to testify. We have had panels of only Members. There is nothing 

that says you can’t do this if you have the common courtesy to do 

it. 
24 

Mr. FRANKS. I would just suggest to you to remind the gentleman, the House rules provide for the participation in hearings 

only by Members of that Committee or Subcommittee. House Rule 

11 states, ‘‘Each Committee shall apply the 5-minute rule during 

the questioning of witnesses in a hearing until such time as each 

Member of the Committee who so desires has had an opportunity 

to question each witness.’’ Now I feel like I have—— 

Mr. NADLER. Mr. Chairman, again, that is questions, has nothing 

to do with testifying. 

Mr. FRANKS. A UC is required in order to allow non-Judiciary 

Member to participate. 

Mr. NADLER. No, I’m not talking about participating. 

Mr. FRANKS. I have given the gentleman ample time to state his 

point and respectfully—— 

Mr. NADLER. You are misstating my point. I am not talking 

about participating, I am not talking about asking questions. I am 

talking about testifying. It is an entirely different matter. 

Mr. GOODLATTE. Will the gentleman yield? 

Mr. FRANKS. Please. 

Mr. GOODLATTE. I want to reiterate the Committee’s position, 

and not just in this Congress but in previous Congresses as well 

is that non-members of the Committee do not sit on the dais. That 

was the gentleman’s subsequent request. His original request was 

that she be given 5 minutes to testify. 

Mr. NADLER. That is my request. 

Mr. GOODLATTE. That requires unanimous consent. That was rejected by the Chairman. And the Chairman made it very plain, and 

I will again, that she is very welcome to submit any materials that 

she would like to for the hearing record, which will be made part 

of the record without objection. 

Mr. FRANKS. Thank you. And now I would like to introduce—— 

Mr. NADLER. Can I ask unanimous consent in view of the rudeness—— 

Mr. FRANKS. Gentleman is not recognized. 

Mr. NADLER [CONTINUING]. Ask unanimous consent to—— 

Mr. FRANKS. Unanimous consent. 

Mr. NADLER. In view of the rudeness of the Committee, I ask 

unanimous consent to place the gentlewoman’s written statement 

into the record. I assume there will be no objection to that. 

Mr. FRANKS. Without objection. 

Mr. NADLER. Thank you. 

[The prepared statement of Ms. Norton follows:] 
25 

EL~ANOR HOLMES NORTON """"" .. ""'-

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...... <_ .... ""',"'- «-..0 __ "' __ , 

"OI __ U.'''''''' """" ......... """" --"'-.,_.,,"'"."'" _ __ .... r 

Chllir",,,,, Trenl FrankJ' denial of my requcst 10 teslify today, par1icularly in light of the 

foct that H.II.. 7, the No Ta.payer Furoding for Abortion Act, singlesoUl the locall.w and local 

furods of my dislrict, is an insult to the people I repl1:SCnt and a personal discourtesy from one 

Member 10 anolher. Members of Congress are usually afTorded the courtesy of testifying, 

especially when a bill uniquely afTect. theirdi.!rict. ! had hoped for some modicum offaimcss 

after the contro,'t"r;cy gen"nued by tl .. chaiml'"" denial last COlrgreu of my request to testifyon 

hi. 2O·weck D.C. abor1ion ban bill .nd 1,is de"ial of my request to teslifyon the No Tupayer 

" mlding for Abonion Act before that. Following that controversy, Chainn"n Franks indicated I 

could t«tify on hi. 20·week D.C. alxHtion ban bililhi. Cong,..,.., but I declined be<a .... he 

.'fliInded the hill to cover women thro!lghout lho: United States and no! only in D.C. 

! .trongly oppem this .wtcpinganti ,cooiec bill in it. enlirety, bllt I am ~p"ifiea ly 

compelled lodi",u,. tho: unique provisiM Ihat . inglesoUl the District ofCo]ulllbi •. SiJICC 

Republiea"s assumed tho: majorily in tho: 112lh Congreos, based on a platfonu of I""al control of 

I""al afTai"" thi~S\lbco,,'miliec has b«no~sed with dual objectives·· infringing on the 

Di.trict's right to self-govcmn1(;nl and intcrrcrin~ with the reproductive heallh of the District'. 

female residents, paniculafly it.low·irn:nmc wOmen. In Ihree )'Cars of Republican control of the 

House. this is tho: f(lurth bill considered by this .ubcommillee lMt would both violate "'y Ioc:al 

gaven,men!". righl to .. If.gav.mn1(;nt arid ham, it. female residenls. 

H.R. 7 would perman.ntly prohibit tho: Di.triet of Columbia govemm.nt, but 110 other 

1"".lgovemment, from using it. 1"",,1 fu"d. forabonion services fnr 10w·j,1(;OO'C women, 

uniquely de"ying tho: Districl go~mment the rightl""al arid SlIIte governments e •• ",i", to 

I'rolCCl the reproductive ngh" oftho:ir fcnlak: ",.idents. The District (If Columbia provision is an 

attempt to codify a I(cpublican-sponsored approprialions rider IMt prohibit> D.C. from :qrendinH 

its I""al funds 00 abortioll ""rvices for low-;noo",,, women. The bill .Iso allcmpt. to ",writ. 

history to pn:tcild tJoat Congn:s.did not pass the Home Rule Act of 1973. Under lho: liD",,, Rule 

Act. Con~dclcgalcd its Icgi.lative .uthorily over the I>i"riet to ""dected 1"".1 government, 

•• cepl foo- a s",.11 number ofenumemted exceplio" .. and the right to rcproduetive choke Wl'Is 

nol .mong lhoseexccrtion •. 11.11..7 appears to recogni"" lhat Coogress cannot legislate local 

law for a local govenm .. nt when itlorturously redefines II", term ~redcml govenlmenlH to 

include the tCrlll "District orColumbia govemmcnt" for plrrposr:s of_bonion. In panicular, lhe 

bill, subject to vcr)' limited exceptions, would ban abortion. in focilities,-,wn.d or operaled by 

""_ ..... - "'-'-'."*-"'-- w __ fi~ __ 

........ - --" .... 

,"'-_ _~c.'"' ..... .... -", 

--~ ---... -_ ---,,-... -

,." ....... ~_ ... _.u. 

-- --""-- r_ ... _ 

--.... 
26 

the federal govt'rmnenl, whkh, by dellnition in H.R. 7} would bRn aboliions in facilities oWl':etl 

or operated by the D.C. government 1'v1oreover} Ihe bill would prohibit a physician or other 

individual employed by the federal govemmenl from performing an abortion, which, by 

definition in H.R. 7, would prohibit a ]lhysician or other individual employed by the D.c. 

government fl·om pmiol'ming au abDrtion. The contortion!:) upon which this provi!-l.ion depends 

umlennine any ba.">is for its legitimacy. 

The District of Columbia is a local jurisdiction of free American citizens, nDt " colony of 

the Congl"<:ss. This bill is a mOJUlmtmt lo autocracy and a mockery of American democracy. Vy'e 

do not intend (0 let Republicans get away yl/i1h supporting democracy evel')7where on earth 

except in our own nation's capital. This bill goes many steps too far outside the realm of our 

democracy, Not only would this bill hat'l11 the women oftbe United States, it would ll111k" 

matkrs even ",ntse fur the womCI) of the Di;;tl'ict of Columbia by also eliminating part of the 

local governmenfs amhority to regulate its own affairs and spend its own funds. 

Republicans say they .sUppOlt limHing the r~derul govenllllent's po\ver and devolving that 

power to the states and lOeB!lties, This bill docs the opposite, It uses federall'0wer to sHale;' 

local authority from Ihe Dislrict of Columbia and its people, Republicans may not want to 

practice what they preach, but we do not inlend to allow them to violate their OWn principles at 

OUi' expense. 

2 
27 

Mr. FRANKS. And I will now introduce our witnesses. 

Helen Alvare ́ is professor of law at George Mason University 

School of Law. Professor Alvare ́ teaches and writes scholarship and 

public essays in leading newspapers concerning law and policy affecting women, children, and the family. She is co-founder of the 

grassroots organization, Women Speak for Themselves, and a regular consultant to the official council advising Pope Francis on matters considering women in the church and in the world. We welcome you, Mrs. Alvare ́. Ms. ALVARE ́. Thank you. 

Mr. FRANKS. Susan Wood is an associate professor of health policy at the George Washington University School of Public Health 

and Health Services, and the Director of the Jacobs Institute of 

Women’s Health. Prior to joining George Washington University, 

Professor Wood served as Assistant Commissioner for Women’s 

Health and Director of the Office of Women’s Health at the Federal 

Drug Administration. Welcome, Ms. Wood. 

Richard Doerflinger is the Associate Director of the Secretariat 

of Pro-Life Activities, United States Conference of Catholic Bishops, 

where he has worked for 33 years. He is also Adjunct Fellow in 

Bioethics and Public Policy at the National Catholic Bioethics Center in Philadelphia. We welcome you, Mr. Doerflinger. 

Each of the witnesses’ written statements will be entered into 

the record in its entirety. And I ask that each witness summarize 

his or her testimony in 5 minutes or less. To help you stay within 

that time, there is a timing light in front of you. The light will 

switch from green to yellow, indicating that you have 1 minute to 

conclude your testimony. When of the light turns red, it indicates 

that the witness’s 5 minutes have expired. 

Before I recognize the witnesses, it is the tradition of the Committee that they be sworn. So if you will please stand to be sworn. 

[Witnesses sworn.] 

Mr. FRANKS. You may be seated. 

Let the record reflect that the witnesses answered in the affirmative. 

And so I would now recognize our first witness, Ms. Alvare ́. And 

if you would please turn your microphone on before speaking. Yes, 

ma’am. 

TESTIMONY OF HELEN M. ALVARE ́ , PROFESSOR OF LAW, 

GEORGE MASON UNIVERSITY SCHOOL OF LAW 

Ms. ALVARE ́. Thank you very much. And I would like to thank 

the Committee for holding this hearing, which even 40 years after 

Roe versus Wade, is a sign of the power of a human rights dream 

that refuses to die. No matter how much abortion is legal, Americans, including American women especially, have never and will 

never make their peace with it. In my remarks today, I am going 

to address two points: First that neither American law makers, or 

citizens, especially women, understand abortion as a public good. 

And second, that abortion is not part of any women’s health agenda, even out of the lips of our own Federal Government in its own 

statements. 

In my first point, it’s understood by lawmakers and citizens that 

abortion is different from anything else the Federal Government 
28 

might fund. It’s unlike the use of the Federal budget, which is for 

things that support and promote human life versus death, versus 

insecurity and want. Our Supreme Court has said abortion is not 

like any other medical procedure. Perhaps this is because, as Justice Stevens and Ginsburg have acknowledged, some of these procedures are ‘‘brutal or gruesome,’’ or as Justice Kennedy in a majority has acknowledged, abortion kills. Finally, President Obama has 

opined that he wishes abortion to be rare and it’s a tragic matter. 

The State legislatures recognize the same thing and have passed 

a record number of laws restricting abortion in the last 2 years. 

Even the most strenuous supporters of legal abortion, Planned 

Parenthood, has acknowledged that there is, in their words, a baby 

growing inside a pregnant woman such that abortion ends her life. 

How disturbing, then, it is that supporters of abortion would continue to urge its funding while acknowledging that it’s killing. And 

the reason they claim is women’s health and rights, which is the 

800-pound gorilla in the room every time abortion is debated, including today, so let me turn to that. 

It’s no longer contestable that for decades—and particularly good 

RAND Corporation study I’ve cited shows this—women have been 

more pro-life than men, lesser educated, are more pro-life than the 

privileged, and the poor are more pro-life than the wealthy. This 

translates also to the matter of abortion funding, where we have 

the particularly disturbing data point that the well-off support 

abortion funding for the poor more than the poor support it for 

themselves. Investigations of women’s voting patterns turn up the 

same information. Women don’t vote because of abortion or in favor 

of abortion funding. 

Finally, when you look at Federal sources or documents that are 

engaging in promoting women’s health, you don’t find any mention, 

let alone promotion, of abortion or abortion funding. The Centers 

for Disease Control doesn’t even keep regular or required records 

on this. The Federal Government seems decidedly uncurious about 

abortion and women’s health. After Surgeon General Koop in 1989 

said studies on the relationship between these were insufficient 

and recommended long-term studies, the government never did 

them. 

I vividly recall my membership on the NIH council that addresses women’s health and asked for one question about abortion and 

women’s health to be put on studies and it never was. Despite the 

fact that increasingly, European studies, including meta analyses 

involving 900,000 women, are showing a relationship between abortion and mental health outcomes that are problems for women. In 

addition to the Federal Government’s having no firm ideas about 

the numbers for abortions or its impact on women, or a lack of curiosity about it, if you look at all the major Federal reports on 

women’s health issued from HHS, from NIH, from the White 

House, and they are all detailed in my testimony, what do you see 

in these? When the government is actually dispensing women’s 

health advice? No mention of abortion or abortion funding. Rather, 

frank acknowledgment that a woman is carrying, in their words, 

unborn babies. You see them addressing what the CDC identifies 

as the serious threats to women’s health, heart disease, stroke, 
29 

cancer; not abortion. You see them recommending that women 

avoid substances during pregnancy that could ‘‘damage your baby.’’ 

In conclusion, the Federal Government has collected no useful 

data about the relationship between abortion and women’s health. 

When it does offer advice, it recommends health care for women 

and her ‘‘unborn baby.’’ Credible studies are indicating distress for 

women following abortion. 

By themselves, these facts indicate how H.R. 7 serves women. 

But there’s another service H.R. 7 might perform. Regular squabbles over Federal funding for abortion too often take the place of 

debates about what women actually need and say they want. Debates about paid leave or Social Security benefits for women’s care 

work. Instead of debating ideas about how to end poor women’s 

cycle of poverty or non-marital childbearing, we continue to debate 

abortion in this country. It’s time, once and for all, to settle the 

matter of abortion funding across Federal legislation and move on 

to a real women’s agenda. Thank you. 

Mr. FRANKS. Thank you, Ms. Alvare ́. 

[The prepared statement of Ms. Alvare ́ follows:] 
30 

Testimony of Helen M. Alvart~ 

Professor of Law 

George Mason University School of Law 

before the 

Subcommittee on the Constitution and Civil Justice 

House Judiciary Committee 

January 9,2014 

Hearing on H.R. 7, No Taxpayer Funding for Abortion Act 

Thank you very much for this opportunity to testify. [ propose to outline why it 

serves the interests of American women for the federal government once and for 

all to remove itself from the business of abortion funding. 

Preliminarily, I would like to thank this subcommittee for holding such a hearing 

in this 41 st year after the Supreme Court overturned the abortion laws of the 50 

states. This bill shows the power of a dream of human rights that cannot be 

extinguished, no matter the amount of money or powers arrayed against it. 

Americans, including American women, have never made and will never make our 

peace with abortion. It is a feature of U.S. culture I hear admired in my work all 

over the world. Abortion is not a social good deserving of federal funding, let alone 

funding in the name of women's health or well-being. 

In my remarks today, I will address the following points: First, that neither 

American lawmakers nor citizens, especially women, understand abortion as a 

public good meriting funding. And second, that abortion is not a part of any 

genuine "women's health" agenda according to the federal government's own 

statements. 

On my first point: abortion is understood both by lawmakers and citizens to be 

different from all other projects, programs or procedures receiving federal 

funding. The federal budget is broadly devoted to national security, social safety 

nets, health care, veterans, federal retirement, safe food and drugs, the 

environment, and investments in education, scientific and medical research, and 

infrastructure. 1 These support and promote human life versus death, insecurity, 

and want. But abortion, in the words of our Supreme Court, is different. Even if 

the Court doesn't get its biology exactly right, it has said that "no other procedure 

involves the purposeful termination of potential human life."2 Even Supreme 

Court Justices explicitly supporting legal abortion acknowledge abortion's 

uniquely problematic nature. Justices Stevens and Ginsburg in Stenberg v. Carhart 

wrote that both dismemberment abortions and partial birth abortions are 

"equally" "gruesome" and "brutal," and that neither one "is more akin to 

1 Center for Budget and Policy Priorities. Where Do Our Federal Tax Dollars Go? at 

http://www.cbpp.org/cms I?fa=view&id=12 58. 

'Harris v. McCrae, 488 U.S. 297. 325 (1980). 

1 
31 

infanticide than the other."3 Justice Kennedy's majority opinion in the second 

partial birth abortion case, Gonzales v. Carhart, said abortion "extinguish[es]life"4 

and repeatedly wrote that abortion "kill [S]".5 Finally President Obama has opined 

that he wishes abortion to be "rare" and that it is a "tragic" matter.6 

Lawmakers at the state level witness similarly to the nation's refusal to make 

peace with abortion. According to the Guttmacher Institute, 205 restrictions on 

abortion were enacted in the States between 2011 and 2013, a record pace.? 

And even the most strenuous supporters of legal abortion -- even a leader of the 

huge abortion provider Planned Parenthood -- acknowledge that there is a baby 

growing inside a pregnant woman such that abortion ends a life.s Having been an 

observer of the abortion debate for decades, I want to highlight how newly 

disturbing it is when supporters of legal abortion cease denying that abortion 

destroys a human life, while continuing to demand legal abortion and abortion 

funding. They do so in the name of women's health and rights, which is the 800 lb. 

gorilla in the room every time abortion is legally debated, including here today. So 

let me turn to the matter of women's beliefs and women's health in relation to 

abortion. 

First, it is no longer contestable that women embrace the pro-life label and positions 

as much or more than men, and that poor women are somewhat more pro-life than 

the wealthier. A terrific and quite detailed study issued by the Rand Corporation in 

cooperation with the Packard, Hewlett and Rockefeller Foundations 9 -- after calling 

abortion an "enduringly divisive issue" in the American political landscape 10 __ 

reported stable attitudes on abortion over decades. According to their crosstabs, 

females survey a few percentage points more pro-life than men - a figure within the 

margin of error, but persistent over decades and therefore significant.ll Also the 

less educationally privileged are more pro-life than the privileged, sometimes by 

3530 U.S. 914, 946 (2000). 

4550 U.S. 124, 128 (2007). 

5550 U.S. 124, 129, 136, 151, 152, 154. 

6 Sheryl Gay Stolberg, On Abortion, Obama Is Drawn Into Debate He Hoped to Avoid, The New York 

Times. May 14, 2009, at http://www.nytimes.com/2009/05/15/us/politics/15abortion.html? 

7 Guttmacher Institute Media Center, More State Abortion Restrictions were Enacted in 2011-13 than 

in Entire Previous Decade, Jan. 2, 2014 at 

http://www.guttmacher.org/media/inthenews/2014/01/02/index.html. 

R See e.g. Faye Wattleton, How to Talk to your Child about Sexuality (New York: Doubleday Inc., 1986); 

Leslie Cannold, The Abortion Myth: Feminism, Morality and the Hard Choices Women Make 

(Connecticut: Wesleyan University Press, 1998), xvii-xviii. 

9 David M. Adamson, et aI., How Americans View World Population Issues: A Survey a/Public Opinion (A 

Rand Program, supported by the David and Lucille Packard, William and Flora Hewlett and 

Rockefeller Foundations: 2000); at 

http://www.rand.org/content/dam/rand/pubs/monographJeportsj2007jMR1114.pdf. 

10 Id. at 54. 

11 Id. at 57. 

2 
32 

margins of 33 or even 45%. And the poor are more pro-life than the wealthy by 16 

to 25%.12 

These differences persist on the question of abortion funding. To wit: a majority of 

the public opposes government funding for abortion; women oppose funding by a 

few percentage points more than men, the more educationally privileged support 

funding more than the less privileged; and the well-off support abortion funding 

for the poor more than the poor favor it for themselves,13 this last a particularly 

unpleasant fact. 

Investigations of what drives women's voting also fail to turn up any special 

female support for abortion14 or abortion funding. Women vote on the economy, 

jobs, and general social welfare spending, along with their perception of which 

candidate really cares about the people she or he will serve.15 If you glance at the 

League of Women voters website, you will find it highlighting voting rights, gun 

safety, campaign finance and the environment,16 not abortion, not abortion 

funding. 

Finally, when you look at federal sources and documents and experts engaging 

and promoting women's health, you notice two things. First, the federal 

government is decidedly uncurious about the role abortion plays respecting 

women's health. The Centers for Disease Control ("CDC") doesn't even require 

mandatory reporting by the states and consequently doesn't have complete or 

standardized data on abortion,17 In 1989, Surgeon General Koop concluded after a 

complete review ofthen-existing material on the effect of abortion on women's 

health, that available studies were insufficient. He recommended that 

"consideration be given to going forward with an appropriate prospective 

12ld. at 58. 

13 ld. at 59-60. 

14 Karen Kauffmann, Unconventional Wisdom: Facts and Myths about American Voters, 106-107 

(2008). 

15 Libby Copeland, Why Do Women Vote Differently Than Men? Slate. com, Jan. 4, 2012, at 

http:(fwww.slate.com/articles/double x/doublex/2012101/the gender gap in politics why do 

women vote differently than men .html; Kira Sanbonmatsu, The Quest for Women's Votes in 2012, 

Scholars Strategy Network, Aug. 2012, at 

http: (fwww.scholarsstrategynetworlcorg/sites/defaultlfiles/ssn basic facts sanbonmatsu on th 

e gender gap.pdf (which also reported that "[hlot-button reproductive issues like abortion do not 

drive the gender gap in voting because most men and women hold parallel attitudes on these 

issues."). 

16 http://www.lwv.org/our-work (viSited week of Jan 1-8,2014). 

17 Centers for Disease Control, CDC's Abortion Surveillance System FAQs, at 

http://www.cdc.gov/reproductivehealth/DataStats/Abortion.htm ('"Are states required to report 

their abortion statistics to CDC? No, states and areas voluntarily report data to CDC for inclusion in 

its annual Abortion Surveillance Report. CDC's Division of Reproductive Health prepares surveillance 

reports as data become available. There is no national requirement for data submission or 

reporting."). 

3 
33 

study."18 But the government has not undertaken such a project, to this day. I 

vividly recall during my membership on the National Advisory Child Health and 

Human Development Council in the early 2000s asking personally and repeatedly 

for even one question about abortion on long-term surveys about women's health, 

only to be continually put off, despite abortion then and now, being performed 

upon women about 3300 times each day ofthe week. This lack offederal curiosity 

persists despite increasing evidence from well-regarded European studiesfollowing hundreds ofthousands of women for their entire lives19 -- and a more 

recent meta-analysis in the British Journal of Psychiatry involving studies 

comprehending nearly 900,000 women, showing that abortion is associated with 

significantly increased post-abortion risk of several problematic mental health 

outcomes.20 

Second on the matter of women's health and abortion, in addition to the federal 

government's having no firm idea about total numbers of abortions, or abortion's 

impact on women's health, and no real curiosity on the matter, it also appears that 

when the federal government is acting seriously on behalf of women's health - via 

women's health initiatives for example from the National Institutes of Health 

("N IH") or the White House, or the Department of Health and Human Services - that 

it does not raise the subject of any health "need" for abortion, let alone abortion 

funding. Take a look, for example, at recent, significant federal initiatives on 

women's health, like NIH's strategic plan for women's health and sex differences 

research for 2010-2020,21 or the Department of Health and Human Services' Office 

on Women's Health report entitled A Lifetime of Good Health: Your Guide to Staying 

Healthy,22 or HHS' websites for women and girls which it calls "comprehensive" 

regarding women's or girls' health,23 or HHS' Healthypeople 2020 initiative, 

providing "science-based, 10-year national objectives for improving the health of all 

1H Letter from Surgeon General C. Everett Koop to President Ronald Reagan. Jan 9. 1989, reprinted at 

http://www.nriestsforlife.org/postabortion/89-01-09Icoop.htm. 

19 See, e.g. David et al., Postpartum and Postabortion Psychotic Reactions, 13 Family Planning 

Perspectives 88. 89(1981); Gissler et aI.. Suicides after Pregnancy in Finland, 1987-94; Register 

Linkage Study, 313 British MedicalJournal, 1996; 313: 1431-34. 

20 Priscilla K. Coleman, Abortion and mental health: quantitative synthesis and analysis of research 

published 1995-2009, 199 The Brit]. of Psychiatry 180 (2011) (moderate to highly increased risk of 

mental health problems after abortion); Morgan etal., Letters, 314 British Medicaljournal903 

(1997). Another study supporting the former explanation was published by L.G. Peppers, "Grief and 

Elective Abortion: Implications for the Counselor," in Kenneth j. Doka, ed., Disenfranchised Grief 

Recognizing Hidden Sorrow (MD: LeXington Bool<s 1989).135 (Grief measurements of the same 

women pre- and post-abortion showed that significantly different groups of women suffered high 

grief reaction scores at the two points in time.). 

21 Office of Research on Women's Health, National Institutes of Health. Moving into the Future With 

New Dimensions and Strategies: A Vision for 2020 for Women's Health Research (2010) (NIH 

Publication 10-7606), at 

http://orwh.od.nih.gov Iresearch IstrategicplanlORWH StrategicPlan2020 Voll.pdf. 

22 U.S. Dept. of Health and Human Services' Office on Women's Health, A Lifetime of Good Health: Your 

Guide to Staying Healthy, at http://womenshealth.gov Ipublications lour-publications llifetime-goodhealth/lifetimegoodhealth-english.pdf. 

"Id. at 2; www.womenshealth.gov; www.girlshealth.gov. 

4 
34 

Americans,"24 or the White House Council on Women and Girls' report Women in 

America: Indicators o/Social and Economic Well-Being,25 What do we find in these 

many lengthy and comprehensive compilations of women's health needs, and actual 

health advice to American women from their federal government? 

We find frank acknowledgement that a pregnant woman is carrying an "unborn 

baby" and reference to human life beginning at conception,26 We find a lot of advice 

about what the CDC identifies as the leading threats to women's health,27 threats 

like heart disease, stroke, and cancer. We find advice and promises regarding future 

research upon diseases women suffer more or differently than men,28 We find 

attention to the highlighted health problem of women's infertility or difficulties 

carrying a pregnancy to term, as well as attention to avoiding substances during 

pregnancy that could "damage '" your baby," 29 

In conclusion, the federal government has collected no dispositive data about the 

relationship between abortion and women's health, When it addresses women's 

health priorities, it rather offers advice to women about caring for their unborn 

child, and says nothing about abortion as health care, Credible studies indicate an 

association between abortion and mental distress for some women, There is no 

empirical basis therefore, upon which federal lawmakers can make the claim that 

women's health is promoted by funding abortion, By themselves, these facts 

indicate how H,R, 7 serves American women, But there is another service for 

women H,R, 7 might well perform, Regular squabbles over federal funding for 

abortion across myriad pieces of legislation seem to have taken the place of an 

actual legislative agenda for women's actual needs, Instead of debating policies 

supporting women's care work, or work/family balance, poliCies addressing paid 

leave or social security benefits -- instead of debating ideas about enabling poor 

women especially to break the cycle of poverty and nonmarital childbearing--

Congress continually debates abortion funding, It is time once and for all to settle 

the matter of federal funding for abortion, and move on to a real women's agenda, 

24 www,healthypeople.gov(202 0 (defaul taspx, 

25 While House Council on Women and Girls, Women in America: Indicators of Social and Economic 

WeI/-Being (2011). at www.whitehouse.gov(administration(eop (cwg(data-on-women #Population. 

'" U. S. Department of Health and Human Services. Office on Women's Health, A Lifetime of Good 

Health: Your Guide to Staying Healthy, 35-36 (hereafter "Staying Healthy"), at 

http://womenshealth.gov /publications/our-publications/lifetime-good-health/lifetimegoodhealthenglish.pdf. 

27 Centers for Disease Control, Leading Causes of Death by RacejEthnicity, All Females - United States 

2010, at hltp: ((www.cdc'~()v /womenjlcod(2010(WomenRace 2010,pdf. 

28 Office of Research on Women's Health, National Institutes of Health, Moving into the Future With 

New Dimensions and Strategies: A Vision for 2020 for Women's Health Research (2010), at 

http://orwh,od,nih.gov (research (strategicp Ian (0 RWH StrategicPlan2 02 0 Voll.pdf, 

'" U,S, Dept of Health and Human Services, Staying Healthy, at 34, 36. 

5 
35 

Mr. FRANKS. And I now recognize our second witness, Ms. Wood. 

TESTIMONY OF SUSAN FRANKLIN WOOD, ASSOCIATE PROFESSOR OF HEALTH POLICY, DIRECTOR, JACOBS INSTITUTE 

OF WOMEN’S HEALTH, SCHOOL OF PUBLIC HEALTH AND 

HEALTH SERVICES, GEORGE WASHINGTON UNIVERSITY 

Ms. WOOD. Thank you, Mr. Chairman. And gentlemen of the 

Committee. I want to thank you for being able to present remarks 

on the bill before us today, H.R. 7. I need to point out that this 

sweeping legislation would affect nearly all women in this country 

and would do significant harm to many, especially those women 

and families who are struggling to make ends meet. While the bill 

is cloaked in the language of taxpayer rights and Federal appropriations, a close examination of its true impact reveals an attempt 

to interfere with a women’s personal decision making by denying 

women insurance coverage for abortion care. And every woman deserves coverage for basic health care, including contraception, maternity care, and abortion coverage, should she need it. 

This legislation reaches far beyond the already troublesome Hyde 

Amendment, beyond the onerous restrictions that were proposed in 

the Stupak Amendment, in the Affordable Care Act, and beyond 

the restrictions that actually were enacted into the ACA by the 

Nelson Amendment. It would virtually eliminate abortion coverage 

from the private insurance market and impose unprecedented new 

tax burdens on business that want to offer abortion coverage to 

their employees. 

Moreover, it would provide exceptions only for rape and incest, 

or for conditions that put a woman in danger of death. Congress 

should reject this harmful and overreaching piece of legislation. 

Now, those who oppose abortion have tried and failed to make 

it illegal. So instead they have worked to make it almost impossible 

to obtain. Indeed some object to even insurance company of contraception, which is the most effective way to prevent unplanned pregnancy and reduce the need for access to abortion care. This bill is 

the most recent attempt. And it is not enough that they have tried 

to deny abortion coverage to the women who qualify for Medicaid. 

It is not enough that this denies coverage to veterans, Federal employees, Native American women, disabled women, and women who 

participate in other Federal insurance plans and programs. 

No, to cut off access to affordable abortion care for the rest of the 

women in the country, we need this bill as the final piece of the 

puzzle. If Congress enacts this bill, you are taking away coverage 

from women who live in places where private insurance plans that 

include abortion coverage are sold today. And you would take away 

a woman’s ability to use her own health savings account to cover 

her medical costs related to abortion care, an unprecedented insertion of abortion politics into tax policy. 

Historically, the vast majority of insurance plans have typically 

covered abortion services. It’s no coincidence, it’s where health policy—good health policy meets good financial policy and meets a 

woman’s health care needs. In our analysis of both the Stupak and 

Nelson Amendments, which I would like to enter into the record, 

we raise the concern that Congress would create a chilling effect 

which would lead many more women to lose abortion coverage. 
36 

Further changing the tax benefits for employees and for employers 

providing health coverage as proposed in H.R. 7 could create a tipping point in the nature of insurance whereby women lose abortion 

coverage because insurers may no longer provide plans that include 

it. 

Since approximately 60 percent of women of reproductive age, 37 

million women, get their health care coverage through private insurance, this legislation could have a far-reaching effect. It represents more than just meddling in their personal decisions, by 

making it unaffordable, it effectively bans abortion for some 

women. And while it may not seem like a big expense to a Member 

of Congress, in these tough financial times for many people, abortion care costs more than their monthly rent, putting it out of 

reach for their family’s pocketbook. 

Moreover, cutting off access to abortion has profoundly harmful 

effects on the public health. Based on the experience with the ban 

that has long been imposed on women who qualify for Medicaid, we 

know that some who seek an abortion are forced to carry a pregnancy to term, due to lack of coverage and cost. And we also know 

that births that result from unintended or closely spaced pregnancies are associated with delayed prenatal care, premature birth, 

low birth weight, and other negative health effects on the children. 

We know that a woman who wants to get an abortion but is denied 

it is less likely to have a full-time job and twice as likely to be a 

victim of domestic violence. Denying abortion care to these women 

who are least able to afford out-of-pocket medical expenses will further exacerbate existing health disparities. 

And although most of the women affected by these bans will still 

find a way to end their pregnancies. Many are forced to delay their 

procedures for 2 or 3 weeks or longer while they pull together 

enough money to pay for the care they need. By banning abortion 

coverage for even more women through private insurance, as this 

bill would do, Congress would expand the number of women and 

families struggling with budget dilemmas, including many middleclass families still recovering from the great recession. And even 

with the primary assistant provided by the Affordable Care Act, 

families have to stretch their budgets to pay for health insurance, 

and women are more likely to fall into poverty if they are not able 

to get the abortion they need. 

Importantly, the H.R. 7 also extends very narrow exceptions for 

abortion coverage now allowed for Medicaid. If private plans decided to continue to provide such coverage, both they and the IRS 

would need to evaluate coverage decisions to ensure that they were 

in compliance. Neither the private market nor the IRS is suited for 

such determinations about a woman’s risk of death or determination of rape or incest. Women potentially could be required to provide evidence of rape or incest to the insurer or to the IRS as part 

of a claim. 

Furthermore, health conditions, such as diabetes, hypertension, 

epilepsy, or others would not necessarily fit the definition of placing a woman in danger of death, but could have potentially serious 

consequences for her health. Health insurance now routinely covers 

the range of pregnancy and other health services that may be needed by the individual woman. But by denying abortion coverage, it 
37 

would not only change the current insurance women have, but 

would put some women’s health at risk. 

In conclusion, this bill would impose a sweeping and unprecedented ban on abortion coverage with far-reaching and harmful 

consequences for women’s health and for their economic security. 

When it comes to the most important decision in life, such as 

whether to become a parent, it is vital that a woman be able to 

consider all of her options, no matter what her income or source 

of insurance. It makes sense that health insurance covers the 

whole spectrum of women’s health needs, including birth control, 

abortion, maternity care. Because when people can plan if and 

when to have children, it’s good for them, it’s good for their families, and it’s good for society as a whole. Thank you. 

[The prepared statement of Ms. Wood follows:] 
38 

United States House of Representatives 

Committee on the Judiciary 

Subcommittee on the Constitution and Civil Justice 

Hearing on the No Taxpayer Funding for Abortion Act 

Susan Franklin Wood 

Associate Professor of Health Policy 

Director, Jacobs Institute of Women's Health 

School of Public Health and Health Services 

George Washinb>ton University 

January 9, 2014 

Mr. Chairman and Distinb'llished Members of this Subcommittee: 

Thank you for the opportunity to appear before you today to present remarks on the "No 

Taxpayer Funding for Abortion Act." 

This bill is a sweeping piece oflegislation that would affect nearly all women in this country and 

would do signitlcant hanll to many, especially those women and families who are struggling to 

make ends meet. While the bill is cloaked in the language of taxpayer rights and federal 

appropriations, a close examination of its true impact reveals a mean-spirited attempt to interfere 

with a woman's personal decision-making by denying women insurance coverage for abortion 

care. Every woman deserves coverage for basic health care, including contraception, maternity 

care and abortion services should she need it. 

This legislation reaches far beyond the already troublesome Hyde Amendment, which as you 

know is an annual appropriations measure that withholds abortion coverage for women enrolled 

in Medicaid unless their life is endangered by a pregnancy or the pregnancy results from rape or 

incest. And it reaches beyond the onerous restrictions that were proposed in the Stupak 

Amendment to the Affordable Care Act (ACA) and beyond the restrictions enacted into the ACA 

by the Nelson Amendments. In addition to all of those harsh measures, it would also virtually 

eliminate abortion coverage from the private insurance market and deny tax credits to small 

businesses that want to offer abortion coverage to their employees. Moreover, it would provide 

exceptions only for rape and incest or for conditions that put a woman in danger of death. 

Congress should reject this harmful and overreaching piece oflegislation. 

The Bill Would Ban Abortion Coverage for Virtually All Women in this Country, 

Including Those in the Private Insurance Market 

Those who oppose abortion have tried and failed to make it illegal, so instead they have worked 

to make it almost impossible to obtain. Indeed, some object even to insurance coverage of 
39 

contraception, the most effective way to prevent unplanned pregnancy and reduce the need for 

abortion. 

One of the ways they have accomplished this goal of limiting access to abortion is to make it 

unaffordable This bill is their most recent attempt to place affordable abortion care out of reach 

for even more women. 

For those who would make abortion illegal, it is not enough that they have tried to deny abortion 

coverage to the 9.7 million women who are currently enrolled in Medicaidl and up to 4.6 million 

more women who will become subject to the original abortion coverage ban if all the states take 

up the Medicaid expansion under the ACA 2 

It is not enough that they have denied coverage to women who participate in other federal 

insurance plans and health programs, making them pay out-ot:pocket for abortion care. This 

includes service women, veterans, and military dependents; federal employees; women in federal 

detention; Native American women; adolescents in the Children's Health Insurance Program; 

disabled women enrolled in Medicare; and Peace Corps volunteers. 

The Impact on the Private Insurance Market 

No, in order to cut off access to affordable abortion care for the rest of the women in the country, 

abortion opponents need this bill as the tlnal piece of the puzzle. TfCongress enacts this bill into 

law, you are taking away coverage from women who live in places where private insurance plans 

that include abortion coverage are sold today. And you would take away a woman's ability to 

use her own health savings accounts to cover her medical costs related to abortion care - an 

unprecedented insertion of abortion politics into tax policy. 

Historically, the vast majority of insurance plans have typically covered abortion services. It is 

no coincidence-it's an instance where good health policy meets good tlnancial policy to 

address a woman's health care needs. Tn our analysis of both the Stupak and Nelson 

amendments, we raised the concern that Congress would create a chilling etfect on plans by 

creating burdensome accounting requirements and would lead many more women to lose 

abortion coverage. Adding to the restrictions already in place in the ACA, further changing the 

tax credits for individuals and for small employers providing health care coverage could lead to 

signitlcant changes in the health insurance coverage that women have had, potentially creating a 

"tipping point" in the nature of health insurance whereby women lose abortion coverage 

entirely. 3 It is the nature of health insurance that insurers may no longer provide plans that 

'Guttmacher Institute, Unpublished tabulations using the 2012 and 2013 Current Population Survey (CPS), March 

Supplements. 

2 Kenney G, et. al. "Opting in to the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could 

Gain Health Insurance Coverage?" Urban Institute, Timely Analysis of Immediate Health Policy Issues (Summer 

2012). A va i la ble at: http:(/www.urban.org/UploadedPDF/412630-opting-in-med ica id. pdf. 

3 Rosenbaum S, Cartwright-Smith L, Margulies, R, Wood S, and Mauery D. An Analysis of the Implication of the 

Stupak/Pitts Amendment for Coverage of Medically Indicated Abortions. (George Washington University School of 

Public Health and Health Services, Dept of Health Policy, 2009). 
40 

include coverage which would come with burdensome reb'lliatory requirements such as proposed 

in H.R. 7. Since approximately 60% of women of reproductive age, or 37 million women, get 

their health coverage through private insurance, this legislation could have a profound effect. 4 

This Bill Would Affect All Women, And Especially Hurt the Most Vulnerable Women 

This bill represents more than just meddling in women's personal decisions; by making abortion 

care unaffordable, it will etTectively ban abortion for some women. While it may not seem like a 

big expense to a Member of Congress, in these tough tlnancial times, for many people, abortion 

care costs more than their monthly rent, putting it out of reach for their family's pocketbook. 

Studies show that most Americans do not have enough savings to cover a financial emergency, 

which means they have to borrow, sell or pawn personal items, or divert money from another 

financial obligation to cover emergencies such as an unexpected health care need. 5 

Moreover, cutting off access to abortion has profoundly harmful effects on the public health. 

Based on the experience with the ban that has long been imposed on women who qualify for 

Medicaid, we know that one in four low-income women who seek an abortion are forced to carry 

a pregnancy to term due to lack of coverage and cost. 

Births which result from unintended or closely spaced pregnancies are associated with 

adverse maternal and child health outcomes. These include delayed prenatal care, 

premature birth, low birth weight, and other negative health effects for children. 

A woman who wants to get an abortion but is denied is less likely to have a full-time job 

and twice as likely to be a victim of domestic violence." 

Women with lower socioeconomic status - in other words, those who are least able to 

afford out-of-pocket medical expenses - already experience disproportionately high rates 

of adverse health conditions. Denying them access to abortion care will only exacerbate 

existing health disparities. 

Although most of the women atTected by these bans still tlnd a way to end their pregnancies, 

they often do so at great personal cost. Many are forced to delay their procedure for as long as 

tV\lO to three weeks while they pull together enough money to pay for the care they need, with the 

price and risks of the procedure increasing the longer they wait. By banning abortion coverage 

for even more women through private insurance, as this bill would do, Congress would expand 

4 Guttmacher Institute, Unpublished tabulations using the 2012 and 2013 Current Population Survey (CPS), March 

Supplements. 

5 Center for Reproductive Rights, "Women's Reproductive Rights in the United States: A Shadow Report" (June 

2006). Available at http://www2.ohchr.org/english/bodies/hrc/docs/ngos/CRR.pdf. See also Biggs et al., 

"Understanding why women seek abortions in the US." BMC Women's Health, 13:29 (2013). Available at 

httpJ/www.ansirh.org/wp-content/uploads/2013/06/biggs gould foster whi7-2013.pdf. 6 Biggs et aI., "Understanding why women seek abortions in the US." BMC Women's Health, 13:29 (2013). Available 

at http://www.ansirh.org/wp-content/uploads/2013/06/biggs gould foster whi7-2013.pdf. 
41 

the number of women and families struggling with unsolvable budget dilemmas, including many 

middle class families still recovering from the Great Recession. 

In the current insurance market, coverage denial policies such as the ones proposed in this bill 

can have a serious and detrimental effect on people's financial security. Even with the premium 

assistance provided by the Affordable Care Act, there are individuals and families who have to 

stretch their budgets to pay for health insurance, leaving no margin to pay for medical costs that 

are not covered by their plans. When policymakers deny abortion coverage and make these 

health services unaffordable, it can jeopardize a family's financial security. When a woman is 

living paycheck to paycheck, denying coverage for an abortion can push her deeper into poverty. 

Indeed, studies show that a woman who seeks an abortion but is denied is three times more likely 

to fall into poverty than one who is able to get an abortion. 7 

Limited exceptions only for rape, incest or danger of death 

HR. 7 limits abortion coverage to the current exceptions in Medicaid coverage: in cases of rape, 

incest or if the woman is in danger of death. These narrow exceptions, now in place for women 

covered by Medicaid in all but 15 states, would be further extended into the private market. 

Though plans could follow the coverage exemptions in Medicaid, it would be simpler for them to 

exclude abortion coverage in all circumstances. If choosing to cover the exceptions, then both 

private health plans and the IRS would need to make determinations of the nature of plan 

coverage as well as evaluate coverage decisions to ensure that they were in compliance. Neither 

the private market nor the IRS is suited for such determinations about a woman's risk of death or 

determination of rape or incest. Women potentially could be required to provide evidence of 

rape to the insurer as part of a claim. 

The need for access to abortion to protect the health of women, not just when they are in danger 

of imminent death, is critical. As stated by the American Congress of Obstetricians and 

Gynecologists when the House considered this legislation during the 112Lh Congress, this bill 

"would leave women whose health is seriously threatened by their pregnancies with limited 

access to the care their doctors recommend to protect their health." Health conditions, such as 

diabetes, hypertension, epilepsy or others would not necessarily fit the definition of placing a 

woman in "danger of death," but could have potentially serious consequences for her health. 

Health insurance currently routinely covers the range of pregnancy care and other health services 

that may be needed by any individual woman. By denying abortion coverage, this would not 

only change the current insurance women have, but would put some women's health at risk. 

In conclusion, this bill would impose a sweeping and unprecedented ban on abortion coverage, 

with far-reaching and harmful consequences for women's health and economic security. When it 

comes to the most important decisions in life, such as whether to become a parent, it is vital that 

a woman be able to consider all her options--including an abortion-- no matter what her income 

or source of insurance. It makes sense that health programs cover the whole spectrum of 

women's reproductive health needs, including birth control, abortion, and childbirth, because 

when people can plan if and when to have children, it's good for them and for society as a whole. 

7 ,d. 
42 

Mr. FRANKS. Now recognize our third and final witness, Mr. 

Doerflinger. Please turn on your microphone, sir. 

TESTIMONY OF RICHARD M. DOERFLINGER, ASSOCIATE DIRECTOR, SECRETARIAT OF PRO-LIFE ACTIVITIES, UNITED 

STATES CONFERENCE OF CATHOLIC BISHOPS 

Mr. DOERFLINGER. Thank you, Mr. Chairman, for this opportunity to voice the support of the U.S. Conference of Catholic 

Bishops, for H.R. 7, the ‘‘No Taxpayer Funding for Abortion Act.’’ 

This bill will write into permanent law a policy on which there’s 

been strong popular and Congressional agreement for over 35 

years: the Federal Government should not use its funding power to 

support or promote abortion. This principle has been embodied in 

the Hyde Amendment, and numerous other provisions governing a 

wide range of domestic and foreign programs. It has consistently 

had the support of the American people. Women oppose federally 

funded or federally mandated abortion coverage as strongly as men 

or more so. Low-income Americans oppose it more strongly than 

the affluent. 

And even courts insisting on a constitutional right to abortion 

have said this alleged right ‘‘implies no limitation on the authority 

of a State to make a value judgment favoring childbirth over abortion, and to implement that judgment by the allocation of public 

funds.’’ In 1980, the U.S. Supreme Court said the Hyde Amendment is an exercise of ‘‘the legitimate congressional interest in protecting potential life,’’ adding: ‘‘Abortion is inherently different from 

other medical procedures because no other procedure involves the 

purposeful termination of a potential life.’’ 

In other words, the Federal Government is perfectly within its 

moral and legal rights, to say that abortion is not basic health care. 

The only mistake in the quote from the Supreme Court is its use 

of the phrase ‘‘potential life.’’ That has no clear biological or medical meaning. In fact, unborn children are actually alive until they 

are made actually dead by abortion. More recently, the Supreme 

Court has said simply that the government may express ‘‘profound 

respect for the life of the unborn’’ by regulating abortion. 

So the Supreme Court and the actions of Congress simply contradict Dr. Wood’s testimony. She’s talking about the government 

‘‘meddling,’’ ‘‘interfering,’’ ‘‘denying,’’ ‘‘making women lose’’ coverage—setting aside the fact that the vast majority of women don’t 

want abortion in their coverage, so saying you are losing the coverage is like saying you’re losing a tumor—‘‘banning’’ abortion, 

‘‘forcing.’’ This is simply a governmental decision to put its support 

behind the life-affirming options for mother and child and not to 

subsidize the lethal option. 

Congress’s policy has been consistent for decades, but its implementation in practice has been piecemeal, confusing, and sometimes inadequate. Gaps or loopholes have been discovered in its 

patchwork of provisions over the years, highlighting the need for 

a permanent and consistent policy across the Federal Government. 

In 2010, Congress passed major health care reform legislation, 

which, as has been mentioned, puts Federal funds into an entirely 

new part, a much larger part of the health care system for the first 

time. And that legislation has, as my longer statement details, at 
43 

least four different policies on abortion funding, ranging from a ban 

on such funding in one section, on school-based clinics, to a potential mandate for such funding in another. These problems have 

arisen partly because various sections of the Affordable Care Act 

not only authorize but appropriate their own funds, thus bypassing 

the Hyde amendment and similar longstanding appropriations provisions. 

Recent developments underscore a need to correct the abortion 

funding problems in the Affordable Care Act. In 2010, the Act was 

used to approve direct Federal funding of elective abortion coverage 

in the State high risk pool program until that was uncovered by 

pro-life groups. 

As State health exchanges have begun to operate, Americans are 

finding it difficult to find plans without abortion coverage or even 

to get clear answers as to which plans those are. And they are discovering that despite public assurances to the contrary, they may, 

in fact, be forced by the government to subsidize other people’s 

abortions as a condition for obtaining the health care their families 

need. 

Congressional employees and Members of Congress are finding 

that if they want a plan without abortion in D.C., they only have 

a choice of nine out of 120—more than 120 plans. Members and 

staff of Congress, previously assured they are free to choose from 

a full range of plans without abortion, are being deprived of that 

freedom or having it greatly narrowed—contrary, in our view, to 

longstanding Federal law. We have submitted comments to the 

Federal Government on that point. 

If a bill like H.R. 7 had been enacted before the health care reform debate began, that debate would not have been about abortion 

funding. A major obstacle to support by Catholics and other prolife Americans would have been removed, and the legislation would 

not have been so badly compromised by provisions that place unborn human lives at great risk. 

H.R. 7 would prevent problems and confusions on abortion funding in future legislation. Federal health bills—and I think a lot of 

us would be relieved at this—could be debated in terms of their 

ability to promote the goal of universal health care, real health 

care, instead of being mired in debates about one lethal procedure 

that most Americans know is not truly health care at all. 

Finally, in our view, and we’d be happy to discuss this, H.R. 7 

does not eliminate private coverage for abortion, but specifically allows it when purchased without Federal subsidy. And it does not 

create an unprecedented policy of denying tax benefits to abortion. 

The Affordable Care Act already broke that precedent by creating 

a system of tax credit subsidies for coverage, which the Act itself 

referred to as Federal funding. My prepared text provides additional details, and I’d be happy to answer questions. Thank you. 

[The prepared statement of Mr. Doerflinger follows:] 
44 

Testimony of Richard M. Doerflinger 

on behalf of the 

United States Conference of Catholic Bishops 

before the 

Subcommittee on the Constitution and Civil Justice 

House Judiciary Committee 

January 9, 2014 

Hearing on H.R 7, No Taxpayer Funding for Abortion Act 

T am Richard M. Doerflinger, Associate Director of the Secretariat of Pro-Life Activities 

at the United States Conference of Catholic Bishops (USCCB). I want to thank this 

Subcommittee for allowing us to present our views in support of H.R. 7, the No Taxpayer 

Funding for Abortion Act. 

A Permanent Ban on Abortion Funding: Long Overdne 

H.R. 7 will write into permanent law a policy on which there has been strong popular and 

congressional agreement for over 35 years: The federal government should not use tax dollars to 

support or promote elective abortion.! 

Since 1976 this principle has been embodied in the Hyde amendment to annual 

appropriations bills funding the Department of Health and Human Services (HHS), and in 

numerous similar provisions governing a wide range of domestic and foreign programs. It has 

consistently had the support of the American people. For example, reflecting a long history of 

public support for the Hyde amendment, an April 2011 CNN survey found that Americans 

oppose "using public funds for abortions when the woman cannot afford it" by a margin of 61 % 

to 35%2 Tn December 2009 a Quinnipiac University poll found 72% opposition to "allowing 

abortions to be paid for by public funds under a health care reform bill." In a survey conducted 

I In this testimony the phrase "elective abortion" refers to abortions that have long been ineligible for federal 

llmding: in recent years this has included abortions except for cases of rape. incest. or danger to the life of the 

mother. The term is used here as shorthnnd for a longstanding federal policy, not as expressing a medical or moral 

judgment. 

2 CNN/Opinion Research Corporation Poll of April 9-10. 20 II, cited at "UIlLl'QlJillg"'JlQI;~Q!l1LalJotrLQI111tl11. The 

same question in 2009 clicitcd an almost idcntical response, with public funding of abortion opposed by a margin of 

61% to 37%. The 2009 pon even found a majority against companies inc1uding ab011ion in private insurance plans 

involving no govcnnncnt money, 51% to -1-5%. Sec CNN/Opinion Research C-arporation Poll of November 13-15, 

2009. at lmp:J1iZ/~~dnJm11~L~Ql!1/gJlll/?-D lUdmn~c~t3J3m~!}QQ1? J~gf. 
45 

for my organization by International Communications Research at about the same time, 67% 

(including 60% of those supporting health care reform legislation) opposed "measures that would 

require people to pay for abortion coverage with their federal taxes." That survey also asked: "If 

the choice were up to you, would you want your own insurance policy to include abortion?" 

Only 24% said yes; 68% of U.S. adults, and 69% olwomen, said no. Also saying no were 82% 

of those who were uninsured, presumably the primary target audience for health care reform3 

Finally, in a March 2013 poll by The Polling Company, lnc., respondents opposed using tax 

dollars to pay for abortion by a margin of 58% to 35%4 

Even public officials who take a "pro-choice" stand on abortion have supported bans on 

public funding as a "middle ground" on this contentious issue - in recognition of the fact that it 

is not "pro-choice" to force others to fund a procedure to which they have fundamental 

objections. And even courts insisting on a constitutional "right" to abortion have said that this 

alleged right "implies no limitation on the authority of a State to make a value judgment favoring 

childbirth over abortion, and to implement that judgment by the allocation of public funds"s As 

the U.S. Supreme Court said in 1980: 

By subsidizing the medical expenses of indigent women who carry their pregnancies to 

term while not subsidizing the comparable expenses of women who undergo abortions 

(except those whose lives are threatened), Congress has established incentives that 

make childbirth a more attractive alternative than abortion for persons eligible for 

Medicaid. These incentives bear a direct relationship to the legitimate congressional 

interest in protecting potentiall!/!!. Nor is it irrational that Congress has authorized 

federal reimbursement for medically necessary services generally, but not for certain 

medically necessary abortions. Ahortion is inherently different/rom other medical 

procedures, because no other procedure involves the pUlposefid termination ofa 

potellfiallife. 6 

The Court's only error here was its use of the vague and incoherent term "potential life" 

The unborn child is actually (not just potentially) alive, unless he or she is made actually (not just 

potentially) dead by abortion. Later Supreme Court decisions have recognized this, saying more 

I These and other recent polls are smnnurrized in National Right to Life COllunittee, --Public opinion on -health C,ITe 

refonl1' and abortion," January G. 2010, at llttl:r!I}\J)~Y~ m:1Q._org/upJQ_(lQ~hlh~lAB(t:9n~S_lpml1f!J}:.,pr1J. For more on 

the ICR survey see USCCB News Release. "New Survey: Most Americans Want Health Care Refoffil, Oppose 

Abortion Coverage, Support Conscience Protection Laws." September 22.2009. at 

",'1,\,"'1.1' .usccb. org/comm/archlves/2009/09-186. shtml. 

4 Sec Natiolk1l Right to Life Committee News Release, "New Polling Shows Strong Support for Prohibiting 

Abortion on Pain-Capable Unborn ChiidrelL" April 22, 2013. at 

1!tm~LhYIt~UlrLc_QJgLgQKlmllli\t(g1iQ11si!~1~-.i~L2DJ JjJ~ill;1.;;~Q±2lL~. 

5 Maherv. Roe, ·132 U.S. -16-1. 474 (1977) (emphasis added). 

6l1arrisv. McRae. 448 U.S. 297. 325 (1980) (roolnoles omilled, emphasis added). Nole Ihallhis courl decision 

upheld Ihe origiml Hyde amendmenl of Fiscal Year 1977, which allowed federal abortion funding only in cases of 

danger to the life of the mother: that policy was also in effect from 1981 to 1993. 
46 

directly that by reb'lliating abortion "the State ... may express profound respect for the life of the 

unbom.,,7 Most recently, in their decision upholding the federal ban on partial-birth abortion, the 

justices reaffirmed government's "legitimate interests in regulating the medical profession in 

order to promote re.spect/br life, including life of the uflborn."g 

So secure is this legal and political consensus against public funding of abortion, in fact, 

that some have assumed it is already fully implemented at all levels of our federal government. 

For example, some wrongly argued during the recent debate on health care reform that there was 

no need for restrictions on abortion funding in the legislation, because this matter had already 

been settled by the Hyde amendment. However, the Hyde amendment itselfis only a rider to the 

annual LaborlHHS appropriations bill, and thus governs only funds appropriated under that 

particular Act. 

The fact is that Congress's policy has been remarkably consistent for decades, but the 

implementation of that policy in practice has been piecemeal, confusing and sometimes sadly 

inadequate. Federal funds are prevented now from funding abortion by riders to a number of 

annual appropriations bills, as well as by provisions of specific authorizing legislation for 

programs such as the Department of Defense, Children's Health Insurance Program, Title X 

family planning, and foreign assistance. 

Past Federal Action to Ensure a Consistent Abortion Funding Policy 

On occasion a gap or loophole has been discovered that does not seem to be addressed by 

this patchwork of provisions, highlighting the need for a permanent and consistent policy to be 

applied across the federal government: 

- In 1979, Congressman Hyde learned that elective abortions were being funded for 

American Indians and Alaska Natives through the Indian Health Service (IHS). In response to 

his inquiries, IHS Director Emery Johnson, M.D., replied that while funding abortions was not 

specifically authorized by any law, the authorizing legislation for the IHS did permit expenditure 

of appropriated funds for the "relief of distress and conservation of health" of Indians. "All 

current requirements having been met, and procedures followed," he wrote, "we would have no 

basis for refusing to pay for abortions" (Letter to Rep. Henry Hyde, July 30, 1979). He added 

that IHS services were funded through a separate Department of the Interior appropriations bill, 

which had no provision like the Hyde amendment. The Reagan Administration later attempted 

to place an administrative restraint on this practice in 1982; Congress finally enacted legislative 

language as part of the lHS reauthorization bill in 1988, but even this language only references 

whatever policy the Hyde amendment places on HHS funds in a given year. 

) Planned Parelllhood v. Casev. 505 U.S. 833, 877 (1992) (emphasis added). 

R Gonzales v. Carhart, 550 U.S. 124, 158 (2007) (emphasis added). 
47 

-In 1997, it was discovered that some states were using federal Medicaid funds not to 

reimburse directly for particular services, but to help pay premiums for overall benefits packages 

or capitation fees for health maintenance organizations (HMOs). Since the Hyde amendment 

only prohibited expending federal funds for abortion itself, some thought states might be free to 

subsidize elective abortions by using federal funds to help purchase overall health plans that 

cover abortion. A second sentence had to be added to the Hyde amendment, to forbid using 

federal funds for "health benefits coverage that includes coverage of abortion." This same 

policy, denying federal funds to any health plan that covers elective abortion, was also 

incorporated into the State Children's Health Insurance Program (SCHW) and the Federal 

Employees Health Benetlts Program (FEHBP), creating a consistent federal policy: Wherever 

federal and nonfederal funds are combined to purchase a health benefits package, no part of that 

package may cover elective abortions. That policy was consistently applied until 2010, when it 

was contradicted by the final version of what is now known as the Affordable Care Act (ACA) 

- In 1998, Congress became aware that Medicare was subsidizing abortions for nonelderly enrollees who were eligible for Medicare due to disability. Because federal funds 

appropriated through the Labor/HHS appropriations bill are combined with other funds such as 

premium payments and co-pays in the Medicare trust fund, which then reimburses for medical 

services, some federal officials thought they could fund these abortions while claiming this was 

not a use offederally appropriated funds. After congressional inquiries, HHS Secretary Donna 

Shalala reversed this interpretation and said that Medicare would follow the Hyde criteria (Letter 

to Senate Assistant Majority Leader Don Nickles, June 22, 1998). This policy, that a trust fund 

receiving federal funds may not be used to help fund abortions (or to help fund a health plan that 

covers abortions), was incorporated into the Hyde amendment for Fiscal Year 1999 and has 

remained in etfect ever since. 

- The absence of a government-wide law against federal funding of abortion led most 

recently to the passage of major health care reform legislation that contains at least/ollr different 

policies on this issue. Section 1303 of the ACA, on health plans in state exchanges, complies 

with the first sentence of Hyde (against direct and traceable funding of abortion procedures 

themselves) but violates Hyde's second sentence (against funding health plans that cover 

abortions). Section 1101, on state high-risk insurance pools, appropriates its own new funds 

outside the bounds of the Hyde amendment, and allows those funds to be used for abortions or 

not, depending on a changeable decision by the Secretary of Health and Human Services. 

Section 10503, on community health centers, omits any reference to Hyde, and allows its new 

funding to be governed by underlying mandates in the authorizing legislation for these centers -

mandates that in other health programs have been interpreted by federal courts to require federal 

funding of abortion, whenever that presumption is not corrected by explicit Hyde language. 

Finally, Section 4101, on school-based clinics, explicitly excludes abortion funding. All except 
48 

the last of these disparate policies are incompatible with the Hyde amendment and similar 

longstanding federal policies; each of them is incompatible with all the others 9 

Three Recent Developments Highlighting Problems in the Affordable Care Act 

Three specific developments since the enactment of the ACA highlight some ways in 

which it allows expanded federal support for abortion, if not corrected by later legislation. 

First, in July 20 I 0, a few months after enactment of the ACA, it was discovered that HHS 

had approved federally funded coverage for elective abortions in several states, under Section 

1101's provision for state "high risk pools." This is a temporary program, providing coverage to 

those who have been unable to purchase it because they have preexisting conditions; it was 

intended to lapse once the state insurance exchanges become active. Each state was to develop its 

list of benefits and other details; the federal government would approve these plans and provide 

all public subsidies for the coverage. Pro-life groups found that HHS had already approved plans 

in some states that covered elective abortions; at least one state was already enrolling people in 

the plan. lO In response to public criticism, HHS belatedly issued new guidance stating that these 

plans would not cover abortion except under the rare circumstances allowed by the Hyde 

amendment But an Administration spokesperson announced that this decision "is not a 

precedent for other programs or policies given the unique, temporary nature of the program. ")1 

The Congressional Research Service later concluded that this program was not covered by the 

Hyde amendment, and that nothing in the Act itselt: or in President Obama's contemporaneous 

executive order on abortion funding, authorized HHS to exclude elective abortions even from 

this program. 12 The Secretary of HHS could art,'uably exclude them in this specific case, only 

because this particular section of the Act explicitly required the high-risk pools to comply with 

Y For morc about this and other problems in the rinal version of the ACA sec ~~)}}\'Jl-,'-~Sl!.9Xg/l-,g!!lJ!19a~. The 

United States ConfefCnce of Catholic Bishops lms declined advocating for or against repcal of the AC A since its 

enactment, focusing instead on advocating changes to address the bishops' key priorities of universal access to 

affordable care, respect for life and conscience, and fairness to i1l1l1Uh'nmts. See U SCCB News Release. "Bishops 

Note Forward With Health Care, Misconceptions:' May 21, 2010, at 

10 Pel111sylvaJua's plan stated that it would not cover "elective abortions" -- but would cover any abortion that was 

not illegal under state law, which amollllted to the same tlung. See Brooks Jackson, "Taxpayer-fllllded Abortions in 

High Risk Pools," Fact Check. at hrtp:llwww.factcheckotgI20 10/07 Itaxpaver-funded-abortions-in-hieh-risk-poolsl. 

II See National Right to Life Coumurtee News Release, "NRLC: Tlus shows the law allows abortion fllllding:' July 

29. 20 I O. at l}nQ0D-'WW.llrlc~Qr,g!"-Q11l!11l11li_"g!iQllsir".lQ.1.seM2 (lJQLt-ej,,--~Q'72 91Q{ 

12 For a more complete analysis or the executive order's railure to address abortion problems in the ACA, see 

USCCB Office of the General Counsel. "Legal of the Provisions of the Patient Protection and Affordable 

Care Act and Corresponding Executive Order and Conscience Protection:' March 25, 

2010, 
49 

G 

"any other requirements determined appropriate by the Secretary.,,13 The chairman of the U.S. 

bishops' Committee on Pro-Life Activities welcomed HHS's final decision in this case, while 

expressing grave concern that federal funding for elective abortions had come so close to being 

implemented. "This situation illustrates once again the need for Congress to enact legislation 

clearly stating once and for all that funds appropriated by PP ACA will not pay for abortions or 

for insurance coverage that includes abortion," he said. "In this program as in others, the issue of 

government involvement in the taking of innocent human life should not remain subject to the 

changeable discretion of executive officials or depend on the continued vigilance of pro-life 

advocates." 14 

Second, as the state exchanges for purchasing individual health plans have begun to be 

implemented, Americans have become more aware of the strange and unprecedented abortion 

policy that will govern these plans (wherever state law has not intervened to establish a different 

policy). Each insurance company will decide whether its plan will include elective abortions, for 

those who receive federal subsidies as well as those who do not; once that decision is made, 

federal law will demand that eVel), enrollee must help pay for those abortions, notwithstanding 

any conscientious objection they may have; this mandatory surcharge for abortion will be kept in 

a separate account from the account used for federal premium subsidies, apparently so it can be 

said that no "federal tax dollars" are being used for elective abortions; and insurers are forbidden 

by federal law to make any special effort to infonn people that their plan includes such abortions, 

or to tell them how much they will be paying for other enrollees' abortions.!' 

This "separation of funds" scheme is contrary to the policy of the Hyde amendment and 

parallel laws, which forbid federal subsidies to any part of a benefits package that includes 

elective abortions. It also violates the spirit of these laws in tenns of subsidies for abortion itself. 

1fT tlnd myself explicitly forced by federal law to pay for other people's abortions, as a condition 

for receiving the health care my family and I need, is it really that important to me whether the 

law calls the forced payment a "premium" rather than a "tax"~ 

13 This requirement, not round in other parts orthe ACA that raise the issue or abortion runding, is at Sec. 1101 

(e)(2)(D) orthe Act. Sec Congressional Researeh Sen-icc. "High Risk Pools Under PPACA and the Coverage or 

Elective Abortion Sen-ices." July 23. 2010. at 

w\yw',mlc,org/llploads/ahclCRSReportAbortional1dHighRiskPools,pdf. 

14 USCCB News Release. "Pro-Life Chair Welcomes HHS Exclusion of Abortion from Federal Insurance PrOh'fam, 

Calls ForPemlanent Law," 15.2010. 

15 For a detailed analysis see USCCB Secretariat of Pro-Life Activities, "Backgrounder: The New Federal 

on C.oerced "November 6. 2013. at 

l"JII]I<';Ilts,p\lf. The secrecy provisions in tins part of the ACA haves prompted tile introduction of a separdte 

federal bill winch the U.S. bishops support. the "Abortion hlsurance Full Disclosure Act" (H.R. 3279, S. 1848). 
50 

7 

Some may answer that enrollees can choose a health plan whose provider has chosen to 

exclude elective abortions. However, the option to do so may be very limited or non-existent for 

some Americans. The ACA requires that at least one "multi -state plan" offered across state lines 

must exclude elective abortions; however, that plan need not be offered in all 50 states until 

2017. In some states it seems eVel), plan in their exchange will include elective abortions. 16 In 

these states, Americans who are conscientiously opposed to paying for the destruction of unborn 

human life through their individual health plans will be forced by the federal government to 

violate their conscience, or forgo health coverage altogether (and pay a federal penalty for 

remaining uninsured) 

Third, the ACA has had the effect of expanding abortion coverage (and greatly narrowing 

freedom of conscience on abortion) by requiring members and key staff of Congress to transfer 

from the Federal Employees Health Benefits Program (FEHBP) to the state exchanges. All plans 

in the FEHBP, of course, are federally subsidized and made available by a federal agency, so all 

have long excluded elective abortions. By contrast, members and stafl'in Washington D.C. have 

been forced to seek coverage on the D.C. exchange, where only 9 out of 112 plans exclude such 

abortions. I? By nonetheless issuing a rule to maintain the subsidies authorized by the FEHBP for 

these federal employees, the Administration has effectively nullified the longstanding 

appropriations rider that forbids use offederal funds for such abortions or "to pay for. . the 

administrative expenses in connection with any health plan ... which provides any benetlts or 

coverage for abortions" beyond the exceptions allowed by the Hyde amendment. 1g 

The Benefits of a Clear and Consistent Federal Abortion Funding Policy 

Obviously the current patchwork of almost a dozen legislative provisions, most of which 

must be reapproved each t1scal year, has not always adequately served the will of Congress or 

the American people in preventing all forms of federal subsidy for abortion. However, at least 

until 2010, Congress has always acted to address the immediate problem once it has understood 

that problem and had an opportunity to address it. It should do no less today. In fact, it should 

finally put a stop to this ungainly mechanism and simply apply the principle of the Hyde 

u~ This seems to be true at least in COlmeetieut and Rhode Island. See C. Donovan and G. Plaster. "Abortion in !he 

Obmmcare LA'"HdH!;C'>," Salional ReviCll' Online, December~. 2013. at 

JC See Rep. Chris Smith. "Only 9 Plans Exclude Elective Abortion" (using information from DC Health Link). at 

ll!!JLlLcl!ri,smitl1)lQilli'CgQ"bW1QJlg<cdfiksL2Ql.'_J2-,OZJJoorJlycLQlunelllb"Ll}£J)lmlij'Jjf. 

18 Sec: USCCB News Release, "USCCB Urges Office or Personnel Management to Comph With Federal Ban on 

Funding Health Plans That Cover Abortion," September -l, 2013, at http.:!lwlnV .. uscc1;u2rgln,ws/2013i1 :1,J5.~.c[Jn: 

National Right to Lire Committee News Release. "National Right to Lire Blasts Obama Administration's Final Rule, 

Charging that the GoVeTIllllent is 'Falsuying' what the Law Says," October I, 2013, at 

tJttpji3I_\?t:\,~.JJIl~,Qrg/~~l!I~11!11I~J.~{1tiQnS![~~L~'!~{)2£2itJ)jr~~~{1~~ LQD lJJ{. 
51 

8 

amendment across the federal government once and for all. 

If a bill like H.R. 7 had been enacted before the health care reform debate began, that 

debate would not have been about abortion funding. A major obstacle to support by Catholics 

and other pro-life Americans would have been removed, and the final legislation would not have 

been so badly compromised by provisions that place unborn human lives at grave risk. 

The USCCB has also supported the Protect Life Act (H.R. 358 in the 112Lh Congress), to 

address these and other abortion-related problems in the ACA itself 19 The benefit of H.R. 7, 

however, is that it would prevent problems and confusions on abortion funding in future 

legislation. Federal health bills could be debated in terms of their ability to promote the goal of 

universal health care, instead of being mired in debates about one lethal procedure that most 

Americans know is not truly "health care" at all. Annual funding bills could be discussed in 

terms of how their budget priorities best serve the common good, instead of being endangered 

because some want to use them to reverse or weaken longstanding federal policy on abortion 

funding. This is a result that everyone in Congress should welcome. 

Answering Questions About RR. 7 

A number of questions have been raised about H.R. 7, sometimes in the fonn of charges 

by groups committed to government support for abortion. These groups have abandoned their 

earlier slogan of "choice" and instead are committed to "access" - which means maximizing 

abortions, and using the coercive power of government to enlist the unwilling aid of taxpayers 

and health care providers who disagree with them. Answers are offered here for some of these 

questions. 

J)oes HR. 7 eliminate pril'ate cOI'eraRejiJr ahortion, orjiJrhid people to ,spend their own 

1110ney on slIch coverage? 

No. In fact, Sections 304 and 305 of Title I explicitly allow such coverage to be 

purchased and provided as long as it does not use federal subsidies. Those who want abortion 

coverage can use nonfederal money to purchase a plan that includes it; or they can receive a 

federal subsidy to purchase a plan that does not include it, and buy abortion coverage separately 

with nonfederal funds. 

Critics claim that such separate abortion riders will not be offered or will be difficult to 

obtain. The experience in states that have generally prohibited abortion coverage except by 

optional rider rebuts this claim. Supplemental abortion coverage is available in these states - in 

some plans offered by large insurers, choosing this coverage requires a simple check-oft'. The 

19 H.R. 358 was approved by the full House 251-172 on October 13, 2011, but was not considered by the Senate. 
52 

9 

problem is that almost no woman chooses abortion coverage, which is to be expected in light of 

the surveys showing that most women oppose it. Abortion coverage is included in so many 

plans now because it is imposed on women and men by employers and insurance companies 

without their consent and generally without their knowledge. (In the ICR poll cited earlier, 68% 

of those who had insurance simply did not know whether their plan covered abortion, though that 

same percentage would reject such coverage if the decision were up to them.) 

What this legislation does is place abortion coverage more in the arena of individual 

choice for women - an outcome opposed by groups that once claimed to be "pro-choice" and 

"pro-woman." They prefer a status quo in which insurance companies or employers choose 

abortion coverage and impose it on others, chietly because it is cheaper for them than 

reimbursing for live birth20 

A more limited and subtle argument has been advanced by Prof. Sara Rosenbaum and 

colleagues at George Washington University21 They point out that the policy outlined heredenial of federal subsidies for health plans that include elective abortions - already affects many 

millions of people under Medicaid, the Federal Employees' Health Benefits Program, SCHIP 

and so on. By extending this policy to millions more (e.g., to middle-income people who 

purchase their coverage on state exchanges), the new legislation when combined with existing 

laws may produce a "tipping point" where coverage without abortion becomes the usual nonn 

for health insurance; coverage that includes abortion will be pennitted but rare. 

My response to this prediction is that I hope it is correct. As the Supreme Court noted 

approvingly three decades ago, the purpose of a federal funding ban is precisely to use the 

government's funding power to encourage childbirth over abortion. Abortion coverage, and 

therefore abortion, may become more rare, a result favored by all but the most committed 

advocates for abortion. 

It is well established that providing federal funds for abortions substantially increases 

abortion rates. In one study by the Guttmacher Institute, for example, Medicaid-eligible women 

whose states provide Medicaid funding for abortion have more than twice the abortion rate of 

eligible women whose states do not provide such funding. 22 At the same time, with or without 

20 John Nugent, CEO of Planned Parenthood of MarylamL says of abortion coverage that "the insurance companies 

think they should be offering it" because if s "cheaper to terminate an unwanted pregnancy rather than taking it to 

term." David Whelan, "Obamacarc: Why Private Insurers Like Paying for Abortion:" Forhes Blog, Janunry 7, 

2010, at IlltQ;L/QJQgi:foJb_~_~con1L;;c iencebl?lZD lD1QJLOJlQb&lJ!lClG~r~~lli1I:QITrJl~ in~lU'er~U~-p--ID:-Lug:fQr-=:;:lQQ1lLoJ!L. 

21 Sara Rosenbaum et al .. "An Analysis of the Implications of the StllpaklPitts Amendment for Coverage of 

Indicatcd Abortions:' The Washington Medical Center, November 16, 2009, at 

2~ "In states that pruvide Medicaid funding for medically necessary abortions. ,yomen ,,,ith Medicaid coverage had 
53 

10 

federal subsidies, some private insurance companies will most likely continue to cover elective 

abortions because they see it as cheaper to dispose of a child than to help provide health care for 

him or her. It is difficult to rebut that claim in its own crass terms. In the short run, at least, live 

people do cost more to take care of than dead ones. Therefore, as long as abortion is legal, 

insurers and others ruled by a profit motive will have an economic incentive to promote abortion 

over childbirth. At the very least, a federal policy against subsidizing elective abortions is 

needed to counter that bias. 

Does Title II of H.R. 7 create an unprecedented policy of denying "tax benefits" to 

ahortion? 

No, that issue was settled by the ACA Members of Congress discussed whether the 

premium tax credits that help make health coverage affordable on state exchanges constitute 

federal funding, and decided in the affirmative The provision forbidding direct use of these 

credits for abortion is even titled "Prohibition on the Use of Federal Funds" (Sec. 1303 (b)(2»23 

The ACA debate drew attention to the issue of how our tax system treats abortion, and 

uncovered some remarkable facts. For example, the individual tax deduction for medical 

expenses can be directly used to help reduce the cost of an abortion performed for allY reason 

(not just abortion coverage but payments for abortions themselves)24 This seems a very explicit 

and direct statement that the government wants to help pay for your elective abortions. Now that 

this loophole allowing tax support for abortion has been discovered, H.R. 7 is addressing it. 

Conclusion 

H.R. 7 is a well-crafted and reasonable measure to maintain longstanding and widely 

supported policies against active government promotion of abortion. It consistently applies to all 

branches of the federal government the principle that government can encourage childbirth over 

abortion through its funding power. It merits prompt and overwhelming support by this 

Congress. 

an abortion rate more than four times as high as \vomen \vithout such coverage (89 vs. 21 per 1,000). In contrast. in 

states that do not cover abortion services for women on Medicaid, the abortion rate among Medicaid recipients was 

twice that of women without Medicaid coverage (35 vs. 16 per 1,000)." Rachel Jones et aI., "Patterns in the 

Socioeconomic Characteristics of Women Obtaining Abortions in 2000-200 L" on Sexual al1d 

Reproductive TTealth. vol. 3~ (2002). 226-235 at 231. See 

23 This provision still violates the policy of the Hyde amendment by allowing use of these credits to purchase overall 

health plans that cover abortion. But it did establish the idea that abortions not eligible for federal funding lmder 

Hyde should bc ineligible for thesc advanccable. rcrundable tax credits. 

:'1 "You can include in medical expenses the amount you pay for a legal abortion." Intcmal Revenue Service, 

Publication 502. Jledical and Denial ~'xpenses (including the JJealih Cm'erage 1"(1X (-:redil). Dec. 9,2008, page 5. 
54 

Mr. FRANKS. We will now go into the time for questions. And I 

would thank each of the witnesses for their testimony. And we will 

proceed under the 5-minute rule. And I will begin recognizing myself for 5 minutes. 

Ms. Alvare ́, I would note that Mr. Doerflinger quoted Harris 

versus McRae in the court. And the court said, ‘‘No other procedure 

involves the purposeful termination of a potential life.’’ And affirmed that Roe versus Wade had created a limitation on government, not a government entitlement. Three years earlier, the Supreme Court had ruled that the government’s refusal to fund abortion placed no restriction on the ‘‘right to choose abortion.’’ 

Your testimony was especially compelling when you mentioned 

about women’s attitudes toward abortion in the coming days. And 

my friends on the left, oftentimes when they are faced with an indefensible position try to change the issue to something else entirely. And it is very difficult then to debate the issue in any effective way. 

Can you tell me how both of those stated concerns coincide with 

H.R. 7, in your opinion? 

Ms. ALVARE ́. If I could clarify, the stated concerns regarding 

what is said in Harris versus McRae? 

Mr. FRANKS. The court’s decision and also women’s attitudes toward abortion. 

Ms. ALVARE ́. Yes. I mean, the court’s decision is very clear. It’s 

established as a matter of law. But I think it also seems as a matter of common sense to many people in the United States that refusing to fund something is not a statement that the government 

has done away with what is still in this country a constitutional 

right, and the court just drew that line very clearly. It’s mystifying 

to me sometimes when people make this argument; from the common sense perspective, it seems as if they’re saying that somehow 

1.2 million abortions a year isn’t enough. That in order really for 

us to say we have some robust right of abortion, we have to have 

an even higher rate than 3,300 abortions a day. We already know 

that poor women are getting a disproportionate number of these, 

and that they disfavor abortion more than the well off. Right? We 

also have minority and immigrant women disfavoring it more than 

majority American women. 

And so the idea that it is an interference is problematic. The 

other statement that comes to mind in connection with this is, you 

know, if you look at Planned Parenthood, the largest abortion provider’s most recent balance sheet, I mean, in addition to the giant 

amount of government funds they have, they have $500 million a 

year of nongovernmental funding. If it’s so important to them that 

there be more abortions among the poorest women in the United 

States, I would wonder why they don’t follow the example of the 

over 3,000 crisis pregnancy centers who are contributing private 

funding to women, about $25,000 per woman per year in the residential facilities, and there are over 350 of those. So that entire argument that somehow a right has to equal funding it and the funding has to come from the government, it is neither legally supported, nor is it supported in common sense, nor would poor women 

in particular support that. 

Mr. FRANKS. Yes, ma’am. 
55 

Thank you very much. 

Mr. Doerflinger, I know some States have made their own decision on what to do about abortion coverage on their exchanges. Can 

you give us an update on what has happened in that regard? 

Mr. DOERFLINGER. Yes, Mr. Chairman. Since the Affordable Care 

Act passed, 24 States have acted to opt out of the abortion policy 

on the State exchanges set out by the Federal Government, the 

presumptive policy in which Federal funds are used to subsidize 

plans that cover elective abortions. Then there’s a little bit of separate bookkeeping, separate accounting for the funds used for abortion. But everybody in those plans is forced to pay that surcharge 

for abortion. States have looked at that policy and said, no, we’re 

going to take elective abortions off the exchange altogether in our 

State. And that policy goes farther than H.R. 7, which only removes elective abortion from plans receiving the Federal subsidies. 

Now, of the 13 Members of this Subcommittee, 10 of you are 

from States that have made that decision to simply take abortion 

off the exchanges, and four of the five Democrats on this Subcommittee, are from States that have made that decision. You 

passed the bill with this abortion policy, and your own States have 

said no. That’s the trend now. In fact, more States than ever have 

taken this opportunity to actually reach out and say that abortion 

will not be available in private plans off the exchanges—except, in 

most cases by supplemental riders. Ten States have done that. 

So the trend out there in the country is that about half the 

States now have said, no, we want a firmer policy against abortion 

on these State exchanges. 

Mr. FRANKS. I thank the gentleman. And I will now recognize 

Mr. Nadler for his 5 minutes of questioning. 

Mr. NADLER. Thank you. Professor Wood, the Affordable Care 

Act requires participating insurance plans to segregate monies for 

abortion services from all other funds, a measure my anti-choice 

colleagues insist was necessary to prevent Federal funding of abortion. To aid in identifying these funds, both in terms of premiums 

being paid for coverage and costs for services provided, the law requires companies to estimate the cost of abortion coverage at no 

less than $1 a month. Some have characterized this segregation of 

funds as an abortion surcharge. Is this an accurate description? 

Ms. WOOD. The short answer to that question is no. As you have 

correctly stated, this is a general premium to provide for all health 

care services. And because of the Nelson Amendment to—it both 

avoids use of Federal funds primarily to avoid the use of Federal 

funds, the segregation of the private dollar contribution of at least 

$1 a month is to be set aside to pay directly for those services. And 

indeed, there are accounting responsibilities of the insurers to 

make sure that they can demonstrate to their State insurance commissioners that they have indeed complied with the statute. 

So I think in this case, it’s clearly not a surcharge. It’s a segregation of the premium. And women who or family plans who choose 

not to have a plan that does not provide abortion coverage, the option to purchase that is available to them. 

Mr. NADLER. You mean that plans that choose not to have a plan 

that covers abortion, don’t you? 
56 

Ms. WOOD. I’m saying aside from the plans that cover abortion, 

there will be plans available to choose if that is such an important 

issue. 

Mr. NADLER. So it would be inaccurate to claim that an individual that objects to abortion will be forced to participate in or pay 

for a plan that covers abortion, or as Mr. Doerflinger put it, to subsidize someone else’s abortion? 

Ms. WOOD. That is correct. 

Mr. NADLER. And that would be inaccurate because? 

Ms. WOOD. That is because plans in the statute, it does call— 

though there is no requirement to cover abortion, sort of in a balancing way, there is a requirement that there be plans available 

that do not cover abortion that an individual can choose. And, indeed, that information about coverage of abortion must be made 

available through the summary of benefits that would be provided 

upon purchase. 

Mr. NADLER. Okay. So now tell me, how common is it now for 

insurance plans to cover abortion services now, and how would that 

change if H.R. 7 is enacted? 

Ms. WOOD. I think this is the crux of the matter. Since the beginning when people have been measuring this, abortion has been covered. And I think it is important—— 

Mr. NADLER. Has been covered by private insurance. 

Ms. WOOD. Has been covered by private insurance. Absolutely. 

And because it has sort of been—and it has not been called out or 

controversial. It has been part of the general medical and surgical 

benefits that are covered as needed by any individual. And it is important to remember that insurance is set up just as that. It is for 

those anticipated and unanticipated things that can happen in your 

life. We will all need health care at some point. We may not know 

what it is. Maternity care hopefully is planned anticipated coverage. 

Mr. NADLER. So that has always been included. How would that 

change if H.R. 7 is enacted? 

Ms. WOOD. Okay, sorry. Yes, it would change dramatically, I 

think, and this is the analysis we did just in looking at the Stupak 

amendment, but we think it applies also even more so to H.R. 7, 

which is it will create a change in the insurance market because 

if insurers have to tease out not an entire class of benefit, but specific procedures under specific circumstances, they will likely, over 

time, begin to decide that this is not worth the effort, it is not 

worth the—— 

Mr. NADLER. So in other words, this bill would have the effect 

of getting private insurance companies that now offer coverage to 

not do so? 

Ms. WOOD. We project that eventually would change, and we 

have used the word tipping point. That historically plans have covered abortion under medical health insurance, and now it will tip 

to the norm being non-coverage. 

Mr. NADLER. And I would assume that that is really the point 

of the bill. 

Ms. WOOD. Right. And the concern would be regulations that 

might be issued by the IRS, having to document, et cetera. 
57 

Mr. NADLER. So last year we had concerns given the unprecedented tax provisions in the bill that this could require some pretty 

invasive regulatory enforcement procedures for women who are 

pregnant as a result of rape or incest and for women whose lives 

are endangered if they continue pregnancy. Is this a concern? 

Ms. WOOD. Absolutely. Having to make that determination is not 

something that either the IRS, insurance companies or Congress 

should really be involved in. 

Mr. NADLER. And setting aside the privacy concerns, how might 

uncertainty over how an expense might be treated by the IRS impact women and how might it impact insurers? 

Ms. WOOD. Well, I think impacting women, to have to document 

a rape or a condition of incest is traumatic at the minimum. I think 

in terms of insurers, they do not want to be in the place of having 

to make a determination of which is an acceptable exception to the 

ban on coverage, or whether it needs to be covered by either the 

woman herself or by this potential rider that would then need to 

be coordinated with the base plan. 

This raises a lot of regulatory and oversight and implementation 

concerns that insurers have traditionally never been involved in 

and would—in their traditional way would be to just cut out that 

entire set of coverage entirely and not want to go into making 

those determination, leaving all abortions uncovered. 

Mr. NADLER. My time has expired. I thank you. 

Mr. FRANKS. We will now recognize the gentleman from Ohio, 

Mr. Chabot, for 5 minutes. 

Mr. CHABOT. Thank you, Mr. Chairman. Mr. Doerflinger, let me 

begin with you, if I can. Can you explain the stance that the Catholic Bishops Conference took on the Affordable Care Act and why 

that organization ended up opposing final passage of the bill? 

Mr. DOERFLINGER. Yes, sir. The bishops have been in favor of 

government involvement in ensuring people’s access to health coverage since 1919, when they made a statement after World War I 

about social reconstruction. We were very much in favor of pursuing health care reform, and we put out a great many materials 

saying basically that we hope Congress will address this problem, 

we want to move to universal health coverage, but there are moral 

principles that that should respect. 

The coverage should be affordable and fair, it should extend to 

everyone— and in that respect, the final bill, in our view, and I 

know I will disagree with some of the majority Members of this 

Committee on this, we felt it should fully cover immigrants, regardless of their legal status. We felt it should respect the existing longstanding policies in all of these other programs, that Federal funds 

do not get used for abortion or any part of a health plan that covers 

abortion. That is current law now in the Hyde Amendment, in Federal Employees Health Insurance, in the SCHIP program. And, 

thirdly, we felt that it should have strong protections for rights of 

conscience, which of course, it does not, as witness two cases that 

are going up to the Supreme Court now. 

So in the end, we were very encouraged by the House bill. The 

Stupak amendment was approved with the support of 64 Democrats, including House Appropriations Committee Chair David 

Obey. We had a bipartisan agreement that we are going to set this 
58 

abortion issue aside and talk about health care. And then the Senate changed it back. 

I don’t know why we are talking about a Nelson amendment. I 

think Mr. Nelson convinced Harry Reid to put in some additional 

accounting procedures, but what is in the bill now is basically the 

Lois Capps amendment that was prepared by—— 

Mr. CHABOT. Let me stop you there, if I can, just because we 

have got limited time. Despite claims from the Administration that 

the Affordable Care Act abides by the principles of the Hyde 

amendment, we know that health care, Federal tax subsidies are 

paying for health care plans, or will, including elective abortions. 

Is it your belief that additional tax subsidies like this to individuals to pay for health care plans which could have elective abortions will, in all likelihood, increase the number of abortions performed in this country? 

Mr. DOERFLINGER. Of course. You know, Dr. Wood said that most 

plans have abortion, and that is true, but that is not because people want it. Sixty-eight percent of women, in the last poll we did 

on this, are against having abortion in their coverage. And so those 

decisions are being made largely by the for-profit insurance companies because abortion is cheaper than a live baby. Wow. Imagine 

that. Live babies are more expensive than dead ones. So the insurance companies have an economic incentive to promote abortion 

coverage and they include it. 

Mr. CHABOT. Let me cut you off there if I can at this time. 

Mr. DOERFLINGER. But what this bill says is we are not going to 

put Federal funds into encouraging that bias. 

Mr. CHABOT. Thank you. Ms. Wood, let me turn to you real 

quickly. Why did President Obama issue his executive order which 

purported to curb abortion funding or stop funding? 

Ms. WOOD. I think it is clear that the Affordable Care Act already through the Nelson amendment ensures that no Federal dollars are going toward abortion. And that certainly is a conversation 

we can have about, you know, my opinion that those bans are not 

appropriate, but that that is, in fact, what is in the Affordable Care 

Act. And his memo merely confirmed what was already in the statute. 

Mr. CHABOT. Thank you. Ms. Alvare ́, let me turn to you if I can 

here. You had stated in your testimony that, and I am putting this 

in my words, you said that women really don’t support abortion 

overall, even though we sort of think politicians think that, the 

press kind of says women are for it and men are against it, you 

know. Would you clarify that a little bit? 

Ms. ALVARE ́. Yes. The best study I have seen on this with really 

great cross-tabs, very detailed on women at every income level, 

women of different racial and educational background, was the 

RAND Corporation in cooperation, I think it was with the Packard 

Foundation, Rockefeller Foundation. You know, these are groups 

that are supportive of population control policies generally, including often abortion. 

But what you see, and you see this in not only the quantitative 

but also the qualitative studies of poor women, the best book ever 

on this, Promises I Can Keep, Why Poor Women Put Motherhood 

Before Marriage, that there is this disapproval particularly among 
59 

poor women, of abortion, just a moral disapproval of it and a desire 

that it not be normalized or encouraged. If you look at the ratio of 

unintended or out-of-wedlock births among the poor, they abort a 

lower ratio of those than do people who are better off. 

So not only is it that women are not supportive of this. I mean, 

this is a top-down sort of groups claiming to represent women sort 

of proposal. It is a political thing, it is not a health care thing, and 

it certainly does not speak for grassroots women, particularly poor 

women in America. 

Mr. CHABOT. Thank you very much. I yield back, Mr. Chairman. 

Mr. FRANKS. I thank the gentleman. I now recognize Mr. Cohen 

for 5 minutes. 

Mr. COHEN. Thank you, Mr. Chair. 

Ms. Alvare ́, let me ask you a question. Do you believe this bill, 

H.R. 7, would include birth control in making it illegal? 

Ms. ALVARE ́. No. My understanding is that it addresses abortion. 

Mr. COHEN. Only abortion. Okay. Let me ask you this too. Does 

this bill ban a State like Arizona from spending its local funds on 

abortion? 

Ms. ALVARE ́. It is my understanding that if a State wants to 

spend its own money on abortion, that a State can do that. States 

already do that. 

Mr. COHEN. So it doesn’t ban a State like Arizona from doing 

that, or Arizona hospitals from performing abortions. It doesn’t ban 

that either? 

Ms. ALVARE ́. The question in this bill is taking Federal funds out 

of it. If you are really—you have to be speaking, and I am sure a 

particular hospital, a particular locale would be able to give you, 

sort of an Arizona expert would be able to give you statements 

about whether their hospitals, their locales, et cetera, how or how 

much or in what way they interact with Federal funding. But, 

again, the purpose of this is to draw the lines between Federal 

funding for abortion—— 

Mr. COHEN. How about D.C.? Would it affect D.C. hospitals and 

D.C. from spending its local funds on abortion? 

Ms. ALVARE ́. It is my understanding because of the definition of 

D.C. for the purposes of this bill and obviously in connection with 

a longstanding relationship between the Federal Government and 

D.C., that, yes, it would prevent D.C. from spending money that it 

wished to spend, which is a good thing. 

Mr. COHEN. I know you were not a Member of Congress and you 

weren’t here during the Republican shutdown, but during that 

shutdown, the Republicans almost were unanimous in favor of letting D.C. spend its local funds, even during the shutdown. So there 

seemed to be kind of a bright chink in the armor of D.C. being a 

Federal—— 

Ms. ALVARE ́. I am not actually political on these question. I try 

to take a principled or a legal or empirical view. I am not about 

recognizing the political—— 

Mr. COHEN. Let me ask you a question. You mentioned a lot of 

polls about lower income people and pro-life—— 

Ms. ALVARE ́. I am sorry, I couldn’t hear you, sir. 

Mr. COHEN. You mentioned a lot of polls about low income people 

and their positions on pro-life. 
60 

Ms. ALVARE ́. On abortion and abortion funding. 

Mr. COHEN. And that most low income people you said, poor people, were pro-life. And you talked about pro-life and the Federal 

Government, and because it was death and it was gruesome and 

it was ugly and all those things. Most polls, and there are more 

polls that I can name, show that most pro-life people, women, are 

also in favor of the death penalty. How do you reconcile that, because that type of death is gruesome? 

Ms. ALVARE ́. Two things. Number one, I could not personally or 

principally reconcile it myself and that is why I have been publicly 

on record against any Federal support for killing, whether it is the 

death penalty or abortion. 

Mr. COHEN. How about war? How are you on war? 

Ms. ALVARE ́. Number two, I guess I haven’t written anything on 

it outright. Because of my background, which is an overlap of both 

philosophy, theology and law in the area, I am—I guess you would 

say my general position would be, in case this matters to you or 

would help shape your opinion on the bill, I am not sure how it relates to anyone else’s opinion around here, I am in favor of life. 

And in my knowledge of the church, its just war theory in particular, which I think is a very good outline of the theory, would 

probably be an explanation of my position, if that is influential to 

you. I hope it would be. 

Mr. COHEN. Right. Just for time limits. Mr., is it—— 

Mr. DOERFLINGER. Doerflinger. 

Mr. COHEN. Doerflinger. You work for the church, is that correct, 

for the bishops? 

Mr. DOERFLINGER. That is correct. 

Mr. COHEN. And Ms. Alvare ́ is a consultant. Now, the Pope has 

been real good on saying that these issues concerning gays and 

abortion are part of the Catholic history, but that they should be 

kind of lessened in terms of the real big issues, which is the great 

disparity in wealth between the wealthy and the poor, and we need 

to do more things about taking care. 

I wonder what you or either of you all are doing to try to influence my colleagues to do things about unemployment insurance, to 

do things about food stamps support and Meals on Wheels and 

things like that, and maybe tax policy that kind of levels the playing field out so you can do the Pope’s work here in the United 

States Congress? I am a big fan of the Pope’s new positions. I am 

just wondering what you were doing to move those forward. 

Mr. DOERFLINGER. I have to begin by differing with you on the 

interpretation of what Pope Francis has said, because what he has 

said is that all of these issues are important, but it is better to put 

them in a deeper context as a consistent message about the dignity 

of all human beings than to treat them as individual political positions. What he said about abortion is that—— 

Mr. COHEN. Let me ask first, what did he say about the disparity 

in wealth? 

Mr. DOERFLINGER. He said there is a huge problem in the disparity of wealth. And I would say this. Yesterday was the 50th anniversary of President Johnson’s announcement of the War on Poverty. That is an issue that is very close to the bishops’ hearts. The 

bishops just yesterday sent up a letter encouraging Congress to in-
61 

crease the minimum wage. We are celebrating Poverty Awareness 

Month—January is Poverty Awareness Month—by educating 

Catholics about the need to fight poverty. Our Catholic Charities, 

our Campaign for Human Development, our Catholic Relief Services are out there providing help to millions of people in poverty, 

and I think doing—no offense intended—doing so more effectively 

than many government programs do. 

We are very much in favor of the War on Poverty. But we also 

insist, and so does Pope Francis, that the War on Poverty must 

never become a war on the children of the poor. Pope Francis has 

said it is not progressive to try to solve our problems by eliminating a human life. 

Mr. FRANKS. The gentleman’s time has expired. 

Mr. CHABOT. Mr. Chairman, I would ask unanimous consent that 

the gentleman be granted an additional 30 seconds and I would ask 

the gentleman to yield to me if he would. 

Mr. FRANKS. Without objection. 

Mr. COHEN. I don’t have a problem. I yield. 

Mr. CHABOT. I thank the gentleman for yielding. My only point 

was he was just about to say on abortion the Pope said, and then 

you cut him off and we never heard, and I would be interested to 

hear what the Pope said on abortion. 

Mr. DOERFLINGER. Oh, I am sorry. Just that this dignity of life, 

even from the very beginning, is so intimately linked with all our 

other human rights, that if you take a wrong turn on that, it undermines the basis of all the other rights we are trying to fight for. 

That has been said by Pope John Paul II and Pope Benedict and 

it has been said by Pope Francis as well. He said the church is not 

going to change its position on this. If it changes its position on 

this, its whole moral logic about the dignity and rights of every 

human being falls down. 

Mr. CHABOT. I thank the gentleman for yielding. 

Mr. FRANKS. I would now recognize the gentleman from Ohio— 

I am sorry, the gentleman from Iowa, I am getting the folks mixed 

up here, Mr. King. I am sorry, we have got the list here. I recognize 

the gentleman from Virginia, Mr. Forbes, for 5 minutes. 

Mr. FORBES. Thank you, Mr. Chairman. I want to thank all of 

our witnesses for being here. I know you are all incredibly good 

people, smart people, passionate about your issues. These are complex issues. Sometimes in these hearings, we do truly the forest for 

the trees when we get off on poverty, war, peace, death penalty, 

those kinds of things, and we have to keep trying to bring it back 

to something we can get our hands around. 

Ms. Wood, I would just like to ask you a question if I could to 

try to get at that core. I had someone the other day that is a friend 

of mine and they showed me a small video of this new baby they 

were going to have that is going to be their grandchild. And it was 

only a few weeks old and they were just amazed at what they could 

see. 

What do you call that? And I want to use the nomenclature you 

want so that I am not offensive to you. But before that entity is 

born, which I would call an unborn baby, but what would be the 

vernacular that I should use that would be appropriate? 
62 

Ms. WOOD. Depending on the stage, it would be an embryo or a 

fetus. 

Mr. FORBES. Okay. In that embryo, and I will use that terminology because it is the one that you pick, or we could use fetus, 

either one, is there no procedure, no action that could be taken 

against that embryo, no harm committed, no matter how horrendous it might be, that you would feel should be prohibited? 

Ms. WOOD. I think the key perspective we have to take here, and 

this is, again, one of the unknowables, is what is the circumstance 

of the individual woman that is trying to decide whether to become 

a parent, what is her circumstances, what is her health needs. And 

therefore, I think there is real—taking it from that thinking where 

I don’t stand in her shoes and none of us can really know what is 

going on in any particular—— 

Mr. FORBES. And I appreciate that. I am sorry, I think my volume—— 

Ms. WOOD. And those decisions are made based on her health 

needs and that of her physician—— 

Mr. FORBES. And I fully understand that. I am not arguing with 

you. I am just saying it would be your position, as I understand 

it, that there would be no procedure, no action taken, no harm committed to that embryo by your definition, that would be so egregious or so bad that we would prohibit it so long as that mother 

or that woman said it was okay to do it. Is that a fair interpretation? 

Ms. WOOD. I don’t think it is a really relevant—I mean, I don’t 

fully grasp the question, because I think it is important to say that 

there are—things need to be done with good medical care in the 

context of high quality medical care. 

Mr. FORBES. But that is not where we are. Where we are at is 

trying to, one, get the baseline and then determine the continuum 

and then determine what Federal dollars can be spent on it. But 

as I understand your position, there is no procedure, there is nothing that we could do to that embryo, in your vernacular, as long 

as that mother or that lady said it was okay, there is nothing we 

could do that you would feel would be a bridge too far that should 

be prohibited? 

Ms. WOOD. I think I would still say that it would be something 

within the determination of the woman and her health professional, and if they came up to some—and I am not a medical professional. I don’t want to say what medical procedures are correct 

or incorrect. 

Mr. FORBES. I understand. But I am just saying that as I understand you, there is no procedure, nothing, that would—— 

Ms. WOOD. I think you are misconstruing my testimony. 

Mr. FORBES. Then please clarify that for me. Tell me what procedures you think would be too egregious to that embryo, that even 

if the mother or the wife said it is okay that you would think would 

be too far and shouldn’t be allowed? 

Ms. WOOD. I think if the woman is getting unsafe abortion care, 

that is egregious. I think there are medical procedures which are 

not acknowledged or shown by evidence to be safe and effective. 

And I think those need to be—— 

Mr. FORBES. But nothing as far as that embryo is concerned? 
63 

Ms. WOOD. I think you don’t separate in this case the embryo 

and the mother. They are—the woman is in the circumstance with 

her health care provider to make those determinations. 

Mr. FORBES. Mr. Chairman, since my time is running out, I 

would simply allow Mrs. Wood, if she has such procedures, such actions that could be taken to the embryo that she thinks should be 

prohibited, even if the mother says it is okay to do it, if she would 

submit those for the record. But at this point in time, through all 

my questioning, I have heard none. And so if the record could just 

state that. And then if she would like to supplement that, we 

would love to give her that opportunity. 

With that, I yield back, Mr. Chairman. 

Mr. FRANKS. Without objection, we would ask Ms. Wood to provide us with that answer. 

I would now recognize Mr. Deutch for 5 minutes. 

Mr. DEUTCH. Thank you, Mr. Chairman. 

Mr. Chairman, I am struggling some to figure out why we are 

here today. As the Ranking Member pointed out earlier, Federal 

funds haven’t been used for abortion in 30 years. Federal funds 

have not been used for abortion in 30 years. So if the problem that 

we are truly trying to solve is to keep taxpayers from footing the 

bills for abortions, mission accomplished. However you feel about 

it, mission accomplished. 

But keeping taxpayer funds away from abortion isn’t why we are 

here. Instead, this Committee, on a regular basis, seems intent on 

picking away at a constitutionally protected right with misleading 

backdoor legislation. Whatever your personal feelings about abortion, and whether you would want a woman in your family to make 

that choice or not, we must all recognize that that woman has a 

constitutionally protected choice to make about her own body. To 

create new restrictions on the coverage of abortion by private insurance companies in the guise of taxpayer protection I think is 

outrageous, and I have some questions for the witnesses that I just 

would like to probe. 

Mr. Doerflinger, starting with you, I respect entirely your belief 

based on sincere and strongly held religious tenants that abortion 

is wrong, and I have the same respect for my colleagues, for so 

many of my colleagues on this Committee. But here is where we 

disagree. America is a multicultural society. We don’t all subscribe 

to same religion. I don’t believe that one religious view should be 

imposed on others, and using the massive power of the Federal 

Government to force others to share your religious views or penalize those who view differently is a dangerous approach. So I just 

would like to explore that with you, some. 

If a majority in Congress had strongly held religious belief that 

blood transfusions were immoral, would it be appropriate for that 

majority to ban blood transfusions? 

Mr. DOERFLINGER. We are not talking about banning anything, 

sir. 

Mr. DEUTCH. Would that be appropriate for the majority to do 

that? That is the question I am asking you. We are just engaging 

in some hypothetical situations, Mr. Doerflinger? 

Mr. DOERFLINGER. No. 
64 

Mr. DEUTCH. And what about vaccinations? Some have strongly 

held beliefs on the matter of vaccinations. In your view, would it 

similarly be permissible for a majority in this Congress to ban vaccinations? 

Mr. DOERFLINGER. No. 

Mr. DEUTCH. And for people who hold religious objections to alcohol and tobacco, there is insurance, maybe this one gets more at 

this issue that we are talking about today, there are insurance 

plans that provide coverage for smoking cessation and treatment of 

diseases borne out of alcohol and tobacco use. If a majority of this 

Congress felt that there is no reason taxpayer dollars should be 

used to support treating disease borne out of alcohol addiction, 

should we be able to take that action akin to what this legislation 

does with respect to abortion? 

Mr. DOERFLINGER. No, nor should the government force people to 

fund those addictions. 

Mr. DEUTCH. And let me just go on because I have a few more 

and only limited time. I am sorry. 

Mr. DOERFLINGER. But this is all irrelevant to the bill at hand. 

Mr. DEUTCH. It is not irrelevant. Ultimately, sir—— 

Mr. DOERFLINGER. You are making a fundamental—— 

Mr. DEUTCH. No, no, let me explain my own position, which I 

thought I had already done but I will do it again. The suggestion 

in this bill, what this legislation does is despite the argument that 

we are protecting people from the Federal Government, it says that 

the massive power of the Federal Government can be used to shut 

down a constitutionally protected right. 

Mr. DOERFLINGER. That is absolutely false. 

Mr. DEUTCH. That is what this legislation does. 

Mr. DOERFLINGER. Have you read the bill, sir? 

Mr. DEUTCH. I had, indeed, read the bill, Mr. Doerflinger. 

Mr. DOERFLINGER. Section 304 says you are wrong. 

Mr. DEUTCH. I appreciate your asking. And the other thing that 

is so troubling to me, I have one more question, it is on the same 

topic, just to finish out the list, embryonic stem cell research. Now, 

I know that embryonic stem cell research, despite its potential lifesaving revelations, is controversial in some parts. Should Congress 

be able to impose tax penalties on people who purchase insurance 

policies that cover cures that were devised from embryonic stem 

cell research? 

Mr. DOERFLINGER. There aren’t going to be any cures from embryonic stem cell research, and this is not about penalizing it. 

Mr. DEUTCH. Mr. Doerflinger, I don’t have the time to engage in 

that debate, but I would respectfully suggest to you that perhaps 

as you have encouraged me to take another look at the book, that 

you might well take a look at the research that is being done right 

now in research centers across the country before you suggest that 

there will be no treatments or cures to come from embryonic stem 

cell research, and for all of the people, for all the advances which 

have been made and the people whose lives could be improved by 

it, I would ask you to reconsider. 

And, finally, I would just suggest to Professor Alvare ́ that she is 

exactly right, exactly right, when she says that what we ought to 

be doing is focusing on a real women’s agenda. I agree. And my 
65 

hope is, Mr. Chairman, that as we go forward in this Congress, we 

might focus on a women’s agenda that acknowledges that women 

earn 70 cents on every dollar earned by men, and that minimum 

wage increases is a women’s issues because two-thirds of minimum 

wage workers are women, and that if we raise the minimum wage, 

which is 30 lower than what it was in 1968, that we will see an 

immediate reduction in poverty among women, and that workers in 

145 countries in the world have earned paid sick days, and the 

U.S. has no mandatory paid family medical leave policy. We are 

one of three counties in the world and the only industrialized country to not have mandated maternity leave. 

This is an agenda for women that this House of Representatives 

ought to take up. I appreciate your making that point, Professor 

Alvare ́, and I yield back. 

Mr. FRANKS. I thank the gentleman. And just for the record, this 

bill does not cause the massive power of the Federal Government 

to force people to make any decision. It simply prevents the massive power of the Federal Government to force taxpayers to pay for 

the killing of innocent unborn children. 

I would now recognize Mr. King for 5 minutes. 

Mr. KING. Thank you, Mr. Chairman. I thank the witnesses. And 

I would first disagree with Mr. Deutch on the statement that the 

Federal Government hasn’t funded abortions for 30 years, and I 

would ask Mr. Doerflinger if he could speak to that. 

Mr. DOERFLINGER. Yes, sir. It is for 35 years that the Federal 

Government has been barred from using Federal funds for the vast 

majority of abortions. What has changed, what is new, and it is not 

a new effort by a cabal of mean-spirited conspirators as Dr. Wood 

would like to say, is that Federal funds have now moved into a 

vastly broader arena of the health care system. We are no longer 

talking about Medicaid just for the poor, we are talking about tax 

subsidies for the middle class—who, by the way, are presumably 

far more able than the poor to use their own money for abortion 

if they are not getting Federal funds. 

Mr. KING. But I would ask you—— 

Mr. DOERFLINGER. Now we are beginning to get into this 

arena—— 

Mr. KING. I would take you back 30-35 years and speak to Medicaid funding of abortions for rape and incest, and funding for 

Planned Parenthood while we are at it. 

Mr. DOERFLINGER. I am sorry, I didn’t understand the question. 

Mr. KING. Okay. First of all, has the Federal Government funded 

abortion through Medicaid funding in the cases of rape and incest 

over the last 30 years? 

Mr. DOERFLINGER. Yes, for many years. 

Mr. KING. So those would be exceptions to Mr. Deutch’s statement—— 

Mr. DOERFLINGER. Certainly. 

Mr. KING. As the Federal Government, I don’t want to say ‘‘we’’ 

in this case, the Federal Government has consistently funded abortion. 

Mr. DOERFLINGER. Since 1993. 

Mr. KING. Under Medicaid funding for the cases of rape and incest? 
66 

Mr. DOERFLINGER. Yes. 

Mr. KING. I thank you. And then we look at something like, I am pulling this number out of my head, I will say in the upper $300- 

plus million a year that goes into Planned Parenthood, is there a 

way that one could contrive, make the argument that none of that 

funding goes to abortion that funds Planned Parenthood? 

Mr. DOERFLINGER. Well, the Title X family planning program 

says that none of those funds can go to a program where abortion 

is a method of family planning. I don’t have evidence that those 

funds are being directed toward abortion. I think what Planned 

Parenthood usually does is have its Title X program on family 

planning done at one clinic and then that clinic refers women for 

abortions to another Planned Parenthood clinic that is not a Title 

X clinic, and it does the abortions. So there is some separation. 

But even a Title X program, 1970 it dates from, put the funding 

ban broader than just the procedure of abortion itself: We don’t 

want to put Federal funds into a program where these are done. 

So the idea that by just not funding the abortion procedure itself 

and taking that dollar out and switching it around, that that respects the history of American law in this area, is not true. 

Mr. KING. And you wouldn’t have to have a Ph.D. in money fungibility in order to figure out that $370-some million, some of 

that spills over into funding abortion through Planned Parenthood, 

even if it goes into administrative funds that in a broader perspective administer the upper side of that program. 

Mr. DOERFLINGER. Well, I don’t want to get into funding Planned 

Parenthood. I think that is a different issue. 

Mr. KING. I am happy to change the subject and I thank you for 

your response. 

Mr. DOERFLINGER. It is a little relevant. It is relevant to this extent, that by giving all this money to Planned Parenthood, we are 

giving money to the organization that does hundreds of thousands 

of abortions a year, more than any other, and I, for one, would like 

to see those funds devoted to organizations that are more clearly 

committed to the needs of women as well as their children. 

Mr. KING. I agree, and I thank you. And I would turn to Ms. 

Wood and thinking back on your testimony, and part of your testimony was the statement to the effect that in the case of some 

women, abortion care costs more than their monthly rent. I have 

trouble calculating that equation. Could you explain that statement 

to the Committee? 

Ms. WOOD. Yes. Particularly because of the nature of the very 

narrow exceptions that are allowed under H.R. 7, which is life 

endangerment, rape or incest, those women who have health concerns or fetal abnormalities may be facing later term abortions 

which can cost in the thousands of dollars. 

Mr. KING. So you answer, then, would be, I think, in exceptional 

cases, it may cost a woman more for a single abortion than it does 

for her 1 month of rent check. Is that an accurate way to depict 

what you said? 

Ms. WOOD. That is correct. 

Mr. KING. Okay. I wonder how many abortions a month does she 

need at the going rate to keep up with the rent check? 

Ms. WOOD. I do know that it pushes women into poverty. 
67 

Mr. KING. I accept your answer and I think it is fine. I want to, 

in the seconds I have left, speak to this issue because I have an 

opportunity to speak to it from the perspective of the church. And 

I am a Roman Catholic, I believe in good standing with the church 

and a faithful follower of much of the teachings. I was very concerned about the Catholic Church’s involvement in the ObamaCare 

legislation as it moved through this Congress and the accepting of 

the Stupak amendment. 

Here in the middle of this political arena, I believe that the 

church was operating in a legislative arena that they didn’t quite 

understand; that they didn’t see that there was going to be a baitand-switch on the Stupak amendment. That is what happened. 

And I think the Church’s desire on the principle of trying to serve 

people and trying to get more people covered by health insurance, 

the things that you talked about, Mr. Doerflinger, about the dignity 

of every human person, which I believe, I think they got too far 

ahead of themselves on this and failed to understand that abortion 

was going to be part of this package and that Rahm Emanuel was 

the person that came up with the executive order that was going 

to amend ObamaCare after the fact. 

So I wanted to make this point in this hearing that I would ask 

the Church to come talk to some of us on the inside of these Chambers when these things come up and understand that we should 

first put the principle, it is the church’s principle, of life first, and 

remember there is a principle of subsidiarity too. And we can serve 

people better many times the closer to the individuals that we can 

get those services than going broadly with a national policy that 

turns this over to a pro-abortion president. 

My heart is sick at what happened with ObamaCare. The conscience protection, the litigation with the conscience protection is a 

result of this desire as is the abortion questions before us today. 

And I think if we would reassert the principle of subsidiarity, we 

would better protect the principle of human life. 

Thank you, and I yield back. 

Mr. FRANKS. I would like to thank all of the individuals for their 

questions—— 

Mr. DEUTCH. Mr. Chairman, I wonder if you could yield just 10 

seconds for Mr. King to clarify that it is his position that the Federal Government through Medicaid should not spend any dollars on 

an abortion in the case of rape, incest or to protect the life of the 

mother. Is that correct? 

Mr. KING. I didn’t state a position. 

Mr. FRANKS. So I would thank the witnesses for their answers. 

I would thank the Members here for their questions. I would suggest that the two most important questions asked today here is 

does abortion take the life of a child, and, if so, should taxpayers 

be forced to pay for it. And with that, without objection, all Members—I am sorry, we have been joined by Mr. Gohmert. I will now 

yield to him for 5 minutes. 

Mr. GOHMERT. Thank you, and I appreciate the time and I appreciate the witnesses’ patience. I was at another hearing. But I want 

to make sure that when my colleagues were bringing up the Supreme Court mandated authority to abortion, that people don’t misunderstand. This hearing is not about the elimination of abortion, 
68 

but as the Supreme Court said in Rust v. Sullivan, that in upholding Federal limits on abortion funding, they said, ‘‘By requiring 

that the grantee engage in abortion-related activity separately from 

activity receiving Federal funding, Congress has, consistent with 

our teachings,’’ which I don’t appreciate teachings from the court, 

they are supposed to make decisions, not be teaching, especially 

being lectured from people that are so duplicitous at times, but separately from this Congress consistent with our teachings, ‘‘not denied it the right to engage in abortion-related activities. Congress 

has merely refused to fund such activities out of the public fisc.’’ 

And that is what we are talking about. And I hear people across 

America that have been—they have had the wool pulled over their 

eyes and they have been led to believe that some of us are moving 

laws that will end the ability to get an abortion, when actually 

what we are talking about here today is the right of religious beliefs, the right of conscience. 

And I know all three of our witnesses, from what I have been 

hearing, has come over the television, you know, you are all three 

very sympathetic to the plight of women, and nobody is more so 

than I am. I have three daughters, and when my first one I held 

in my hands, I could have held her in one but I didn’t want to risk, 

she was so premature, I would do anything to keep her alive. And 

it is hard for me to fathom someone wanting to kill what I call a 

child, what some may call an embryo, when she is living in my 

hand at the same time a child of the same age is living in someone’s womb. 

So I have been married for 35 years. I have three daughters. 

There is no war on women. But when I hear of countries around 

the world, and it seems to be creeping, the thought creeping into 

America, that we could give a woman the right to destroy a child 

in her womb because it happens to be a female. It is happening all 

over the world, China especially, babies being killed because they 

are a female? How long before some who support abortion with all 

of their heart, mind, and soul will say, wait a minute, wait a 

minute; the war on women has become a war on women in the 

womb, and at some point, at least please don’t make people who 

see that as killing a child pay for others to kill that child. That is 

what we are talking about. 

Legislation, we talk about Supreme Court rights, my friends 

across the aisle about you can’t go against Supreme Court rights. 

The Supreme Court has said over and over and over that forcing 

somebody to pay, against their religious beliefs, against their heartfelt beliefs, to pay for someone else’s abortion is where the problem 

is. So I just think that hasn’t been made clearly enough from what 

I had been hearing. 

And with regard to the Stupak amendment, Bart Stupak is my 

friend, I haven’t seen him in a long time, but what he didn’t know 

is what Mr. Rahm Emanuel said. ‘‘I came up with an idea for an 

executive order to allow the Stupak amendment not to exist in 

law.’’ Mary Poppins, a fictional character that I never saw until I 

had kids said that is something easily made and easily broken. It 

is not in law. We are trying to get it in the law. And I appreciate 

all of you being here today. Thank you. 
69 

Mr. FRANKS. Once again, there is always tremendous intensities 

related to this debate, and sometimes people on both sides want to 

suggest that the one side doesn’t care about the mother or the 

other side suggests that the one side doesn’t care about the child. 

But ultimately it is my belief that history and time will point out 

that abortion on demand has been the ultimate war on women and 

America is better than this. 

With that, it concludes today’s hearing. I want to thank our witnesses for attending. Without objection, all Members will have 5 

legislative days to submit additional written questions for the witnesses and additional materials for the record. 

I thank the witnesses and I thank the Members and the audience, and this hearing is adjourned. 

[Whereupon, at 11:45 a.m., the Subcommittee was adjourned.] 

(71) 

A P P E N D I X 

MATERIAL SUBMITTED FOR THE HEARING RECORD
72 

Statement of the Honorable John Conyers, Jr. 

for the Hearing on H.R. 7, the "No Taxpayer Funding for Abortion Act" 

Before the Subcommittee on the Constitution and Civil Justice 

Thursday, January 9, 2014 at 10:00 a.m. 

2141 Rayburn House Office Building 

Today's hearing on H .R. 7 is yet another attempt to push a divisive social 

agenda instead of focusing on what Americans care most about: creating jobs and 

improving our Nation's economy. 

Rather than addressing these critical issues, my colleagues on the other side 

of the aisle have chosen to use the first hearing of 2014 to attack - yet again -

women's health and their constitutionally-protected rights. 

To begin with, we must acknowledge that this hearing sadly reflects the 

Majority's relentless on-going anti-woman, anti-family, and anti-child agenda, 

which dates back to the last Congress. 

For example, the GOP-led government shutdown last October robbed more 

than 9 million women and children of critical supplemental food assistance and 

health care referrals under the Women, Infants, and Children Program, known as 

WIC. 

The shutdown also left 19,000 children without early education and 

necessary social services provided by Headstart. 

Let's be clear. The so-called "No Taxpayer Funding for Abortion Act," is 

not really about prohibiting federal funding abortion. Federal law already prevents 

that. 

The real goal of this bill is to make abortion and coverage for abortion 

services paid for by private individuals with their own money unavailable. 

It does this by adding restrictions and imposing an unprecedented penaltyby use of the federal tax code - on privately-funded health care choices made by 

women in consultation with their family and their faith. 

Let me also point out that the version of this legislation that we considered 

in the last Congress would have narrowed the already inadequate exceptions for 

rape, by further limiting funding to cases of "forcible rape." 

According to Mr. Doerflinger, who is here again with us today, this "forcible 

rape" limitation was intended to "prevent the opening of a very broad loophole for 

federally funded abortions for any teenager." 
73 

f 

What a shocking admission. 

Fortunately, the Majority responded to the justifiable fury over this 

outrageous limitation by removing the term "forcible" from the bill's text. 

Unfortunately, they made clear in the Committee Report that accompanied 

this bill that they still intended to prevent the federal government from subsidizing 

"abortion in case of statutory rape," an exception that directly contlicts with the 

Hyde Amendment, which makes funding available in all cases ofrape. 

H.R.7 also endangers women's health by denying coverage even where an 

abortion is necessarv to protect the health of a woman, in complete disregard of 

the Supreme Court's dictates in Roe v. Wade and Planned Parenthood of 

Southeastern Pennsylvania v. Casey. 

Further, the bill targets women in the District of Columbia by usurping the 

ability of the District's local elected officials to use local revenue to provide access 

for abortion care. 

No Member would tolerate that level of intervention into local decisions to 

spend local money. Yet here we are again treating Americans who live in the 

District like second-class citizens. 

Finally, H.R. 7 makes an unprecedented use of the Internal Revenue Code to 

penalize private health care decisions by denying tax deductions, credits, and 

benefits for money spent to cover out-of-pocket medical expenses related to 

abortion services or to purchase health insurance that includes such services. 

Let's call this legislation exactly what it is: a tax increase on individuals, 

families or small employers who make a particular health care choice that some of 

my colleagues do not like. 

The overall impact of this bill is clear: It will discourage most insurers from 

including coverage for abortion services in health insurance plans, which will 

effectively eliminate coverage that families across America now have and now pay 

for with their own money. 

Tn sum, this bill is a travesty. 

Page 2 of 2 
74 

Material submitted by the Honorable Jerrold Nadler, a Representative in 

Congress from the State of New York, and Ranking Member, Subcommittee on the Constitution and Civil Justice 
75 

The Supreme Court has also determined that neither congress 

nor a state may place an "undue burden" on that right. 

Now comes H.R. 7, the "No Taxpayer Funding for 

Abortion Act," which is misleading and misnamed, because the 

bill seeks to burden all women's health care choices in a variety 

of ways that have nothing to do with Federal funds. Contrary to 

the assertions of its supporters, H.R. 7 is not the mere 

codification of existing law. 

This bill seeks to extend current funding restrictions in the 

Hyde Amendment that are limited in time and scope and apply 

them to all Federal laws, without any effort to determine how 

such a sweeping and permanent expansion would impact 

American women and their families. If this were all, that would 

- 2-
76 

still be reason enough to oppose it, but H.R. 7 actually goes 

much further. This bill - for the first time ever - denies tax 

deductions and credits for women who use their own money to 

pay for abortion or to purchase insurance that covers abortion 

and - in so doing - increases taxes for women and families with 

respect to one of the most personal and private decisions that 

they may face. 

In particular, H.R. 7 denies the itemized tax deduction that 

otherwise is available for medical expense if the expense is 

abortion, and treats as taxable income any distribution from a 

flexible spending account or health savings account that is used 

to pay for abortion expenses. H.R. 7 denies small employers the 

ability to use tax credits to provide health coverage if that 

coverage includes abortion. The bill also denies income-eligible 

- 3 -
77 

women the use of premium tax credits available under the 

Affordable Care Act if selected insurance coverage includes 

abortion. 

In first opposing, and then voting to repeal, the Affordable 

Care Act - not once, not twice, but I think we're up to 47 times 

now - my Republican colleagues have complained that 

government should not meddle in the private insurance market, 

or in private health care choices. But this legislation obviously 

is designed to do just that. It seems that many Republicans 

believe in freedom provided no one uses that freedom in a way 

that they do not approve. That is a strange understanding of 

freedom. 

- 4-
78 

Even more stunning, this bill increases taxes on families, 

businesses, and the self-employed if they spend their own 

money - let me repeat that: their own money - on abortion 

coverage or services. As we know, the power to tax is the 

power to destroy, and, here, the taxing power is being used to 

destroy the right of every American woman to make private 

health care decisions free from government interference. And 

this tax increase is being championed by Republicans, almost all 

of whom have taken a pledge not to raise taxes on individuals or 

businesses. 

I am equally surprised to find out that my Republican 

colleagues think that a tax exemption or credit is a form of 

government funding. Should we now consider every tax 

exemption or credit as a form of government funding for the 

- 5 -
79 

recipient? I'm sure that there will be many businesses, charities, 

and religious denominations that will be alarmed to discover 

this. 

I also join many other Americans in being absolutely 

horrified that the Majority of this Committee seem not to know 

what rape is. 

When this bill was introduced in the last Congress, its 

sponsors sought to limit the Hyde Amendment rape exception to 

instances of "forcible" rape. Many in Congress and across 

America were outraged. According to the bill's champions, date 

rape drugs and sex with minors were not really rape. 

- 6-
80 

In the face of public outcry, the Majority removed the term 

"forcible" from the bill before this Committee marked it up in 

the last Congress. 

But let no one misunderstand or be fooled by that change. 

My colleagues still seek to narrow the rape exception, as they 

made clear in the Committee report accompanying H.R. 3 in the 

last Congress (House Report No. 112-38). As they explained: 

"Reverting to the original Hyde Amendment language 

should not change longstanding policy. H.R. 3, with the Hyde 

Amendment language, will still appropriately not allow the 

Federal Government to subsidize abortions in cases of statutory 

rape. The Hyde Amendment has not been construed to permit 

Federal Funding of abortion based solely on the youth ofthe 

- 7-
81 

mother, nor has the Federal funding of abortions in such cases 

ever been the practice." 

The Majority's assertion - as explained in a memo from the 

National Women's Law Center - is false. In fact, a 1978 

regulation clarified that funding is required for all cases of rape, 

whether statutory or forcible. Nothing in the language of the 

Hyde Amendment qualifies the term "rape," and Congress 

rejected a proposal to limit the Amendment to cases of "forced" 

rape. As explained in the 1978 regulation, and as remains true 

to this day, Congress's "failure to use the word 'forced' in [the 

Hyde Amendment] when referring to rape is conclusive 

evidence that congress intended funding to be available for 

victims of statutory, as well as forced, rape ... " I ask 

- 8-
82 

unanimous consent that the National Women's Law Center 

memo be entered into the record. 

In their Committee report, my colleagues displayed their 

true intent with regard to the exception for rape, which is to 

remove federal assistance for children and teenagers who are the 

victims of predators. 

They have not been as transparent about the overall intent 

behind this bill. But it is nonetheless clear: it is to end 

insurance coverage for medically indicated abortions for all 

women, whether or not they obtain their insurance on an 

exchange, and even if they use their own money to purchase the 

msurance. 

- 9-
83 

My colleagues in the majority believe that if you like your 

insurance coverage, you should get to keep it, unless it is for 

choices that they don't like. Then, they have no qualms about 

taking your coverage away. 

That is the intended and likely result of this bill. Currently, 

the vast majority of insurance products cover abortion services. 

But, as Professor Sara Rosenbaum of George Washington 

University's School of Public Health testified in the last 

Congress, insurance companies will respond to the tax penalties 

this bill imposes by dropping coverage for abortions from all of 

their plans. This will have a significant impact on all women, 

not just lower income women who have long felt the brunt of 

federal restrictions on their health care choices. 

- 10 -
84 

My colleagues blithely assert that coverage will be 

available, if in no other way, through supplemental insurance 

policies. But - as Professor Wood, the witness invited by the 

Minority can explain - there is no evidence that such product 

lines are being developed. 

H.R. 7 is not codification of existing law, nor is it just 

another attempt to enact the approach taken in the Stupak/Pitts 

Amendment to the House-passed Affordable Care Act. H.R. 7 

is a radical departure from current tax treatment of medical 

expenses and insurance coverage; and it is neither justifiable nor 

necessary to prevent Federal funding of abortion. 

I yield back the balance of my time and look forward to 

hearing from our witnesses today. 

- II -
85 

THEGEOAGE 

WASHINGTON 

UNIVERSITY 

...s ON. DC 

[anuary 16, 2014 

Chainnan Trent Franks 

......... _- --- _ ........ ..., ' 202_-"'''' , 202_-..000 

--

Subconunillee 00 \he ConsliMion and Civil JUSlicc 

Commitl<:<:on the JlIdiciary 

US House ofRepresenlalives 

Atlas! week's hcaring""II.R.7. I wasasked by Representative Fornes ifth"", were any medical pr<><:<:dure. 

that a pregnant "'-Oman s«king an aoortion might und«go \() which I object. 

My lLI\S"'cr 10 that questi"" is: The only appropriate procedure for a pregnant womM, including one seeking 

aool1ion services. is Ollt that is appropriate for her medically, according 10 accepted standards of care; thai is 

provided by a hcaJth...,are professional who is properly tJ1lir.cd. credentialed. and licensed. using his or her ~t 

medicaljudgrnent; that is administered in a hygienic. properly regulatOO. and safe environmc1ll: and for which a 

paticnfs appropriate informed =nt has ""'n ob!air.cd. I believe lhat if a medical procedure meets these 

5landard., il is not appropriate for any third pany. includill3 poli'iciam.. 10 interfere. 

Thank you for inviting me to testify at the h .. ring and for pennining me to submit this answer for the record. 

Attached for the record is a final copy of my wrinen testimony, as wdl as a copy of the Memo by Rt)Seflbaum 01 

aI. on the impact of the StupaklPins Amendmcnt to the Affordable Care Act, as was diseussc:d at the hearing. 

Sincerely 

~~~o0J Susan F. Wood, PhD 

Associate Professor of Health Policy 

Dirtttor of the Jacobs Institute of Women's Ilealib 

Sehool of Public Health and Health Services 

George Washington University 
86 

ScOOOl.Of I'I:IIIX Hf. '"1'' 

ItIt ..... TIO S .. """~ 

An An>ll.i. f'h~ Impliu,;On. Of 'h, 'up kfPill . ,\m. ndm. n, 

for Co,' ..... g. of hli<~lIy I ndio<l lhl Abortion. 

Introduction I nd R .... ul" in Brio( 

Sa .. Rosenbaum 

lIu. Cl l1wrigh,·Smith 

Ross Margulies 

SuJ,a.nWood 

o Riohard .~ 

No"embe< 16. 2009 

This analysi. "".mines the impHca!i"". f ... COVCflge of medically indicated aborti"".' under !he 

SlUpaklPiU. Amendmen! (SlUpaklPin.) ", H R. 3962. 'he A!f ... dablelleahh Care f ... Amerioa Ac!' In 

,hi. analysis w-e focus"" 'he Amendmenr". implication. for the health ""ncfit services indu,,'Y a •• 

whole We .1.., consiMr 'he Amendment'. implication. for ,h. grow'h of . marl<et for public or prj,'.'. suppltmenral oO"'.-..ge of medically indi cated aixonions. Finilly. w. examine ,h. issues tha, 

OIl y ari", as insurers OUtmp< '0 impl"'\Cn' o"'-erall" dettmlin.,ion. in .... hich oixonion moy "" I 

"""""IlletICC of I GOOdition . .-..therth.n 'he primary basis 0( trealment 

I",}"slr)'.~'kk m'I"'" Iilm ,fl "Nfl 1M ,uuJJ<mJ <if row.',,,,,,,,, for IIW<llcall)' In'}":'.1I,'{/ "1>/".#0<,,. j<". all 

M'omt'''-' In view of how Ihe health beeefit...-vice. indu,,'Y operates and how insurance pmducr desil!-" 

resP<l"ds lQ broad rtgulatOl)/ in''''-'''tioo aimed at reshapinll produ« con,,,,,. "'e condude ,h •• the 

" 08tmen, ""elusions requi~ ur.M-r the Stup.tl:lPius Amendmen, ,,;11 ho,'. In induSIJ)'.wide e!fC<:l. 

climinalinll coverage of medically indicated l bonioo. ""er ,ime f ... I II women. 1101 OIIly those whose 

coI'mgt i5 dcril'ed Ihrough I health inwlllnce exchange. As a roul~ SwpakIPius can be expected 10 

move Ihe indu,,'Y . way from curren' norm. of """crage for medically indicaled abonioos In 

combinaiioo ",i,h Ihe H)'de Amendment. StUpakIPills "ill impose a cov ra~e exclu.iOll f ... medically 

indica'ed oOOniOl\s on such a widuptead basiS t!a.ltlle helhh ""ner.t services indus'!), can "" e.'jl«1ed 

'0 rtt.Olibra'e product design d""lIward across ,he board in ord ... to accommodate tilt' e<dusioo in 

..,rC<:led mari<els. 

S"I'I>/,·"",,,/(,i ;'"",m," COl'f"'P' for ""'Jica/ly ;,.hc(l/eJ "IJo,IIO<lf: In our view. 'he ttmlS and impaCl 

of Ille Amendmenl "'ill ",or\: 10 <!efeal the developmenl of I supplem ... ,,"1 c"'=8e market for 

medically indicated pixoniOllS, In any supplemCD1aJ """era~ amongemen,. it is esu 'D1ial tha, the 

supplemental C""e"'Ke be admini"C1ed in conjunClion "ith basic ""'-crase. This in'cn,,-;ned 

I dmini,,"'tion Ipproach is barred undC1 StuplklPillS because of the prohibition 19ains' fonancial 

romingling. This bar i s in addilioo 10 Ihe chlnenlles inheren, in admini'tering Iny supplemental policy 

These challenlle, would be m>gnifoed in 'he case of medically indiclled lbon;"". because. given !he 

relati"ely low "umbel" of medically indicaled .boni"" .. the co"crage oupplement would apply to only 

, I ........... ) . .;.. "'" "'no m<dic>l~ ' ono:Ii<:aIod _"n" """'" a..,' ~ po ohbonioo for ",ho:h ""'"' io. nO<dio::oI ;nIb:;oI",n or '"'<d. .. di .. ircw>h«! from __ ,I\>t ,,",'. "" _I 0\'''''''' ., ,.,.of) ; ...... "'" <0'>' .... ,,_ 

, "'«0_ Hcohh Co.., r.t ....... nca ...... H.I\_ )%2. III" C .... (l" s.s., lOO9), ",,·.i...," '" hUp'lifrns!!. aI£"""" gOP IQIini.t.Wp;jdQs crOJnwnt;- 111 CQFJF bilb.tdgs,.t·flM62ch.I'1 pd( 

lOll K S!J.o:n, ~W. s<'m;!lQ(l . W .... """""", DC _ ·202·2_ 22· fA.' lO 1·2 9(i.(l(l ~ 
87 

The Shlpak/Pitts Amendment 

November I (). 2009 

a handful of procedures for a handful of conditions. Furthermore, the House legislation contains no 

direct economic incenti ve to create such a market Indeed, it is not clear how such a market even would 

be regulated or whether it would be subject to the requirements that apply to all products offered inside 

the exchange. Finally, because supplemental coverage must of necessity commingle funds with basic 

coverage, the impact of Stupak/Pitts on states' ability to offer supplemental Medicaid coverage to 

women insured through a subsidized exchange plan is in doubt 

5/pillover effects as a result of admhlistration of StupakPitrs. The administration of any coverage 

exclusion raises a risk that, in applying the exclusion, a plan administrator will deny coverage not only 

for the excluded treatment but also for related treatments that are intemvined with the exclusion. The 

risk of such improper denials in high risk and costly cases is great in the case of the StupaklPitts 

Amendment, which, like the Hyde Amendment, distinguishes between life-threatening physical 

conditions and conditions in which health is threatened. Unlike Medicaid agencies, however, the 

private health benefit services industry has no experience with this distinction. The danger is around 

coverage denials in cases in which an abortion is the result of a serious health condition rather than the 

direct presenting treatment 

The remainder of this analysis examines these issues in greater detail 

Overview of Current Federal Law 

1. The Hyde Amendmenl and Medicaid 

The Hyde Amendment has been part of each HHS-related appropriation since FY 1977. As set forth in 

the most recent annual LaborlHHS federal appropriations legislation,3 the Hyde Amendment provides 

in pertinent part as follows 

Sec. 507. (al None of the funds appropriated in this Act, and none of the funds in any 

trust fund to which funds are appropriated under this Act, shall be expended for any 

abortion 

(b) None of the funds appropriated in this Act, and none ofthe funds in any trust 

fund to which funds are appropriated in this Act, shall be expended for health benefits 

coverage that includes coverage of abortion 

(c) The tenn 'health benefits coverage' means the package of services covered by 

a managed care provider or organization pursuant to a contract or other arrangement 

Sec. 508. (a) The limitation established in the preceding section shall not apply to an 

abortion-

(1) if the pregnancy is the result of an act of rape or incest; or 

(2) in the case where a woman suffers from a physical disorder, physical injury, or 

physical illness, including a life-endangering physical condition caused by or arising 

from the pregnancy itselt~ that would, as certified by a physician, place the woman in 

danger of death unless an abortion is performed 

3 Omnibus Appropriations Act. Pub. L. No. 111-8. 123 Stat. 52+. 802-803 (Mar. 1 L 2009) 
88 

The Shlpak/Pitts Amendment 

November I (). 2009 

(b) Nothing in the preceding section shall be construed as prohibiting the 

expenditure by a State, locality, entity, or private person of State, local, or private funds 

(other than a State's or locality's contribution of Medicaid matching funds) 

(c) Nothing in the preceding section shall be construed as restricting the ability of 

any managed care provider from offering abortion coverage or the ability of a state or 

locality to contract separately with such a provider for such coverage with State funds 

(other than a State's or locality's contribution of Medicaid matching funds) * * * 

Under this Amendment, states may neither directly expend federal funds for abortion other than the 

procedures authorized by the Amendment nor use federal and matching state funds to purchase 

products that cover a broader range of abortions. At the same time, the Amendment preserves states' 

authority to either pay for, or purchase coverage of, additional abortion services using state and local 

funds that exceed federal Medicaid contribution requirements. Twenty-three states currently pay for 

some abortion services that extend beyond the limited range of coverage permitted under the Hyde 

Amendment and seventeen of those pay for all or most medically necessary abortions. 4 

2. fhe Flnp/oyee Retirement Income Security Act (fJRI5A) 

The Employee Retirement Income Security Act (ERISA) governs private employer-sponsored 

coverage in the U.S. Because most workers are employed by private finns, ERISA has a broad reach, 

affecting health plans that account for 81 percent of all persons covered by any employer-sponsored 

arrangement. The remaining population of workers and their dependents are enrolled in an ERlSAexempt plan (typically a plan offered by government employers and subject to separate legal 

requirements). :> 

ERISA contains few provisions regulating the content of employer-sponsored health benefit plans 

Instead, the law relies on the health benefit services companies that sell products to employers, as well 

as employers themselves, to negotiate the tenns of coverage. Despite the considerable investment of 

taxpayer financing that supports the employer-sponsored system (currently estimated at $246 billion), (, 

ERISA contains no mandatory exclusion of certain types of medically indicated treatments for 

abortion, instead leaving the matter to the discretion of purchasers and sellers. The best available 

research indicates that 87 percent of employer-based insurance plans cover medically appropriate 

abortions and that 46 percent of workers have coverage that includes some level of abortion services. 7 

The fact that an employer plan is subject to ERISA does not render state insurance law irrelevant 

ERISA health benefit plans that cover participants and members by buying a health insurance product 

.j GlIl1macher Institute, Stale Funding or Abortion Under Medicaid, 5,'wfe Policies 111 Hrlef, 2009. A\ailable at 

htTp.!iY·, 'Ilu;l1tlmafh£ . .urrgt.tHtcc~akEW~l SF AM.lli..:tf. ~ Emplo)er-Based Health Plans: Issues, Trends, and Challenges Posed by ERISA. (GAO/HEHS-95-167. July 25. 1(95) 

~ Joint Committee on TaxatiOlL Tax Expenditures/or HealTh Care (JCX-66-08), July 30, 2008. Tllis document is !wailable 

at ~,{.'!l_I~JYLgQ-"_ 

- Two major studies have been conducted on tins issue. A federally supported Shldy conducted by the Guttmacher Institute 

and assessing leyels of insurance coverage for a wide range of reproductive health sen'ices found that in 2002. 87% of 

typical employer-based insuTImce plans covered medically necessatT or appropriate abortions. In a 2003 sun'ey, the Kaiser 

Fanlily Foundation fmUld that 46% of insured \\olkers had some Ie-~;el of abortion coyerage. The number may be eyen 

higher considering that the SUf\CY also ~ic1ded a high (2() percent) "don't know" response rale. Gul1macher Institute, Memo 

on Insurdnce Coverage of Abortion, updated Sept. 18. 2009 

hlu,.lJ~!_1}~'-"--£!llEn~~(,;her.9IgiJ.IJ\~JJJ.gli~.JtJ.le.[.!i~_,--,-silQ0l[~)7jULillgesllllI!j 
89 

The Shlpak/Pitts Amendment 

November I (). 2009 

are subject to state law with respect to the products that are purchased. Thus, state insurance content 

mandates or regulatory exclusions could affect certain ERlSA plans. (In contrast, ERlSA health benefit 

plans that self-insure are exempt from state insurance law.) 

States exercise their powers under the McCarran-Ferguson ActS to regulate insurance, but only rarely 

regulate the tenns of abortion coverage in the individual or group markets. Currently, five states 9 

appear to regulate coverage of medically indicated abortions by banning coverage of most procedures 

except where the life of the mother is in danger. These state laws effectively impose a mandatory, 

regulatory coverage exclusion directly affecting benefit design of insurance products sold in their 

states. These states also allow for the sale of separate abortion riders, but the evidence available shows 

that markets for abortion-specific insurance products have not developed in these states. lO 

The Federal F.mployee Health Benefits Prowam 

The Federal Employee Health Benefits Program (FEHBP) reaches some 8 million beneficiaries, 

including federal employees and their spouses and dependents 

Unlike the ERlSA market, the laws governing health benefit coverage for federal employees directly 

regulate abortion content. The annual federal appropriations statute governing the program provides in 

pertinent part as follows 

Sec. 613. No funds appropriated by this Act shall be available to pay for an abortion, or 

the administrative expenses in connection with any health plan under the Federal 

employees health benetits program which provides any benetits or coverage for 

abortions 

Sec. 614 The provision of section 613 shall not apply where the life of the mother 

would be endangered if the fetus were carried to tenn, or the pregnancy is the result of 

an act of rape or incest 11 

Like the laws in the five states that have elected to regulate plan content, this statute reaches plan 

content by imposing a coverage exclusion on plans sold to federal employees, barring coverage for 

most medically indicated abortions. Furthermore, the legislation bars payments to any health plan that 

administers coverage reaching the prohibited types of treatments. This bar conceivably could cost a 

plan its federal contract even if its plan administration activities were limited to the coordination of 

benefits between its own product and a supplemental product offering coverage of excluded 

R 15 U.S.c. §§ 1011-1015 

~ ID. KY, MO. ND. OK. OK limits cm"Cfugc to life cnd::mgermcnt rape or incest circumstances; and the other four states 

limit co\'erar,e to cases of life elldntlt,ennent. GUllmaeher Institute. Restricting insuf:mce eo\er:lge ofnbortioll. Slate 

Policies ill Brief 2009 

1O Insurance depmtments in Idaho. Kentucky and Missouri sn} the) do nottmck the existence of such riders (although 

presumably the content of such riders would have to be registered with a state' s insunlllce department). It is very unclear if 

any riders me offered. North Dnkota and Oklahoma officials report that insurers do not currently offer such riders 

Oklahoma reports that one insurer has filed for a rider to offer abortion coverage to small,b'Ioups, but apparently has not yet 

offered that coverage. Idaho reports that one of the state' s major insurers will offer abortion coverage to small groups if 

they pay an additional premium charge. How Would /he House .1horllOn rUnils H"ork? MSNBC 

%tttU)!~ :'.1:>} JJlli!l~~_,)t~!!'('mIlitg,,::;t';_~~~~~? J;Y.1~il~gll!Jdw~I;lL<;;"<!Ie_ 

II The Omnibus Appropriations Act, 2009 (Pub. L. 111-8). 
90 

The Shlpak/Pitts Amendment 

November I (), 2009 

treatments. For this reason, it would appear that companies selling products to federal employees 

would not be permitted to offer supplemental abortion coverage without risking the loss of their plan 

administration financing unless they could demonstrate that the sale and administration of such a rider 

was completely segregated from general plan administration. This would be virtually impossible, since 

coverage determinations related to the supplement would of necessity have to be coordinated with the 

basic plan, causing administrative spillover into the base plan. While a federal employee in a state in 

which supplemental coverage is offered might buy such a supplement, not only is there no evidence 

that such a market exists, but the base plan would be barred from coordinating benefits with the 

supplemental insurer, thereby leaving the employee exposed to the risk of coverage denial from all 

sources of coverage 

There is evidence that in the absence of exclusion, the coverage nonn would be to include a range of 

medically indicated abortion procedures. Tn 1994, the last year when products were not subject to such 

coverage exclusion, half of all products sold in the FEHBP offered at least some abortion coverage 

beyond the current limited coverage. 12 

InteractioNS hetween reKUlatmT 1m!' and the health henefit services industry 

In the absence of federal or state regulatory laws governing the design and administration of health 

benefits, the health benefit services industry has the discretion to design and administer products in 

accordance with market preferences. As noted, it appears to be customary for the industry to cover 

medically indicated abortion procedures, with 87 percent of health benefit plans offered reporting 

coverage of abortion services,l) 

Once regulatory law is introduced however, industry norms can begin to shift if the reach of the law is 

broad enough to affect a significant portion of the market. The health benefit services industry, like any 

large producer of goods and services functioning in a national economy, depends on standardization 

and norms. If certain types of products are excluded in certain large markets, over time the market as a 

whole for the product can be expected to shift, as manufacturers move to accommodate their product to 

reflect the regulated design. This is particularly true where the rebrulation deals with details of the 

product, that is, where the regulation attempts to redesign certain product details rather than some 

substantial aspect of the product that can be readily modified for certain customers. The analogy here 

would be regulations that address the inner workings of a car engine (crucial and detailed) rather than 

the color of a car, which can be modified with relative ease to satisfy the desire of certain customers 

(e.g., a red car with black trim). 

The effect of regulatory law where the content of insurance coverage is concerned can be seen in the 

changed market for insured contraception. Prior to the enactment of state contraception coverage 

mandates, most health plans did not provide the benefit. As state laws regulating the inclusion of 

contraceptives have become more prevalent, the broader health benefit services market has been 

12 Center for Reproductive Rights. Federal Employees Deserve Comprehensiye Reproductiye Health Care (NY- NY. July 

2(09) 

11 Adam Sonfield et al .. C/)', Insunmce Coverage oj Contraceptil'es and the Impact OfContraceptil'e Coverage ,Mandates. 

2002. PerspectiYes on Sexual and Reproductive Health. 36(2):72-79 (200~>. 
91 

The Shlpak/Pitts Amendment 

November I (). 2009 

affected. 14 National health benefit services companies report today that they routinely include 

contraceptive coverage in their plans in all markets, not only those directly affected by state law. 15 

This potential for regulation to spill over into unregulated markets can be expected to work in reverse, 

particularly where the regulation prohibits specific procedures and conditions and creates additional 

disclosure, network design, coverage determination, and provider payment complexity for plan 

administrators. The same national and regional companies that sell products in the private employee, 

federal-employee or the state-regulated markets can be expected to sell products in the exchange 

markets; indeed, a goal of health refonn is to create a large new market of high quality insurance 

products for the 30 million people who will derive coverage through the exchange. Until now, the very 

large private employer market has been a dominant force in product design. But as the exchange 

market grows, its design requirements - particularly when combined with those from the large 

emerging Medicaid managed care market and the federal employee benefits market - can be expected 

to gain real dominance 

The critical task for companies faced with multiple markets, will be to design products that can 

compete in all markets. For example, Blue Cross of the National Capital Area might sell a PPO 

product in multiple forms: as a Medicaid managed care product; as a state-licensed insurance product 

in the individual and small group markets; as a product for federal employees; as an administered 

product in the self-insuring employer market; and finally as an insured product in the exchange. The 

company will want the plan "engine" to operate as much the same as possible across all markets, even 

if the "color and trim" aspects of its products (e.g., a benefit package supplement for vision and dental 

or its prescription drug plan) may vary for certain markets 

To be sure, sellers of health benefit services products do customize those products in certain ways, 

varying cost-sharing for example or adding entire benefit classes (such as a dental coverage 

supplement). But in the case of abortion services, the issue is not adding an entire benefit class that can 

be clearly described and efficiently administered. Instead, the challenge is to customize in certain 

critical but small-bore ways the range of procedures that a plan administrator will cover and the 

specific types of patients for whom additional procedures will be made available. Abortion regulations 

that allow coverage of most medically indicated procedures for most health conditions but prohibit a 

few procedures for a handful of conditions essentially compel changes in the inner workings of plan 

administration. Thus, as more and more markets demand these changes, the plan's inner workings 

must change as well 

In effect, in order to preserve broader coverage of medically indicated abortions, the health benefit 

services industry will confront the challenge of adding coverage procedure by procedure for specific 

women and based on the specific details oftheir underlying health conditions. Accomplishing this task 

-- or offering an entirely separate plan that operates according to a separate set of rules -- will pose a 

major burden on the industry, one that it might undertake were it to receive direct financial incentives 

for doing so, or were it to conclude that the market is large enough. But where the market is for a 

handful of medical procedures for a small number of conditions - as crucial as they might be - the 

H Guttmacher Institute, Insurance coverage contraceptiws. ,':.'tate PoliCies In Bnef. 

.lli.1J2Ji~"\~'I.'''U!lmachcr.orn,'SW1;;:CCll~C~5!5Djb IfL.uQ[, acccsscd Novcmbcr 13, 2009 

l'i Adam Sonfield et al .. CS. Insunmce Coverage oj Contraceptil'es and the Impact OfContraceptil'e Coverage .Mandates. 

2002. PerspectiYes on Sexual and Reproductive Health. 36(2):72-79 (200~>. 
92 

The Shlpak/Pitts Amendment 

November I (). 2009 

burdens associated with administering a parallel plan or a supplemental product will quickly work to 

outweigh the economic benefit of offering more product choice 

Tn sum, while the additional coverage of medically indicated abortions may be minimal from an 

actuarial viewpoint, as studies of contraceptive coverage have suggested,16 the administrative burdens 

can be considerable. Enrollment materials and summary plan benefit materials would need to be 

altered to reflect broader coverage for members who buy additional coverage either as a separate plan 

or via a coverage supplement. Individual coverage determinations will differ for women depending on 

the procedures to be used, the severity of their health conditions, and the medical evidence in the case 

Coverage determinations and grievance and appeals procedures will have to be separately administered 

to respond to different coverage rules. Medical provider networks may have to be augmented in order 

to make the fuller range of coverage accessible to members, with separate negotiated payment rules 

Most importantly, extensive interaction in order to coordinate benefits between the basic plan and the 

supplemental plan (or the separately purchased coverage supplement) is necessary to assure that costs 

are apportioned properly and that coverage risks are distributed according to the terms of the plan 

For example, consider a case in which an abortion is medically indicated as a result of a woman's 

health. In this case, coverage might be available through a basic plan if the condition were determined 

to be life-threatening, but only through the supplemental plan if the condition that led to the abortion 

were detennined to only threaten her health. Making such a determination might be difficult, 

particularly where the health threat is severe and long-lasting. Significant interaction between the 

administrators of the basic and supplemental plans would be essential to resolve the evidence; where 

the administrator is the same person, the task inevitably would require construing the plan terms across 

all products 

One can begin to appreciate why the market for supplemental coverage is limited Where companies 

are precluded from participating in markets if they offer certain abortion services, offering alternative 

plans or a supplement leaves them exposed to the risk that in administering the supplement in relation 

to the base plan they will be considered to be administering a prohibited product. The only way to 

avoid this outcome might be to assure that the cost of the supplement is high enough to absorb all 

administrative costs over both the base plan and the supplement, as well as the actuarial risk of need 

Making this type of adjustment would of course drive up the price of the product 

The legal risks inherent in offering a supplement in a market that legally prohibits the commingling of 

plan administration duties can be expected to drive the industry away from the sale of a plan 

supplement. These problems are compounded by the fact that the market can be expected to be 

extremely small where the product is not for a broad swath of benefits such as vision and dental care 

but instead for a handful of procedures for a handful of serious conditions. 

Thus, it is not surprising that the supplemental coverage market for medically indicated abortion 

procedures that are excluded from a basic plan has not grown, either for federal employees or in states 

that prohibit basic abortion coverage. There are just too many difficulties - legal and technical - to 

justify the cost, and the market is infinitesimal when one considers the handful of women who might 

need this critical protection. While the numbers of women in need of this additional coverage are of 

16 "Contraceptive Coverage Must Be Tncluded in the Federal Employees Health Benefits Program: National Women's 

La\\ Center. l.;It.R~[ !l.l,}}_':l.tJ\':k,oxWJif1.2'.g\;T4l.!"COJ!CO_'L0.lf. 
93 

The Shlpak/Pitts Amendment 

November I (). 2009 

course small, the financial risks that the absence of the protection creates for families can of course be 

considerable, since medically indicated abortions, when undertaken in response to serious health 

conditions, can run into the thousands of dollars 

The StupakIPitts Amendment 

On November 7, 2009, during 1100r debate on the Affordable Health Care for America Act (HR 

3962), the House adopted the Amendment alTered br Representatives Stupak and Pitts to broaden the 

bill's prohibition on federal funding for abortion.' The Amendment provides in pertinent part as 

follows 

(a) IN GFNFRAI -- No funds authorized or appropriated by this Act may be used to 

pay for any abortion or to cover any part of the costs of any health plan that includes 

coverage of abortion, except in the case where a woman suffers from a physical disorder, 

physical injury, or physical illness that would, as certified by a physician, place the 

woman in danger of death unless an abortion is perfonned, including a life-endangering 

physical condition caused by or arising from the pregnancy itsel( or unless the pregnancy 

is the result of an act of rape or incest 

(b) OPTION To PURCT1;\Sr: Sr:P;\R;\Tr: SlJPPU-;:Mr:NT;\L COvr:R;\C;r: OR PL;\N - Nothing in 

this section shall be construed as prohibiting any nonfederal entity (including an 

individual or a state or local government) from purchasing separate supplemental 

coverage for abortions for which funding is prohibited under this section, or a plan that 

includes such abortions, so long as -

(1) such coverage or plan is paid for entirely using only funds not authorized or 

appropriated by this Act, and 

(2) such coverage or plan is not purchased using (A) individual premium 

payments required for a Exchange participating health benefits plan towards which an 

affordability credit is applied; or (B) other nonfederal funds required to receive a federal 

payment, including a state's or locality's contribution of Medicaid matching funds 

(c) OPliON To OFtER Sl::<,PARAIE SUPl'LH'v1l::HfAL COVEHAGl::<, OR PLAN - Notwithstanding 

[the foregoing] nothing in this section shall restrict any nonfederal QHBP offering entity 

from offering separate supplemental coverage for abortions for which funding is 

prohibited under this section, or a plan that includes such abortions, so long as-

(I) premiums for such separate supplemental coverage or plan are paid for 

entirely with funds not authorized or appropriated under this Act 

(2) administrative costs and all services olTered through such supplemental 

coverage or plan are paid for using only premiums collected for such coverage or plan; 

and 

(3) any nonfederal QHBP offering entity that offers an Exchange-participating 

health benefits plan that includes coverage for abortions for which funding is prohibited 

under this section also offers an Exchange-participating health benefits plan that is 

identical in every respect except that it does not cover abortions for which funding is 

prohibited under this section 

r 155 Congo Rec. H12962 (Nov. 7. 2009). 
94 

The Shlpak/Pitts Amendment 

November I (). 2009 

The Amendment, as passed, thus appears to represent an amalgam of the Hyde Amendment and the 

FEHBP coverage exclusion provision in its construction Summarized as follows, the Amendment 

would 

• Prohibit the use of funds under the Act either to directly pay for abortion or to buy an exchange 

product that covers abortions other than the narrow range of pennissible abortions 

• Prohibit the coverage of all but the allowable abortions under the public plan 

• Permit states and localities to use their own funds either to pay directly for abortions or to buy a 

plan covering abortion, as long as the purchase is with funds other than mandatory state 

expenditures under the Act 

• Pennit companies to sell supplemental coverage or plans that include broader abortion 

coverage, but only to the extent that "administrative costs and all services offered through such 

supplemental coverage or plan" are paid for using only "premiums collected for such coverage 

or plan" 

• Prohibit companies from offering supplemental coverage or plans that cover abortions unless 

they also otfer an exchange plan that is identical in every respect except that no prohibited 

abortion coverage is included 

The Potential Impact of the Stupak/Pitts Amendment 

The Stupak/Pitts Amendment can be expected to influence the industry as a whole by considerably 

broadening the market for products that exclude all but a limited number of abortion procedures The 

Congressional Budget Otnce projects that within six years of the exchange being implemented, 30 

million people will get their health insurance through the exchange, including three million who will 

not receive subsidies and nine million who -will receive exchange-based coverage through their 

employer. 18 Tn effect, the size of the new market is large enough so that StupaklPitts can be expected 

to alter the "default" customs and practices that guide the health benefits industry as a whole, leading it 

to drop coverage in all markets in order to meet the lowest common denominator in both the exchange 

and expanded Medicaid markets 

Furthermore, for the reasons outlined above, because the Stupal, Amendment bars the subsidization of 

plan administration activities in connection with prohibited procedures, it can be expected to chill the 

development of abortion coverage supplements as well as entirely separate plans to non-subsidized 

women. The refusal of plans to engage in plan administration in connection with broader coverage 

arrangements may also begin to affect access to abortion coverage in states that voluntarily offer such 

coverage under Medicaid ifplan administrators seek to avoid coordination of benefits activities across 

basic and supplemental coverage 

18 Congressional Budget Office. Letterto Rep. Dingell. Nov. 6. 2009. Available at 

ht1p.jj:'l·DJ", .. cl!~") .. g:o!.!ttp.rt(tC~.a..Q.720..'9oC;U,)?1J)/!Jl.:i't.(~2.Ril],g~.lL.mg~:",.8.U1.~l1@J.~11LnIJfli.jj;e_J24f· 
95 

The Shlpak/Pitts Amendment 

November I (). 2009 

10 

Finally, the Amendment can be expected to have spillover effects on plan administration activities in 

connection with abortions related to women with serious health conditions that result in abortion, even 

where abortion is not the primary treatment sought, which may result in the denial of coverage for a 

broad range of medical treatments. This result flows from the difficulties associated with administering 

exclusions tied to a limited range of medically indicated procedures 

1. Impact on currently uninsured women and women who are employees (or spouses or dependents of 

employees) of small businesses 

Of the 12.02 million women ages 18-45 who are classified as uninsured under the 2009 Current 

Population Survey, more than 10.5 million have family incomes below 400% of the federal poverty 

level,l,) the income cutoff for subsidies in the Senate Finance Committee measure. 20 These women 

-will qualify either for coverage through Medicaid or for a subsidized exchange product. They will be 

barred from enrolling in plans with abortion coverage exceeding Hyde Amendment or Stupak/Pitts 

Amendment restrictions. States might subsidize a broader range of abortion procedures for these 

women, but the StupaklPitts provisions barring the commingling of funds in relation to plan 

administration may lead plans to resist coordination of benefits efforts with state programs. A plan that 

cooperates with a state Medicaid agency may be determined to put its own exchange or federal 

employee benefit plan participation at risk. 

The small number of more affluent women (those earning too much to qualify for a subsidy) who gain 

access to individually-purchased exchange products might be able to afford to purchase supplemental 

coverage for additional medically indicated abortion procedures (if such a supplement exists) or a 

supplemental plan. But the StupaklPitts Amendment effectively requires that this additional coverage 

be administered separately from other plans. As a result, the cost of the supplement or the separate plan 

could be expected to be far higher than simply the cost of the additional procedures, as noted above. In 

other words, compared to other conditions, the cost of supplemental coverage for certain medically 

indicated abortions would be disproportionately high because of the additional administrative expenses 

resulting from the Amendment. This added cost can be expected to drive down the market, leaving 

women in need of these procedures with serious financial exposure 

Medically indicated abortions carried out early in pregnancy may be relatively inexpensive But the 

cost of abortions performed later in pregnancy and as part of other treatment for serious health 

conditions could be considerable. Indeed, medically indicated abortions carried out later in pregnancy 

and flowing from underlying health conditions or severe fetal abnormalities can carry a price tag in the 

thousands of dollars. 21 With the risk of cost for these conditions effectively excluded from the larger 

risk pool, the cost ofa supplement or a plan that carries additional coverage could be considerable 

Women covered through small employers that elect to purchase coverage through the exchange would 

confront the same barriers as individual women who do not receive subsidies Approximately 36 

19 US. Ccnsus Burcau, Current Population Surycy. Atlliual Social and Economic Supplement 2009 

JI) America's Healthy Fnhlre Act of 2009. S. 1796. Illth Congo (l st Sess. 20(9). Sec. 1206 

21 Stanley Hcnshmv and Lmyrencc Finer, l'he Acccsslbllil)' of.,.J.borfion Sen'lces 111 the ['l1lted Srares, 200J. PerspectiYes on 

Sexual and Reproductiye Health. 35(1):16-2+ (2003) (nonhospital surgical abortion charges ranged up to $3000 at 16 

,\ eeks and $2000 at 20 weeks): Agency ror Healthcarc Research and Quality. National and regional estimates on hospital 

use for all patients from the HCUP Natiomvide Inpatient Sample. 2007 (mean charges for threatened abortion. abortion 

withoutD&C and abortion ,vithD&C aspirdtion curettage or hysterotomy "ere $9.964 to $13.802). 
96 

The Shlpak/Pitts Amendment 

November I (). 2009 

11 

percent of employees work for small employers (those with 99 or fewer employees).22 If it is assumed 

that the figure is comparable for women and men, then millions of women who today derive coverage 

through small employers might be affected, depending on the extent to which small employers switch 

to exchange purchasing. 23 

To the extent that small employers migrate into the exchange system (as envisioned), the impact on 

employer-sponsored abortion coverage could be considerable as smaller employers that now regularly 

include abortion coverage in their plans move into a market in which similar plans may no longer be 

available unless specially marketed either as more comprehensive plans or as more limited plans linked 

to an abortion supplement Simply put, the market for these women is highly speculative. Because the 

bills contemplate opening the exchange to employer plans of increasing size over the years,24 the 

impact of the Stupak/Pitts Amendment on women with employer-sponsored coverage could be 

dramatic, especially since there is no indication that companies would develop comprehensive or 

supplemental products that cover a wider range of medically indicated abortions 

To be sure, a migration over time of thousands of smaller employers might encourage health benefit 

services companies to create supplemental abortion coverage products or offer plans that provide for 

more generous abortion coverage. But two facts militate against this. The first is the virtual nonexistence of supplemental coverage products to date in states that bar the sale of products that offer 

abortion coverage. The second is that in contrast to a program such as Medicare Part D, which creates 

supplemental coverage for an entire class of benelits (prescription outpatient drugs), no federal policy 

will offer a financial stimulus for the creation of such a market Indeed, federal policy is designed to 

push the price of supplemental coverage higher by prohibiting the integration of administration costs 

into a single administrative scheme. 

2. Impact on women covered by large employers outside of the exchange 

Ostensibly the StupaklPitts Amendment does not have a direct elIect on large employers operating 

outside the exchange. At the same time, the Senate Finance Committee measure allows subsidies for 

individuals for whom employer coverage is not affordable or whose employer plans have low actuarial 

value. The interaction between public support to persons covered under ERISA plans and the 

Amendment is unclear. Even were a bright line to be maintained, with such individuals removed from 

their plans and enrolled in exchange plans, the interaction between the markets could further dri ve the 

industry to shift away from current abortion coverage nonns and toward product designs that meet 

exchange and Hyde Amendment requirements 

~2 U.S.Censils Bureau. Statistics <Ibout Business Si/.e (including Small Business). Emplo)ment Si/.e or Employer and 

Nonemployer Finns, 200-1-

~j Bureau ofL<lbor Statistics. Labor Force Statistics from the Cnrrent Popultltion Survey. 2009. (There are approximately 

67 million women over 16 currently in the vvorkforce, ofvvhich 36 percent may be assumed to \york in small businesses.) 

~·1 The House bill would permit employers with more than 50 employees to participate in beginning in20!5 and the Senate 

Finance Commillee's bill \\ ould penni! states to open their exchanges to large rinns \dth 0\ er 100 employees starting in 

2017. Affordable Health Care for America Act. H.R. 3962. 1111h Congo (1 ,I Sess. 2009), Sec. 202(c)(3); Ameriea's Healthy 

Future Aet of2009, S. 1796, ll1th Congo (1't Sess. 2009). Sec. 1101 (new See. 2230(a): 2235(d)) 
97 

The Shlpak/Pitts Amendment 

November I (). 2009 

3. Impact on the health benefit services industry 

WithdraH'ing coverage qfmedicalfy indicated ahort;onsfrom alf markets 

12 

For the reasons noted above, health benefit services companies operating in either the Medicaid or 

exchange markets could be expected to resist offering coverage supplements or broader plans, since 

the legal and technical complexities of doing so far outweigh the potential market for the products. Not 

only would companies have to absorb all costs of administration into the supplemental or separate plan 

fee, but companies would confront having to expand provider networks to assure access to the full 

range of medically indicated abortions in the case of women who purchase expanded coverage. Health 

care providers can be expected to resist participating in supplemental networks if only because they 

will resist making their services available to some but not all of their insured patients, without any 

clear idea of which patients have which level of coverage. Furthennore, companies that offer 

supplemental coverage or separate plans may find extensive unwillingness to participate among 

providers that refuse to furnish abortions~ while the legislation prohibits plan discrimination against 

providers that refuse to furnish abortions, it does not protect plans from providers who refuse to join a 

plan that offers broader coverage for medically indicated abortions, even if the provider does not have 

to furnish the treatment 

Furthennore, as the proportion of women of childbearing age covered by an abortion-related treatment 

exclusion grows, companies offering coverage products in the employer-sponsored market ultimately 

may elect to simply remove the procedures from their products so that they can be sold in all markets 

Under these circumstances, what is the norm today in the employer-sponsored market - broad 

coverage of medically indicated abortions - is likely to narrow considerably as the industry seeks to 

restructure its product design to meet the most restrictive demands. If this consequence flows, then the 

industry, confronting the challenges of distinguishing between enrollees for a handful of covered 

procedures and specific conditions, can be expected simply to eliminate certain procedures and 

conditions from coverage altogether, leaving women and families exposed. 25 

The .spillover problem of cOI'erage denials where the need for all abortion is secondary to the 

treatment (?f a medical condition 

An additional consideration is the potential for spillover effects from the administration of an exclusion 

that imposes a life-threatening coverage standard. If the entire industry moves to this life-threatening 

standard, it is likely that all women will risk coverage denials, regardless of the market in which their 

coverage is obtained. 

StupaklPitts and Hyde, for that matter, presume that abortion is the immediate subject ofthe claim for 

coverage. In these cases, plan administrators must make complex decisions about whether treatment is 

for a life threatening condition or one that threatens health. But difficulties mount where the abortion 

procedure is part of broader treatment for a serious health condition, essentially an unfortunate 

downstream consequence of upstream treatment for a significant health problem, leading to the 

unwanted loss of a pregnancy. In these circumstances, how are plan administrators to distinguish 

bernreen the abortion procedure and the rest of the treatment? Will the entire cost of a course of 

treatment (e.g., surgery to repair a damaged pelvis following an automobile accident) be denied if 

~'i Interview \yith Robert Laszewski. Health Bill Abortion Clause May Derail Insurance, Julie Royner. XatlOnai Public 

Radio. Noyember 1~. 2009 
98 

The Shlpak/Pitts Amendment 

November I (). 2009 

13 

abortion is part of the procedure? Health plan administrators, confronted with the prospect of a legal 

violation for paying for the excluded abortions, may elect to deny the treatment altogether, claiming 

that it is all related to the excluded treatment. As the denial is appealed, the financial consequences for 

patients potentially will be enonnous 

This tendency to exclude entire classes of treatment where coverage of a particular treatment for a 

particular underlying condition is excluded can be seen in the case of mY/AIDS, where the exclusion 

typically runs not only to IllV/AIDS itsel( but also to conditions and health problems that are 

considered "AIDS-related."" High risk pregnancies themselves could be identified as potentially 

abortion-related. Conditions such as diabetes (observed in 1% of pregnancies27) which are poorly 

controlled can lead to serious health consequences for both the woman and the fetus, including major 

congenital abnonnalities, and a higher risk of spontaneous loss, which might in turn trigger an abortion 

if the pregnancy cannot be saved. Management of recurrent pregnancy loss28 or complicated multifetal pregnancies (increasingly prevalent with widespread use of assisted reproductive technologies) 

may also be considered abortion-related conditions. Similarly, uncontrolled hypertension, trauma 

during pregnancy, seizure disorders and other conditions, all require complex management29 and may 

persist beyond the pregnancy, and may result in abortion-related care. These concerns have increasing 

individual and public health consequence as age at pregnancy ~O, body mass index and associated 

metabolic and cardiovascular abnonnalities, Cesarean section rates, multi-fetal pregnancy rates, and 

use of assisted reproductive technologies31 have all increased dramatically in recent years. 32 

Additionally, in response to more limited access to abortion services, there may be an increase in selfinduced abortion, potentially through increased self-administration of misoprostol. Coverage for 

treatment of complications such as hemorrhage and incomplete abortion in such cases could be denied 

Thus, as an increasing proportion of the market for health benefits becomes subj ect to exclusionary 

regulation, coverage for all women can be expected to diminish industry-wide. Moreover, plan 

administrators, cognizant of the exclusionary ret"rulations under which they operate, may be more likely 

to broadly interpret the exclusion in order to avoid the sanctions of being barred from the market or 

losing the right to collect subsidies. Since there is no similar sanction for improper claims denials other 

than to reinstate the coverage following a successful appeal, the risks all weigh in favor of overly broad 

interpretation of the exclusion 

~f, McGmm v. H ~:Uld H Music Comp,my, 9-l-6 F. 2d 401 (Sill CiT.. 1991); Doe Y. Mutual of Omaha. 1798 F. 3d 557 (7111 Cir 

19(9), cert. den. 528 U.S. II or) (U .S. Jan. 10, 20()O) 

~' American College of ObstetricimlS and Gynecologists. Pmctice Bulletin, Number 60, Pregesrariollal Dlaberes .:.\Jenitus', 

March 2005 

~8 Americall College or Obstetricians and Gynecologists. Pmctice Bulletin. Number 2-1-, Ma11(}gement or Recurrent 

Pregnancy Loss. Febmary 2001 

:9 Guidelines ror Perinalnl Care: American Academy or Pediatrics and the American College or Obstetricians and 

Gynecologists, pp 175-203,2008 

30 Bet\\een 1991 and 2001 the number or rirst births per 1000 women 35 to 39 years or age increased 16% and 70% ror 

women agcd 40 ----J.-l- years. National Vital Statistics Systcm, alUlUal file; 2003 

hnl)j.61J~:}Y _l:dG. gQYI~~lllJ',}~:r/ll.r'f:ij:S:;lYWltJ~:rl·'T_n!I/mm~·l:LrL1t I1tm '1 TI1C reported number of ART cycles has increased from 6-l-,681 to 13-l-,160 ART cycles in 1005, 1Uld from 1-1-.507livcbirth deliyerles in 1996. to 38.901 in 2005. Centers for Disease Control and Prevention. 2005 Assisted Reproductive 

l'eci1l1%gv r:1JUj Report: ,','eellOn 5- . lIn l'rend.\ J996-](}()5, Atlanta: Centers ror Diseasc Control and Prc\cntion: 1007 

,2 Luke. B., & BrmnL M. (2007). Eleyated risks of pregnancy complications and adverse outcomes \\ith increasing 

maternal age. IIuman Reproduction. 22(5), 126-1--1272 
99 

The Shlpak/Pitts Amendment 

November I (). 2009 

Conclusion 

1-1 

One of the great challenges in insurance refonn is the unintended consequences of regulation The 

StupaklPitts Amendment is intended to reach only a specific part of the market But the cumulative 

effect of the provision, in combination with existing federal laws governing Medicaid and federal 

employee health benefits Cas well as the law of certain states) inevitably can be expected to move the 

entire health benefits industry away from its current inclusive coverage nOTInS and toward a new norm 

of exclusion. The provisions of the legislation, as well as the technical challenges that arise in benetits 

administration, militate against the creation of a supplemental coverage market Thus, if the result of 

national health reform is to move millions of women into a market that operates subject to the 

exclusion, then it is fair to predict that the entire market for coverage ultimately will be atlected as a 

product tipping point is reached and virtually no supplemental market appears 

In addition, given past experience and the sanctions that arise from a violation, it is reasonable to 

predict that in interpreting and applying the exclusion, health plan administrators will err on the side of 

coverage denial. This is because the legal risks associated with coverage detennination are all on the 

side of incorrectly awarding coverage, not erroneously denying it. This balancing of risks can be 

expected to lead insurers to calibrate coverage determinations in a way that works against women 

whose medical conditions ultimately lead to an abortion that they never willingly sought 
100 

Dear Representative: 

The undersigned organizations strongly urge you to oppose the deceptive "No Taxpayer Funding 

for Abortion Act" (H.R. 7), a bill designed to fundamentally alter the health insurance market -

from a market where abortion coverage is the industry standard to one where abortion coverage 

is eliminated. H.R. 7 does this by changing the laws that govern both private and public 

insurance and by twisting the tax code into a tool to take away abortion coverage from women 

who have it. This bill would not only raise taxes for many women and businesses, but it could 

also require "rape audits" in which women have to prove to the IRS that they were raped. 

Ultimately, this bill is designed to deny women the decision whether or not to have an abortion 

by taking away their insurance coverage. 

H.R. 7 twists the tax code into a tool to take away health insurance coverage that women 

have today. For example, the bill would deny millions of women and families premium 

assistance tax credits if they purchase a health insurance plan that covers abortion. The bill 

would force these women to forego a health insurance plan that includes abortion in order to get 

the premium assistance they need. 

H.R. 7 would also raise taxes on small businesses by denying the Small Business Health Tax 

Credit to businesses that offer health insurance that covers abortion. This credit was created to 

encourage small businesses to offer health insurance to their employees by making it more 

affordable This bill would penalize employers for choosing comprehensive coverage for their 

employees and their families. 

H.R. 7 also has severe consequences for women who experience sexual violence. Incredibly, 

a rape or incest survivor seeking to include the cost of an abortion in her medical expense 

deductions or to use tax-advantaged savings to pay for the service may have to provide evidence 

of the rape or incest if audited by the IRS. Such "rape audits" are a level of government 

intrusiveness into an individual's private and personal life that is not only unacceptable, but is 

highly inappropriate. 

Finally, H.R. 7 would endanger women's health by eliminating abortion coverage in both 

the private and public insurance markets. This is particularly true for women underserved by 

the health care system and women with health problems, even in circumstances where a woman 

needs an abortion to prevent severe, permanent damage to her health. Because H.R. 7 provides 

no health exception, it would leave women whose health is seriously threatened by their 

pregnancies without access to the care their doctors recommend to protect their health 

The legislation would also codify harmful legislative riders that deny women access to public 

coverage for abortion. These riders include those that deny the District of Columbia the ability to 

decide whether to use its own local funds to provide abortion coverage and the restriction that 

bans Medicaid from including abortion coverage, both of which disproportionately affect women 

of color and low-income women. 
101 

In summary, H.R. 7 would deny millions of women the ability to make their own decision 

about whether to have an abortion by eliminating private and public insurance coverage 

for it. H.R. 7 is a dangerous bill that jeopardizes women's health by directly banning abortion 

coverage, by raising taxes on families and small businesses that purchase comprehensive 

insurance coverage, and by putting women who have survived sexual violence through intrusive 

tax audits. We strongly urge you to reject this bill. 

Sincerely, 

Advocates for Youth 

American Association of University Women (AAUW) 

American Civil Liberties Union 

American Public Health Association 

American Society for Reproductive Medicine 

Asian & Pacific Islander American Health Forum 

Association of Reproductive Health Professionals (ARHP) 

Black Women's Health Imperative 

Catholics for Choice 

Center for Reproductive Rights 

Choice USA 

Feminist Majority 

Hadassah, The Women's Zionist Organization of America, Inc. 

Jewish Women International 

Joint Action Committee for Political Affairs 

Methodist Federation for Social Action 

NARAL Pro-Choice America 

National Abortion Federation 

National Asian Pacific American Women's Forum 

National Center for Lesbian Rights 

National Council of Jewish Women 

National Family Planning & Reproductive Health Association 

National Health Law Program 

National Latina Institute for Reproductive Health 

National Organization for Women 

National Partnership for Women & Families 

National Women's Health Netvliork 

National Women's Law Center 

People For the American Way 

Physicians for Reproductive Health 

Planned Parenthood Federation of America 

Population Connection Action Fund 

Population Institute 

Raising Women's Voices for the Health Care We Need 

Religious Coalition for Reproductive Choice 

Religious Institute 

Reproductive Health Technologies Project 

2 
102 

Sexuality Information and Education Council of the US. (SIECUS) 

Unitarian Universalist Association 

Unitarian Universalist Women's Federation 

United Church of Christ, Justice and Witness Ministries 
103 

C A THOLICS 

' 0" 

C H O I CE 

I N GOOo CONSCIENCE 

Janual)'l1,2014 

US Hou~ of Resm~tatl .. , 

Commitu.o. 00 1M JudiciaI)' 

Subcommlnoe on the Conn;wt",n and Ovil ,Ju'tice 

H2·362 Fo,dHoo~ Offl<:e8ulldlng 

W~'hlngton. DC 20515 

I wt1te to >lrongl~ e oo>u'l9l!)"OU and)"OU1 fellow wlxomm~toe memben to ~ 

HR 7. the "NO Ta'paye, Funding f<)T AOOrtion At:t" ,ponWfed by Repr=ntati"" Ch,1< 

Smith IR·NJ), wt.lch I. ~ng ~ard In wbcommltt"" today, for 40 YNI" Catholic, for 

Choke h~ served .u voice for catholics who believe Ihat ou, faith'.teadling, 

demand tim twry Individual mu<l follow his or tt.:, own con<c"nce~.nd .-.s~ 

othe,,' right to do the ... me, We "and with thf: majority of the more than 10 million 

C.tholic< In the United St.t ... wlto .... won access to .-.prod"'tive tt.:althare ~rvIc ... 

for ttt.:m~lves and their r.eighbors and who oppo~ to this ha,s.t\ and ",st,leU"" bl l, 

~nQn cathol'lCS. in ru ll itC(or(!a~ with ttt.: I('achlrogs ofou, faith, IUpport the 

right ofw()m('n and men to follow tP>elr own con<cien<es wilen mal:!ng critical Il10<0 1 

eled.ions. Inc luding deC""". boul ",productive IIN t~,e. In doing >0. catholic< ".nd with the majority of ~r (lns. who want heal\hca,e dedslons to be made by 

patien", accordirog to their own <Of'I<cience. and In conlUl ta~on with the medical 

profes<lonol .. 1oved on ... or dergy they chao .. t<, Involve-not restricted by 

legl,lato" witl>out knowledge 01 thf: >'f1$On,)1 circumstances inllOived. catholics 

expeCl OU' elected officials to " and up for the consdtn<e 01 evel)' IIIdlvldual. 

includlrog the million. of W<>ITt.., who will .uff..-If thl< legislation" allowed to pa .. , 

Nationwide, wt.en catholic VOl ..... con.lde,ed hea lthca.-. reform In 2009,' mljorfty 

IUpponed IINlth I"", .. nce co_age (tlth ... public Of prr.-.Ie) for abort",,, in most 

drc"mot.nee<.: when a Plegnancy poses a th,eat to the lik! of a woman (84 perc ); 

when 'p'egnancy Is due to rape Of Incest (76 >'f,cent~ w!>en ~ pregnancy pose. longtt<m tt.:Jkh risks for. wornatI (7] percen!); when tMt 1tIU~' <how. ws has ...... "'e 

abnormal condit",n (66 perc",,!); and wh...,....,r a women and M-r doctor deckle ~ I. 

apprepri<ne (50 percent}.'ln Florida a 2012 stite oon<lIMIOt\iI ""ltndment <ee1<irog to 

Impose sorr>e of the same rescricUoous HR 7 at the state 1e';eI .... , ""'IIdIy defeated 

by a strong majority (55 perc..,t),' According 10 ~It poIlirog, thl< Included 

approximately 1 mi llion Florida CilthoIics.· 

'!li"~""'W ~ ... )O' "i"'~ OClOOO'l "'~H'H09J ~_~H)I·1fH <1<_"", __ """000-__ .",,, 

"<C~T'~< 

~'C' "'''<N' 

~-... ,,,,,, -.... ~,-

..... ,,""""-""" 

~,­

-~ 

-~, 

-----,-,,--

,-
104 

In contrast to this public support for protecting access to these services, HR 7 instead disrespects 

women's consciences and religious liberty rights, particularly those of lower-income and marginalized 

women. Contrary to our Catholic social justice tradition, this legislation would permanently impose 

unreasonable obstacles to safe and legal healthcarefor American women who access care through 

our nation's safety net programs. These include women serving in the military or from military 

families, women who seek care through the Indian Health Service and women whose insurance is in 

any way affiliated with the federal government. Placing additional delays and burdens before these 

women is unjust and demonstrates a cruel disregard for women's human dignity. 

In addition to its assault on the dignity and conscience rights offamilies struggling to make ends 

meet, this legislation would unjustly hinder the consciences of women who wish to purchase health 

insurance for comprehensive reproductive health care, OrlO use their private health spending 

accounts to cover the cost of abortion care, penalizing them simply on the bas.is of how they receive 

their insurance. If adopted, HR 7 would also inappropriately interfere with the budgetary autonomy of 

the District of Columbia and intrude upon theconsciences of all women living or seeking medical care 

in DC. 

Most importantly, HR 7 does not answer the problem it purports to resolve. The bill will create more 

challenges, hurdles and barriers for American women and cost American taxpayers-your 

constituents-more in uncompensated healthcare costs that result when people cannot access safe, 

affordable and reliable healthcare when they need it. 

This legislation attempts to use our nation's tax and health insurance systems as bludgeons with 

which to impose the personal views of its sponsor upon all American women. Congress should have 

no part in compounding the difficulties of women's lives in service of a political agenda and should 

instead respect each woman's right to follow her conscience, no matter how she accesses healthcare 

or insurance. 

The stance oftwo witnesses from whom you will hear today is not shared by the majority of Catholics 

in the United States. The bishops' position-opposing abortion in every instance, even in cases of 

rape, incest or when an abortion is necessary to preserve a woman's health or Hfe-is shared by fewer 

than 15 percent of American Catholic voters/"and according to the bishops' own polling, by only 1 1 

percent of the American populace. Those supporting this bill do so because it furthers their ultimate 

goal of making it impossible for women who need abortions to receive the care they need. The 

bishops have failed to convince Catholics in the pews of the value of their anti-reprodudive health 

agenda, and are now seeking to use civil law to impose their beliefs upon all people. 

Catholics support healthcare that is both accessible and comprehensive. Our Catholic social justice 

tradition encourages us to advocate for the poor, and our intellectual tradition requires our respect for 

the conscience-based decisions people make about their lives, including decisions about reproductive 

health. Our commitment to religious liberty further requires that we respect the right of individuals to 

follow their own beliefs and practices, without having others' beliefs forced upon them. 

As a result, Catholics support policies that enable women to make decisions about theirfuture and the 

future of their families, each according to her own conscience or faith tradition, and no matter how 

they receive their insurance. Large majorities of Catholic voters support access to and coverage for 

abortion-either in private- or government-run health systems. Catholic support for reproductive 

healthcare is grounded in the core principles of Catholicism, which respect the moral agency of all 

people and their right to follow their consciences on all matters. 

Catholics for ChOice, Page 2 of 3 
105 

I ask you to appreciate the breadth of Catholic opinion on these issues and not be taken in by false 

claims about this bill's intent or about what Catholics truly believe. I urge you to oppose HR 7 and to 

speak out for those who would suffer if this bill's uncompromising agenda is enacted into civil law. 

Now more than ever, your voice is critical to preserve our freedom, 

Sincerely, 

Jon O'Brien 

President 

I Belden Russonello & Stew<lrt, "Catholic Voters' Views on Health Care Reform and Reproductive Health. Care Services: A 

National Opinion SmveyofCatholic Voters," September 2009. 

II CNN Politics America's Choice 2012 Election Center, "Florida Amendment 6: No Public Fundsfor Abortion," 

http://www.cnn.com/election!20 12!resu Its/state/FL/ballot/02. 

III CNN Politics America's Choice 2012 Election Center, Florida PreSidential Election A.esults 

http·l!www.cnn.com/election/20 12/resu Itslstate/FL/president. 

I~ Belden Rlissonello & Stewart, "CatholiC Voters' Views on Health Care Reform and Reproductive Health Care Services: A 

National Opinion Survey of Catholic Voters," September 2009. 

Catholics for Choice. Page 3 of 3 
106 

VINCENT C. GRAY 

MAYOR 

January 8, 2014 

The Honorable Trent Franks 

Chainnan 

House Judiciary Committee Subcommittee on 

the Constitution and Civil Justice 

2138 Rayburn House Office Building 

Washington, D.C. 20515 

Dear Chairman Franks: 

I write to express my outrage with legislation that is pending before the House of Representatives, H.R. 7, 

which contains language extremely offensive to the District of Columbia. H.R. 7 pUrpOlts to limit the use 

of taxpayer funds for a constitutionally protected activity, bul in truth, it goes much further in its effects 

on the District of Columbia. The language used in the bill convelis the District into a Federal property for 

the first time in its history. This unprecedented affront to tbe soverei6'l1ty of a local and state government 

would never be contemplated anywhere else in lhe United States. Yet, the District is particularly singled 

out in the bill for such treatment. 

This effort to alter tbe entire status of the District Government is truly beyond the pale. The District of 

Columbia is comprised of nearly 650,000 people who deserve the same rights as other citizens and 

residents of their nation. The foundation of our great country is resistance to oppression while promoting 

freedom and democracy. Given the principles upon which tbis nation was founded, and America 

contrives to promote steadfastly world-wide, how can you justify the disparate and disrespectful treatment 

to which District residents are subjected? 

The Constitution guarantees every citizen of age a direct line of communication to tbe highest levels of 

our representative government so that their interests are always heard and protected. Our interests are not 

being protected; they are being stripped from us. As an elected member of the national government, we 

implore you not to further encroach upon the rights of the people who live in our city. 

I cannot urge you strongly enough to remove the nation's capital from this bill. We are not a mere 

component ofthe federal government; we are the District of Columbia. 
107 

ACLU 

AMERICAN CIVIL UBERTIES UNION 

HIE: AMERICAN CIVIL LlBERTI.ES UN ION 

WRllTEN STATEMENT FOR A HEARING ON 

II.R. 7. 11If' No TII_1pa)'tr Funding for Abortion A(I 

TO THE 

~o rllrlliu ~ orl tht Constillltion a nd Civ;1 JuSl~t 

The Commiu« on the Judiciary, U.S. House of Reprtsenlali,-es 

January 9.2014 

La ura W. Mu rphy. Dir1'Clor 

ACLU Washington legislative Ofiice 

Sarah Upton-Lube!, Polky Coun 1 

ACLU Washin,!l1on Legislative Oflice 
108 

On behalf of the American Civil Liberties Union (ACLU), a nonpartisan public interest 

organization dedicated to protecting the principles of freedom and equality set forth in the 

Constitution and in our nation's civil rights laws, over a half million members, countless 

additional activists and supporters, and 53 affiliates nationwide, we would like to thank 

Chairman Franks, Ranking Member Nadler, and members of the Judiciary Committee's 

Subcommittee on the Constitution and Civil Justice for the opportunity to submit a statement for 

a hearing on H.R. 7, the so-called No Taxpayer Funding for Abortion Act. 

The ACLU opposes H.R. 7 because it further entrenches discriminatory laws that deny 

abortion care to women who rely on the government for their health care. The bill also extends 

these unjust prohibitions into the new health care exchanges in an unprecedented attempt to 

greatly undermine, ifnot eliminate, the insurance market for abortion, and rewrites the tax code 

to penalize abortion care. Abortion is basic health care for women and a right protected by the 

United States Constitution. Congressional interference in women's private decision-making, as 

embodied in this bill, is wrong, harmful and discriminatory. 

1. H.R. 7 Makes Permanent Discriminatory Restrictions on Abortion 

The bill currently before the Subcommittee provides that "no funds authorized or 

appropriated by federal law, and none of the funds in any trust fund to which funds are 

authorized or appropriated by federal law, shall be expended for any abortion." This language is 

intended to codify current abortion restrictions on appropriations bills and would do away with 

Congress' need to consider each year riders that harm women by singling out and excluding 

abortion from a host of programs that fulfill the government's obligation to provide health care 

to certain populations. In so doing, the bill would permanently deny millions of women, 

including Native Americans, Peace Corps volunteers, women eligible for Medicaid, and women 

in federal prisons, access to abortion care except in very limited circumstances. 

The inequity caused by these restrictions is almost as old as the constitutional right to 

abortion itself and was opposed by the ACLU from the onset. Although Medicaid originally, 

and appropriately, covered medically necessary abortions, access came under attack in 1976 with 

the adoption of the Hyde Amendment, which was blocked for nearly a year by an injunction 

obtained by the ACLU, Planned Parenthood, and the Center for Constitutional Rights, who 

challenged the law on behalf of a pregnant Medicaid recipient and health care providers in 

McRae v Mathews. l Although the Supreme Court would later uphold the Hyde restriction, the 

1 See 421 F. Supp. 533 (E.D.N.Y. 197G). The United States Supreme Coun vacated the injunction in August 1977 

after issuing t\VO decisions that upheld state limitations on the use of public funds for abotiioll. Three years later, the 

Com1 would uphold the constitutionality of the Hvde Amendment. See Hanis v. McRae, 448 U.S. 297 (1980). The 

ACLU has also initiated and supported legal battles in state courts to ensure abOltion access for Imv-income \vomen 

affected by these ftmding restrictions See Access Denied: Origins oj the fZvde Amendmem and Other R(;'striC:lions 

2 
109 

devastating and detrimental impact it has had on low-income women's exercise of a fundamental 

right cannot be denied. As a result of Hyde and its progeny, women who rely on the government 

for their health care do not have access to a health care service readily available to women of 

means. A woman who does not have independent financial resources must scramble to raise the 

necessary funds, delay receiving abortion care (which can increase the medical risks and costs) 

and can be left with no choice but to carry to term in circumstances where she is physically, 

emotionally, mentally and t1nancially unprepared to care for a child. 

The Hyde Amendment and similar bans should be repealed-not made into pennanent lawbecause they are discriminatory and harm women's health. If a woman chooses to carry to tenn, 

Medicaid (and other federal insurance programs) offers her assistance for the necessary medical 

care. But if the same woman needs to end her pregnancy, Medicaid (and other federal insurance 

programs) will not provide coverage for her abortion, even if continuing the pregnancy will harm 

her health. The government should not discriminate in this way. It should not use its power of 

the purse to intrude on a woman's decision whether to carry to tenn or to terminate her 

pregnancy and selectively withhold benefits because she seeks to exercise her right of 

reproducti ve choice in a manner the government disfavors. 

Justice Brennan's words about the Hyde Amendment apply equally to the bill currently 

before the Subcommittee: 

"the Hyde Amendment is a transparent attempt by the Legislative Branch to impose the 

political majority's judgment of the morally acceptable and socially desirable preference on a 

sensitive and intimate decision that the Constitution entrusts to the individual. Worse yet, the 

Hyde Amendment does not foist that majoritarian viewpoint with equal measure upon 

everyone in our Nation, rich and poor alike; rather, it imposes that viewpoint only upon that 

segment of our society which, because of its position of political powerlessness, is least able 

to defend its privacy rights from the encroachments of state-mandated morality.,,2 

Indeed, Rep. Henry Hyde was clear about his intent, explaining that "[he] certainly would 

like to prevent, if [he] could legally, anybody having an abortion, a rich woman, a middle-class 

woman, or a poor woman. Unfortunately, the only vehicle available is the .. Medicaid bill.,,3 

With H.R. 7, abortion opponents are pursuing a new, sweeping vehicle 

on Public FundingforAbortion, AlvI. Cr'nLLIBERTIES U::\IO::\ (Dec. L 1994), https:!/ww\v.ac1u.org/reproductivefreedom/access-denied -origins-hy de-amendment -and -other -restrictions-public-funding -abor 

'Han'is v McRae, 448 U.S at 331 (I3rerman, J., dissenting) 

~ Heather D. Boonstra, The Heart of fhe' A1alf(:T: Public Funding ofAborlion jor Poor Women in llle Uniled ,')'Iale8, 

10 GUTI'cIACIIER POL 'y REv. 12, 12 (2007), available at http://www.guttmacher.oI2/pubs/gprIl01l/gprlOOI12.pdf 
110 

2. H.R. 7 Makes Permanent the District of Columbia Abortion Ban, Disenfranchises 

and Marginalizes D.C. Residents and Denies Women of Color Access to Basic 

Health Care 

Although under current law federal funds may not be used to cover most abortions, states are 

free to include coverage for abortion in their medical assistance programs if they pay for it 

themselves. This is true under H.R. 7 as well. The only exception is the District of Columbia. 

H.R. 7 makes pennanent a provision-lifted by Congress in 2009 but reinstated in 2011-

that violates the District's autonomy and forbids it from choosing for itself whether to use its 

own locally raised non-federal dollars to provide coverage for abortion for its low-income 

residents. 

Tn 1980, the Supreme Court held that the Hyde Amendment's restriction on federal Medicaid 

funding of abortions was constitutional despite its devastating impact on low-income women. 

But at the same time the Court also ruled that state and local governments were still free to pay 

for abortion for low-income women with their own funds. The Court stated that "a participating 

state is free, if it so chooses, to include in its Medicaid plan those medically necessary abortions 

for which federal reimbursement is unavailable." 

In recognizing the limited federal role in establishing local health policy, the Supreme Court 

placed the primary fiscal responsibility for funding abortions with the state legislatures and, in 

the special case of the District of Columbia, with the District government. In fact, numerous 

states currently use their own, non-federal funds, to provide medically necessary abortions. 

Congress does not order New York, California or Arizona not to spend local tax dollars on 

abortion and it should not do so with the District 

In 1973, Senators and Representatives holding widely divergent political views, also 

recognized that the citizens of the District of Columbia had been denied the most basic privilege 

enjoyed by all other Americans - the right to elect those men and women who will control their 

local governments. They enacted the Home Rule Act to "grant to the inhabitants of the District 

of Columbia powers of local self-government. .. and relieve Congress of the burden of legislating 

upon essentially local District matters.'" The Home Rule Act was viewed by many as a key civil 

rights victory for the predominantly Atrican American residents of the District. 

With the enactment of home rule, Congress clearly recognized the importance of allowing 

the District's leadership and residents to exercise control over their municipal atTairs. While the 

scope of the local legislative prerogative has never been precisely defined, the Supreme Court 

4 District of Columbia Self-Govemment and Govemmental Reorganization Act, Pub. L. No 93-198, 87 Stat. 774, 

777 (1973) 

4 
111 

has held that our system oflimited federalism reserves certain subject areas, including fire 

prevention, police protection, sanitation, public health, and parks and recreation for state and 

local decision-making. The provision of services to pregnant women-including abortion care--

is clearly a matter of local public health policy intended to be left to the District of Columbia 

under home rule. Congress should respect the democratic process in the District and respect the 

choices its residents and leaders make. 

As one member of Congress noted, "the government of the District of Columbia representing 

the wishes of its citizenry must ... be able to choose how to spend its revenues collected through 

property and income taxes and other sources.'" 

The D.C. abortion ban is antithetical to the spirit of the Home Rule Act. Measures such as 

the abortion ban serve only to disenfranchise and marginalize the District's leaders and residents. 

Through this provision, non-resident Members of Congress impose their own ideology upon the 

District's residents and utterly disregard the needs or wishes of the broader community or those 

directly impacted. Most egregiously, those who seek to negate the will of the District's residents 

or leaders are not accountable to the people of the District. That which they could not do in their 

own home districts, they do with impunity against the residents of the District. Measures such as 

the abortion ban erode and undermine such progress and accentuate the voicelessness of those 

residing in the District. 

3. H.R. 7 Imposes an Abortion Coverage Ban in the New Insurance Exchanges 

The Patient Protection and Affordable Care Act (ACA) created new state-based market 

places called exchanges for individuals and small businesses to buy health insurance. HK 7 

would revive the so-called Stupak Amendment, rejected by the 111th Congress, which would bar 

anyone receiving a federal premium assistance credit from buying a private insurance policy that 

includes abortion coverage on those exchanges 

The Stupak Amendment was-and remains-deeply troubling and alarming for a variety of 

reasons. It effectively bans abortion coverage on the exchanges. Because the majority of 

individuals in the exchanges will receive some premium assistance, this provision would mean 

that no policy sold in these exchanges would include abortion. What is more, a ban on insurance 

coverage of abortion in the exchanges would have a ripple effect on plans outside the exchanges. 

This would jeopardize abortion coverage for millions of women 

H.R. 7 is a direct attack on a woman's ability to make personal, private medical decisions 

and it endangers women's health. The bill makes no exception for women to get the coverage 

they need even in cases when a woman faces severe and permanent health risks. 

5 See 132 Congo Rec. H4872 (daily ed. July 24,1986) (statement of Rep. Theodore Weiss (NY» 
112 

4. H.R. 7 Rewrites Tax Law and Policies to Penalize Women in Need of Abortion Care 

H.R. 7 rewrites long-standing tax laws to penalize a single, legal, medical procedure: 

abortion. In particular, it penalizes small businesses and middle-class families, taking away 

coverage that women already have. It would deny small businesses tax credits designed to make 

health insurance atTordable to all Americans if the insurance they provide includes abortion 

coverage. According to the Joint Committee on Taxation, that would lead employers to exclude 

abortion from their plans." H.R. 7 also imposes a tax increase on women who need abortion care 

by excluding it from health savings accounts, medical savings accounts, and flexible spending 

arrangements. In addition, individuals could no longer claim the itemized deduction for 

unreimbursed medical expenses if the medical expense is related to abortion care. That would 

mean that a woman with serious medical complications who needs an abortion that costs 

thousands of dollars would not be able to deduct the cost of her abortion; she would have to pay 

higher taxes than someone with a comparably expensive medical condition, simply because her 

care required an abortion. 

5. Conclusion 

Abortion is a legal, medical procedure protected by the United States Constitution. It is also 

basic health care for women. Yet H.R. 7 attacks women's fundamental right and access to 

abortion. It first targets women-many of whom are low-income and women of color-who 

rely on the government for their health care and seeks to permanently deny them coverage for 

abortion. Then, under the guise of "safeguarding" taxpayer dollars, H.R. 7 advances an 

aggressive campaign to destabilize the insurance market for abortion coverage In sum, H.R. 7 

intrudes in a woman's private medical decisions and plays politics with women's health. The 

ACLU opposes this bill 

(J No T (J)..lJa},(;T Funding/or Abortion Act: Hearmg on Llu! Tax-Related Provision oj H.R. 3 B(fore llle Subcomm. 

,)'elec:t Revenue Jfeasures ofllu! H. ('amm. on Wa,vs and A1eal1s, lI2th Congo (2011) (testimony of Thomas A 

Barthold, Chief of Staff, Joint COllllll. on Taxation) 

6 
113 

ACOG 

IHtAMERICAN CONGRESS 

OF OBSTETRICIANS 

A~D GYNECOLOGISTS 

January 8. 2014 

ACOG Position Re: HR 7 

The American Congress of Obstetricians and Gynecologists represents more than 57,000 

physicians and partners dedicated to improving women's health. In order for women to receive 

the best health care and disease prevention, they must have access to all medically appropriate, 

legal medical procedures, regardless of ability to pay. The provision of all medical care must be a 

medical matter determined by the patient and physician, subject to the physician's clinical 

judgment, the patient's informed consent, and the availability of appropriate facilities. 

The No Taxpayer Funding for Abortion Act (HR 7) however would limit women's access to 

medical care, jeopardizing the health and safety of our patients, and putting government between 

a physician and a patient. By imposing new tax penalties on millions of families and small 

businesses, the likely consequence would be to take away the health insurance coverage that 

women have today. By not allowing for a health exception, HR 7 would leave women whose 

health is seriously threatened by their pregnancies with limited access to the care their doctors 

recommend to protect their health. The legislation would also codify harmful riders that deny 

low-income women access to abortion care. 

If you have any questions, please contact Nevena Minor, Federal Affairs Director at 

nminor@acog.org or 202-314-2322. 

THE AMERICAN CONGRESS OF OBSTETRICIANS AND GYNECOLOGISTS. Wo\IEN'S HEALTII CARE PHYSICENS 

40912'" STREET SW, WASHINGTON DC 20024-2188 Phone: 2021638-5577 
114 

I CENTER FOR 

REPRODUCTIVE 

I RIGHTS 

O ilIer for Rt prQ!!IIrti.,C' Right. 

T(u''''''''y 

Before the Subconuniuee on the Con~ti!U1ion 

Committee on the Judiciary 

United States House of Repre!;entati ,'eS 

.lillI/Wry 10, 20/-1 

The CenlC1" for Reproductive Rights USeS the law to advance reproductive f«<dorn as a 

fundamental hum;rn right that all governmentS He legally obligated to protect, respect. and 

fulfill. Reproductive freedom lies althe hean of the promise orhum"n dignity. selfde1crmination. and equality embodied in both the U S. Coostitution and the Universal 

D«lanl!ion of Human Rights. 

We ornvision a ",odd when, ewry woman is freo: 10 decide whether and "'horn to have 

children; where every woman has access 10 the best reproductive healthcare available; where 

every woman Can eJcercise her choices without coercion or discrimination. More simply pUl. we 

envision a world in Which every woman panicipates .... 'ith foil dignity as an equal member of 

society 

An es~l1! ial st~p to realizing this vision is to ensure that every woman has accl:'SS to 

comprehensive heahh care. including abortion care, regardless of her income or SOOrce of 

insurance. In contrast, H.R, 7 is a s"-eeping ban on abortion coverage representing yet another 

mean-spirited attempt to intctfere with a woman's personal dt'dsion·making. one that will fall 

hardest on women who arealready stl\ll.(!llinll to !let by. Consress should emphatically rejoo this 

extreme proposal. 

II.R. 7 WQuid Mak~ urr 1It () ~n alJ of CQ, uag~ Mo~ nlra~lab . 

H R.7 would punish the many women who lIet their health care or CO\'er<l!le through the 

federal government. Federal employees, women enrolled in Medicaid, military servicewomen, 

Peace Corps volunteers and many others are currently denied insurance coverage for aboniQfl by 

a range offederal policies, Most of these restrictions ha,-e no honle in the U.S. Code; instead. 
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they are re..,n acted each year in annual appropriatiO<lS bilb. H.R. 7 would make these damaging 

restrictions even more ;nlmcl.ble by enshrining them in permanem)aw. 

Al1houl!Jl (he damage that would be done by H R. 7 extends fa. beyond the codification 

Qfthcse discriminalOt)1 policies. this efTw aJone would be tragic because these dcniab of 

co,"erage have a tremendously hanuful impact 011 the women they ta'get. f or example. as OOT 

2010 repon documents. the ban on ahortion coyerage for wOmen enrolled in Medicaid has forced 

,..,'omen to sell or P""o11lheir poss.euions. forgo paying bills. gel evicted for failure to pay rent. go 

hungry. and sufTerthe feaTofnOl knowing whether they will be able to access the care they 

neW ' The stlU!!i!le to raise funds forces many women to delay obtaining abortion se,,,;= and 

others to ca.ny unwanted pn:gnitncies to term. In Qlher cases. as we know from dec;ldes of 

experience prior to Roe ", W,Kle and from place!; throughout the world where abonion i$ banned, 

many women who waHL to end their preWlancies but are faced with seemingly insurmountable 

obstacles will put their health and life at risk see~ing an unsafe abonion, 

These restrictions - although most disastrous for women with the least mean, - know no 

soci<>-e<;Onomic boundaries, For ample , restrictions on coverage for federal employees cruelly 

compOUnded the agony ofa woman who terminated a wanted pregnancy because she learned that 

her fetus had no brain and no chance of survival. After making that profoundly difticult decision, 

she disco,'ere<! that her federal insurance did not cover the procedure. In the midst of her grief, 

she was handed a 59,000 bill " . 1 R. 7 guaranl ees that more women .... ill .uffer similar injustices, 

H.R. 7 is a radically broad bill that creales burdensome new tax penalties designed to 

make co,'erage ofabonion unavailable through private heahh insurance policies, stripping away 

cO"erage that millions of women currently h.,'e, including insurance paid for .... ;lh private dollars 

or prOl'ided by employers in the new Slllte maIketplace$. 

a. TI. ~ bill wlluld dfKlinly ban aborlion cll"uage in th ~ new sta lf mRrktll,la ces, 

denying cumprrhtnsi.-r hea lth i"su"'II)u 10 women usin g their Ow" fund s to 

purchase co>'tragt 

On the surface - and COIlsistenl with other attacks OR women's access 10 aboniOR services 

- H.R. 7 targets low to moderate income families eligible for premium assistance credits in the 

new Stale marketplaces. Under the Patienll'r01ettion and Affordable Care ACI (PI'ACA). 

2 
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insuflltlce issue~ may (lffer plans that CQ"er abortion in the new state marketplaces if they 

segregate funds paid for abonioo coyer.ge from the funds paid for all OIhe. em-erag<: - lUI 

onerous administrative requirement that already stigmatizes abortion by treating it differently 

from other health care. Vel now, by banning premium assistance credits from being applied 10 

any plan thaI includes abortion, R R, 7 represents a new clTon to drastically expand an 

ide<;>logical agenda into the private market and completely eliminate abortion coverage from stale 

marketplaces ahogether, 

The efTeet is that H.R. 7 not only targets low and moderate income women, bUI (11/ 

Women purchasing insurance in Ihe state marketplaces, including those paying for coverage 

entirely with private dollars_ !Jt:(:jIUie a g'eat majority of individuals in the marketplace'S are 

eligible for premium assistance. H_R. 7 wQUld essentially eliminate comprehensive pl;rns that 

include abortion coverage, Insurers are unlikely to otTer I product that a majority ofpolemial 

CUstonters are baITed from purchasing. Thus the ban will impact everyone participating in Ihe 

marh1places. induding millions ofunsubsidi~ed individuals and small business employttS, 

Over time. these restrictions will affect ml)fe;rnd ml)fe women. as the marhtplaces are designed 

to grow over time 10 encompass the large-employer market.;ij 

Funhermore. while the bill offers up the ability for .... "Onten eligible for premium 

assislance credits to purchase separate abortion coverage. there is little evidence thai such 

policies "ill be made available by insurers, This is largely because insurance does n01 ..... 00; on 

an a la cane basis, Consumers cann01 anticipale all oflheir future health care needs and a system 

ofinsurllllce coverage ....-QUld be ineffective if consumers were required to lailor their cov .... age in 

advance based On unforeseen. unexpected needs. Moreover, if such policies with separate 

CCl'o-erage for a bortion did e~ist, women eligible for assistance in purchasing health care insurance 

are very unlikely to be able to afford a second insurance policy on their OWn . 

b. The Bill PUII;sh., ", II Businusu ror Orrering Co"'prebellsin Conrage 

H-'t 7 ,,-auld further restrict the private market by creating tax penalties for small 

businuses thai otTer comprehensive coverage by denying Ihe small employerheaJth insurance 

Ia' credit for any employer contributions to plans tbat include abortion coventge. 

Small businesses are essential 10 economic gffi",h. Those health insurance tax crediu are 

critical nOl only to stemming the escalation in health care COSt5 broadly but to making health care 

3 
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I RIGHTS 

C(),-erage afford able for American entrepreneurs and their businesses. Yet instead of rewarding 

small businesses, this bill would punish them in ever more innovative ways. H.R.7 would greatly 

complicate and confuse this community's ability 10 pr()1.'ide insurance coverage 

The bin imposes alOUgh. assignment on Ihe 4 million small businesses eli~bk for the 

credit - 10 dig through the detaili. of lIS health insurance policy 10 delermine ifi! covon abortion. 

Whether I health care plan e<wefS abonion care is far from simple to figure OU1. as coverage 

could occur in many categories. from prescriplion drugs to outpatieT1l WI"get)' 10 maternity care 

that includes unforeseen complications. Indeed, many plan managers do nOl know .... -hether 

abortion is co~'erro . and will have 10 spend considerable lime trying 10 figure i1 out. And if their 

plan does include abortion \:Overage, which is likel y given that ~ .bs~nt political interferen~_ 

most fflJployer-Sp<')Il$Ored plans do, "' they will eith .... have to give up the tox credit or spend more 

time and money tindingl new plan. delrimemal !O both the employer and its fflJployees. In the 

end, this provision in H.R 7 will have only served the purpose ofundennining employees' 

access to comprehensive health inrul1lnce, 

This bill forces small busi ness owners to pay a price b«ause some in Congress ha"e 

decided to rewrite the tax code to suittheirown narrow ideological goals - goals that have 

nOlhinglo do wi th rustaining.gro",;ng. and supponing small businesses, 

c. The Dill Punish .. Indi,'iduab U.i" g Ih.ir o..'n i\-lo"ry 10 ~y for Abortio n Ca rr 

In addition to the disin~ntives int.-oded to prevent won'en from accessing insuran~ that 

could co".,- abortion, H.R. 7 also seeks to punish a:.d shame women who pay direcdy for 

abortion Clre. The bill would eliminates la~ deduclions for medical e~penses related to abortion 

and bar individual. from using their own money set aside in health flexible spending accounts 

(FSAs) or OIh e r lax preferrro savings accounts to cover abortion relaled OO5t5. Such provisions 

make clear the true intent of this bill - nOlto simply "prevent taxpayer funding of abortion" but 

to eliminate women's access!O this constitutionally protected service altogether. 

II.R. 7 Wo uld Force Tn A udilon a nd Employrn to In trud. in to the 1\1"" Prrso nal. 

Pri"alt Aspects ofWomr " ', Li ... ~s. 

The 1a>I penalties in'posed by H.R 7 would be subject to narrow exceptions for 

pregnancies that are the result of rape. incest. complications arising from abortion , or ",here the 

woman'. Ii fe is endangered. 

• 
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I CENTER FOR 

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Essentially, H.R. 7 calls on the IRS to conduct ra~ audits,' As Thomas A. Banhold, 

ChiefofStaffofthe Joi nt Committee on Taxation, testified in 2011 , the burden of proof 

regarding whe1heror nOl an abor!ion occurred within (he nafTOW confInes of one orthose 

exceptions will fall on (he taxpayer." This means thai womCtl will be required 10 kttp records. 

and to open up those feCQrds - and their highly p<nOIlal traumatic experiences - 10 the probing 

investigations of IRS agents. According 10 a fonner longtime IRS official, "00 audit [she] would 

ha,"c to demonSlrateor prove. ideally by contemporaneous wrillen documentation. that it ""as 

incest. Of rape, or [her) life was in danger .. ,(i)t would be fairly intrusive for the " "oman,"' '; 

The case ofincesl is even more difficult. ILR. 7 could requil"<' (he toxpaycr (which coold 

include an abusi~e father) 10 substantiate thallhe abon;OIl was the result ofabu$C, creating an 

untenabl e and vola tile situatiOll for a family already in difficult and painful circumstances. To 

make matters worse, in addi!iOll to policing rape and incest, H R, 7 would tum IRS officials into 

amateur physicians, rC<juiring them to determine which dangerous conditiOlls should qualify as 

life endangering under the bill. 

Needless 10 say, such de1e11llinatiOlls - for pflIClical, medical and emO!;OIlal ~s - are 

far beyOlld thc e.penise and training of the typiCIIllRS audi tor. in addition to being outrageous 

and inappropriate, This alOlle constitutes substantial t"\'idence (hat H R, 7 wOlts a serious abuse 

of the laJ< code in the service of ideology, 

In additiOlltO inviting the IRS into the most perwnal aspects of women 's livO$. H,R. 7 

could rC<juire a woman 10 repon an abon iOllIO her employer. As noted above. H.R 7 provides 

that aboniOll services must be e~cluded from health FSAs, Which othen>.;se allow individuals to 

reduce their cash contpensatiOll and Set aside funds for medical e.penses. When this pnwisiOll 

was proposed in 201 1, the Joint Committee 011 TIIXItiOfi rcpooed that it;s likely that the IRS 

would requi", that any amount paid for abonion services"be reponed on the employee 's Form 

W-2 ... as wllges, tips and other compensation ..... '·; H.R. 7 nOw e~tends this restriction to other 

tax-preferred savings aCCOUnts (health savings aC<:OUntS or SAs~ and Archer medical savings 

accounts (Archer MSAs . H.R. 7 creates a big brother regime in which women 's private 

medical decisions are forced into public view, exposed to myriad parties who could use (hat 

information to the wontan's delrimenl. 
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I CENTER FOR 

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II.R. 7 Unbirly T~rg 5 Women in th t DiU.if ! orColu"'bia. Dt nyin g Their Rt Wod uCli,'c 

Frttdom 

I R. 7 defines the District of Columbia city go\'ernmenl as pa" of the federal 

g<>Vtm",~m for the purposes of abortion, thus pem.ancnlly prollibitins Ihe District from 

Spen<ling ils local fund. on abortion services for low.;nCQrnt women. regardless "fwhal OC 

talIpayers want. This audacious provision denies the District its rigln [0 self-S,wemmem whil e 

jeopardizing the health and safely orlhe District's female residents. panicuiarty low-income 

women. For no clear reason other than to deny this group of women their reproductive freedom. 

the bill singles oullhe OiWict of Columbia in a way thal;1 does nOi for any other state or 

locality. This is an unwarrnnted and unfair attack on one group of women and OI1ejurisdiction _ 

The Center for ReproduClive Rights urg<:s Congress 10 rejecllhis dan!leroos and exlreme 

legislation. 

' Cent .. for Rcprod""!,, .. RLghts. If""-Cltok.? 11001 ,'" II}." ,1.,,,,,bMnlllanm pO<}/' Ifo .... n 28-~9 20!O~ 

mYlilab/. '" h"p:l/rq>mdua,,'Crights.otgI.nrr .. ,uMI hoso.c"",,,,,._ · .. "'.h)'de+.maldmen,./IWJl'LS.poor.,,omen, 

• So .. """",! of Dj Fcl4 .... "" H.,.uul ImP"C! of Abon'"" CO\ ..... gc: R""rkloons. NO\' 16.](109 <II 

hup:l/rq>mdua""riP.l$.or;JcnIfc:oonlno·.bonioo-b3n·sutemcn,.by.q 

- I'I''''C''' J lJI2(f)(Z)(S)(i), 

• Sn Gultmxhcr 1n$U(u", . .1/ ... 0 <HI Pm""" I"'MrolOC< C"'~rng<" of ,1_;- 0 011 2(10). "'",lIlahk '" 

hllp.l"'·,,'" g",,"'x I>c:r ,0IJ/n>«I1 ar.""",,,," sf.!(Il I /0 11191\ndcdl mi. 

, 1I<a""8 011 ,'" T~·R"o"d rro.#';""olll.R. i : lI.on"8 &J>,. ,'" s..brom,... on "'''U, R"ymw .l/mJM,.., 01'''' 

II. C"",m, on If",~ anJM,,, .... 11;:,h Cong, (2011 ) (01'31 '.""'>ony orThorn .. A a.."boI4. Ch .... orSO.rr . .Ioo'" 

CO""" , on Toxat>on). mUllah!. '" 

bu p ,'''" y OOIIl<>D' boo.,.!!pI'lrs"WdocwgeDlsjnils IIps7C!ocymrnllP-U072U 0 .... 1'>I;led Jan. 9. 20 1~). Sn 

_ N"~ Boumann. GOP fllllll""ki fiNc< IRS", C"",/..c, ,1/"",_ A.,h". Mon,n Jos.:s. Mar 18. 2011. 

lAYlIlabl. '" hllR;llwww,mollwioatl wmhx>lj!k lI20UlOli&oQ-Dili1ru borJ/o''hludju (10$1 ,; .. ,«1 Jan. 8. 201~ ~ 

" Sn,d. 

.~ Bwnunn. ,upmllOlt Ii. 

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, 
120 

NATIONAL 

ABORTION 

FEDERATION 

Testimony of Vicki Sapona, President and CEO of the 

National Abortion Federation 

Submitted to the House Judiciary Subcommiucc on the Constirution 

Hearing on H.R. 7, the "No Taxpayer Funding for Abortion Act" 

January9, 2014 

The National Abortion Fcdennion (NAF) is the professional :association of abortion providcl"S in 

North Amerio. Our members include priV:lle and non-profit dinics, Planned Parenthood 

dlilim,s, women's health centers, physicians' offices, and hospitals who together care for rno", 

than half the women who choose abortion in the U.S. and Canada each year. Our members also 

include public hospitals and both public and private dinics in Mexico City, and private dinics in 

Colombia. 

The mission oflhc National Abortion Feder.nion is to enSure thai abortion tare is safe, icg:U, and 

accessible, which promotes health and justice for women. Since 1977, we ha''C actively opposed 

funding bans and restrictions on access to .bortion care at the federal.nd state levels. We have 

also provided direct support to women seeking aecunte information lIbout pregnancy options and 

abortion care. 

As President and CEO ofNAF, I'm in a unique position to comment on this bilL NAF hears 

from tens ofthous:l nds of wOmen e"ery )'ear who would be harmed by the unjust policies 

contained in H .R. 7. E"ery day we hear from women facing considerable barriers to accessing the 

abortion care rhey need, often due to existing fu nding bans. These women are desJII'nte to make 

the best decisions for themseh'Cs and their families, but frequently cannot - because of law, 

because of circumstances, and because of the de<:isions of politicians who think they know beuer. 

In this already difficult climate, H.R. 7 would implement insurmountable obstacles for countless 

women nceding to access abortion ure, and I ha\"C no doubt that this is the bill's sole intention. 

Not only does this bill burden low-income women, a perennial target for anti-choice lawmakers, 

but it .lso targetS e~'ery woman deJll'ndent On the private insunnce market for health care. It is an 

unprecedented interference in the lives of women and their families. 

H.R. 7 \ Vould Inte rfere in \ Vomen's Private Health Care Decisions 

The "No Taxpa}'Cr Funding for Abortion Act- is a misleading and dangerous bill that aims to 

dismantle insumnce coverage for abortion care. Its dTe<:! would mllg<: from burdensome to tmgic, 

and would be felt by millions of wOmen and families. The Smith Bill would drastically alter the 

insumnce landscape with two sweeping changes. First, through a regulation similar to the 

defeated Stupak-PittS amendment, it would rende r any swe exchange health plan that covers 

abortion unsustainable. Second, by banning health care related t:llC deductions for priv.ue 
121 

insurance plans that include abortion care, this bill would penalize individuals and small businesses 

for keeping plans that offer comprehensive coverage. These two regulations would have a dramatic 

effect on the insurance market, where historically the majority of private health insurance plans 

cover abortion care. 

As the professional association of abortion providers, we know that serious health conditions or 

life endangering situations can arise during pregnancy that make abortion care a woman's best 

option. But, after dismantling the currcnt insurance market, H.R. 7 could create a market that 

only offers coverage for abortion care in tbe narrow exceptions of rape, incest, and life 

endangerment. A woman's health or well-being is not a consideration in Representative Smith's 

bill. 

H.R. 7 would affect women like Carly; who could be forced to choose between financial ruin and 

her health and well-being. Carly was suffering from kidney disease and was in a great deal of pain. 

She was unable to work, and was having trouble providing for her two children. When shc becamc 

pregnant, she made the decision to have an abortion so that she could have her kidney removed 

and begin the road to recovery. Carly knew that carrying her pregnancy to term would create many 

morc health problems, and would leave her unable to care for her family. A lack of coverage likely 

to result from H.R. 7 would mean that Carly could not afford the care she needed. 

Further, the tax penalties in H.R. 7 would deter small businesses from choosing the most 

comprehensive reproductive health coverage for their employees, with devastating health 

consequences for small business employees and their families. We recently heard from Samantha," 

who was seriously injured in a car accident, which left her unable to walk. Samantha was pregnant 

and carrying the pregnancy to term was not an option for her. vVithout coverage from her 

employer's health plan, she would not have been able to afford the abortion care she needed. 

Under H.R. 7, women like Samantha could lose their coverage. 

H.R. 7 Contains Hyde-Like Restrictions on Federal Funding That Jeopardize Women's Health 

This bill also contains a federal funding ban targeting low-income women who rely on the federal 

government for thcir health care. It would codity the Hydc Amendment, which since 1976 has 

prohibited the use of federal funds for most abortion care. The Hyde Amendment is a harmful 

policy that unfairly denies comprehensive health care and autonomy to our nation's low-income 

womcn. Women should not be forced to sacrifice basic necessities, including rent, food, or child 

care, in order to obtain the necessary funds to have an abortion. Nor should they further risk their 

own health by delaying their abortion care until later in their pregnancy while they try to raise 

nmds. 

Thc restrictions imposcd by federal funding bans unfairly jeopardize thc hcalth and well-being of 

low-income women and their families. Women in desperate situations may resort to self~inducing 

an abortion or obtaining unsafe procedures from untrained practitioners. Federal funding bans also 

harm women's health by denying covcrage for abortion care in cases where women have serious 

physical or mental health concerns. 
122 

The Hyde amendment denied Reagan'" coverage for her abortion care. When Reagan discovered 

she was pregnant her doctor told her that the medication she took to control her seizures was 

likely to cause fetal anomalies. Reagan decided very early in her pregnancy that an abortion was 

the best course of treatment. However, :Medicaid would not cover her abortion care. Fortunately, 

Reagan worked with a clinic, which helped raise the fi1I1ds so she could have an abortion. 

Federal fi1I1ding bans have a disproportionate effect on women of color, who are more likely to live 

below the poverty line and become eligible for government health care. According to census data, 

25.5 percent of African Americans, 25 percent of Latinas, 67 percent of Laotians, 66 percent of 

Hmong, 47 percent of Cambodians, and 27 percent of Native Americans and Alaskan Natives arc 

living below the poverty level, compared to only 10.4 percent of whites," 

The sweeping ban contained in this bill would also deny coverage for abortion care for federal 

employees, servicewomen, and Peace Corps volunteers. The employees, volunteers, soldiers, 

airwomen, marines, and sailors who serve our country, and their families, do not deserve to be 

denied access to comprehensive reproductive health care because of the political posturing of 

members of Congress. 

The National Abortion Federation has worked on equity for servicewomen for more than a 

decade, and we've heard from many women who are affected by this ban. i"'omen like Jane,' an 

active duty servicewoman stationed in Afghanistan whose first priority is serving her country, not 

starting a family. Unfortunately, her doctors failed to tell her that her government-issued malaria 

pills would interfere with her birth control pills. As a result, J anc, who is stationed with her 

husband, became pregnant. She should not be forced to end her front-line duty in Afghanistan 

and her military career, but that's exactly what could happen under H.R. 7. 

H.R. 7 Restricts DC from Using Its Own Locally Raised Funds 

H.R. 7 would also permanently prohibit the District of Columbia from using its own locally raised 

funds to provide abortion care. This is a violation of DC's right to self government, and 

detrimental to the health care needs of women who live in the District of Columbia. VVhen the 

federal ban was temporarily lifted in recent years, DC's own ci\~e representatives chose to provide 

abortion cO\'erage for Medicaid eligible women. Women like Allison," who is a single mother of 

four, living in the District of Columbia. Unfortunately, when Allison learned she was pregnant, 

the federal restriction was back in place and the District of Columbia, once able to help her, was 

barred by Congress from offering ber aid. Allison was enrolled in Medicaid and only had $20 to 

her name. After exhausting all of her options, she was fortunately able to get support from a local 

Dmd, and the clinic a!Sreed to discount the cost of her procedure so she could access the abortion 

care she needed. 

NAF Urges You to Vote Against this Extreme and Harmful Bill 

A ban this widespread would deny millions of women the reproductive health care coverage they 

need to make the best decisions for themselves and their families. VVe urge you to reject this 

dangerous bill. 
123 

I Nume clull1ged to prolect privucy 

1~ Name changed to protect privacy 

III Name changed to protect privac~' 

1\ S(>(> SUL,mne Macartney el aI, --Pov(''f"ty Rales for Selected Detailed Race and Hispanic Groups by State and PIa.;.;.;.; 

2007-2011"" C0l ashington: United States Census Dtrreau, 2013), and National Asiml Pacific .A.merican 'lv' omen" s 

Forum b'act Shed '"Hyde: Thirty Years is Enough"" (200g) 

v Name changed to protect privacy 

V1 Name changed to protect pnvacy 

4 
124 

"7. 

~.# -,,/ 

.~. 

" 

J.m.a~ IO 2014 

The Ilonor:lbl~ Jerrold N.>dlo •. Ranking Member 

Judiciary Subrommiuce on lhe Consli1U!ion and Ci"il Ju,tice 

U.S. l-Iouse ofRcp""s<nt,UI"", 

W.tShington, OC 20515 

Dc:r.r Coos"'ssnun Nodlcr. 

Thonk)"ou fo,'he OppOrtlUliry to submir 1his SWcn>enton bch..>lfoftlw; GUl1m:>chcr lnsri'"'. 10 OppOSition 

10 IHt 7. llH: No Tax",,)"cr Funding tOr Abortion AOI. on which a hc3l'lng W:I.S hold hefo", the 

S4Jbcomn,inccon the CouSliM;"" and Cil it J" nice ()fI Jan~' 9. W14. 

ll"""gh Us wor!< .. an Independent. "",·for-profil organ;.,uon (oc:""ngon "'product" .. heal1h "' .. "r<:h. 

polic!' anal)~i. and public lXIU<:auQn In the UniWd Sial£> and inlcm:uoonali)'. ,110 Guumachcr InSlIMe h:ls 

dc,-ciopcd >nd "":Il~ zo:I , grc.>I de3I of ,nforrMlIon on publi.,. >nd pn"31c""'otor <>boot,on ,n .... """", 

00"''''8<'. lbe implicalions for the ""31th and well-being of "-.:>me" and their families of in ... ",""", 

oo'-c"'l:!c <>r the lacle thc",of. ;rnd llH: ",!;Iiions.hip be'ween i .... """"'" CQHr;lgC and abortion ;""idenee. 

Man! ofth< InSlituw", """arch finding', :dOllS with key rc=rch findingsofothcrcxp"r15 in lhe field , 

arc :ddrosscd in 3n Mielo din:aly ro""-:lnl 10 II.R_ 7: "Insumncc C"'''rngo of Abonion: Dcyond!he 

E."epl'ons For Life End.nllenncn1. R:Ipc and lneesef",,,, lhe (JII"moc/w:, I'Q/'C)' R.V/~'. anacbcd for 

i""lusion in ,he rooord. 

A pri ",a~ J>IIIJ>OSC of H R 7 is 10 " 'rile inl0 pel1l13nCOIlawlhe H)Oc Amcndmcnl. which hasbeen 

illCOrpor.>rcd inlO 3n nu:d 3pprQp>1OlIonS law Smee 1976 3nd $hrupIy Iomll$ ;>bonion ccl>'erngo (cum:n~y 10 

C3SCS of life cndangenncnl. "'p" and i""'''1 under Medicaid. lhe joinl fcdor:>1-s1aIC heal,h in .. """" 

P"'llr;lm for !he n,uion's lowe$l·iDCQmO oi,i""nJ, H.R, 7 \\ould aI"" m:Ik pcnn3nCn'lhe H)'dc 

:omcndmcnf, so-called progen)", a seri"" of polioies tll:u simH3ri)" """rico abortion co"''''8o or sen'iccs 

for OIher II""'I'S of ,,-omen depen<icnl on !he so'-emment for their health in,u",,"cc or hcalth c:oro. r.onging 

from " 'ornen in fcdcr:>1 priSO<l$ to wornen in !he U,S. annc:d forces. 

Mo"""-er. HR 7 "",,·uld c.'tend the Iurm, of'he Hyde :omcndmcn' and Us progen)' funher by sc<; ~ing. 

un.dcr lhe disingenoous ''no ""'I"'l'" funding ~ Illbei. to c1,mi.we ;>bon,on e,we"'8c in !he pri"3I<: he"hh 

insu"""" n13ri;cI '00. Tbc eff«! cf!his DCW i""ursioo ''''><Ild be 10 take abortion co'-e",!>e a"-.)" from 

m .... y \\-ont<n fo' whom Lhis has been a $IMd.1.rd heallh insu"'""-<: !>c""r" for 3 long limo:_ 

~ 

A. diseu .... -d in "Insuoo'" CqlliGlSe o[Abonmn Dc,ond Ibe E"Wplions Fpr !.Ife E!!d;mge!IOOll. Sapo; 

~ ,he H)d c A~dmcnl " a pernicious lal\" lh31 cxpl,:"lr I:UJltI$ !he poe",51 and "",$I 

''11I""",ble wornen_ A numbe, of stud"" coodUCled Ol",!he los' 110"", decades h31'e """,sod !he imp.1C1 of 

!he H,-de amcndmcnt', """,-ban on Medicaid ;n..,,,,,"cc coI"rngo afabortion. Rcsearch , how, lh:oc one In 

four Medi"",d enroUe« who w .... , 10 ICrmln" ...... un"-:ln,ed pregn:>nCy 3/'C un3ble 10 do SO l>cc:wl<: Lh<:)' 

"",,', rome: up WI{h (he necessary funds. As !he all~",portan{ Mcdic:oid CXpaMioru; take effect {his YC3. In 

IS Sl:II<;s and Lhc DI';{rico ofColumbl'" i,,,,, pen'Crsc ironyLh .. one ICSllh is 'hOI c'-en morc women 3/'C 

.... _ .......... ,-----...... __ .... _- 1l0'~ __ N,W, Suito'OO 1_""' .... OC1003. I T .. 1O'-'90 .•• " I f .. '.'.22'."'" I ........ _ ."'lI 
125 

DO" subj<XI to lito Hyde "mendmenl Roughly 9.7 million """",n of reproducti"c-<lgc we", enrolled In 

Med'C.lld 35 of2012: .,ilhon'!DOre will qualify 35 .ut~. <>plIO "''''' Medio:lid i""""", chgibihl)' IO 13&0/. 

oflhc fede",1 PO"c"y hne . 

M3I'I)' """",n who "'" purchaslnS pn,· ... InsOlf3I\O; "'''''rag<: on the "",,,.II<allh in,u"",,,,, cxolungt::, ma)" 

wdl bc ".....amI b,· Hyde_hkc "'SlriCli""" as "ell. Under lito AfTordlblc C.." Ael. fcdc",1 .ubsld)' doll:m 

for indindu.al. purch3$ing pi"", on III< heal'" in'u"",,,,, mru\;clpl""", m3)' not bc used 10 J>'l' for 300nlon 

",''CI'>go. """"pi in c=.oflif< end3l'lgenncnl. rap< or ince .... A. of2012. mughly 37_5 million w"""," 

>ged I ~-44. occoun,ing for 6O",j, of""""," of reprod"","'" age. ""'" pri">lely in.ured. 

I would like to add", .. a poinlOll "hich GUllmadw" .....,=h i. f""lllOnlly in.-oked >11<1 mi.repn:5Cnled. 

WhIle one In four Mo'ho:lid enrollee. "ho would ha'" 31'1 abort,on if" werc OOI"R;d under Medicrud i, 

ull3ble to do so. II doc. not foil"" lh:ll reSlOl'3lion of federal Medicaid "",'cf3&C "<><lId result in , 

cornmcn. ur:llc increase in lhe: incidence of abortion n:llionllidc Thi. is bix.1usc only a """,II proport"'" 

ofwomon = enrolled in Medicaid In an,' 1131<:. and k<;""", 17 SI:II"'. induding s<:'-eral of the nlIlIQn ', 

mos\ populous. are among those Ih:ll uS<: lheir own mon<:y 10 pal for abortion se,,'ices for poor " -omon. 

AOC<Irdingl)'. "'0 re$Carch ,how, ""', repealing "'0 fod~ral H)'de Amendmenl would 1mns!3l" inlO an cSlim3lcd 5% ri.., In lhe 10Ia1 numbcr of 300n;"'" in lhe group o(o'.>Ie5 in " 'hieh funding is "u""",I), 

rtSlriclcd-and """Iy" 2,$% i""re.1$l; in ,he 10Ia1 numbcrofabonl""" pcJfonncd n3liO)n"'idc , 

In conclu,,,," . both for public and pri'"3le in,ut:IIICC "",'e!:>ge ofaborti"". thi' bill igoores ,II< reallI) "'.>I 

3borti"" "" legol. eon$lltult""all y pror=cd and mcdirnJl)' appmpri3l" heal'" ""'" sc,,;""_ The lIyde 

Amendmenl and ilS progeny shoold be repealed. nOt reinforced. and certainly nOt e'pandcd further tnlo 

III< pm'''''' '"surante madel, 

Th3l'lk you for lhe app<>nunily 10 p<OI'ide Ihcsc <OI11"lCnlS, 

S'H«:n:ly. 

Sus:>n Cohen 

Acting V,ce Ptc$i<icnl for Publi" Policy 

..... __ ....... , ............. ----....... _ .. _"""-- 13.' ~_N,W" s..;", 'OO I ..-"", .. ,0.-:'.031 I ToO 00',' ... '." I f .. '.2 >2"" ~ I ....... _ .... 
126 

Policy Review 

........... 20" I \Idu"", 'S I No", .. ,) 

Insurance Coverage of Abortion: Beyond the Exceptions 

For Life Endangennent, Rape and Incest 

a, "to" '" D. a ....... 

I

n ,ount _a. ant iabonion ad;.; ... ha •• 

""' ... tOo.;f"".' ,,0/;10<.01 """ Iegj"",,,, !Pmo " ",. _nol . nd "'" 10 ..... In . t , .... 

on< _., _. ' ...... moy '" "".,,,, •• _ 

;ng tI\oI, "'nd. by ",""ng f<>< .... >rty . blOl",. 

b.n. "'" ._. ""on in ;n."""'" of ",,"' In 

.runo. """''''''' .... . ru",,1Id during MM. "'" • 

b,11 '0 bon ,,,,,,..,. 011 .bon,on. I" . in ~""f><\'. 

Tho I><A·. a"'l>o<. JU<hci.o", Sub<ommitt .. "" 

the C",," ilulion Ch.i, ..... Tro", F"o"l~·AZ). 

_<>dod tho I .... of • ' . ... ' '',"'''>on;n ,ho 

or'll,n.' 1><11 "" .no";"", th ... "'. _""" 

of ,_ , .. uK;ng in ""gn.f><\' . ro . .... low.· ' 

Willoin hour. of " ... nb· "''''''''''''' , 11>0 1",.,..., 

Iii up .... 'h """"pM;""" ' 0 Todd ""'1ft """ ~Od1 .. d 

Mou,dod, In iI.uou" 20'2. 1 ... d<OO up to tt.o lall 

..... ""' •• AIOn-tho Rt .... bIir;.on 50 ..... "",,"n" 

f,om M"sou'i----oo'''''oI<od ' .. OO"on 'h. "","reof 

._,um ""-' he _{IOn"" ,h .. ""<0",;"'" f<>< 

. bon;"" ... co ... of ,,"" .... ,. un __ ...... bocouM on ,ho """ of 0 ·Iog",mote ,_; • wom· 

. n·, body eould -,h", ,,.. .. hole 'hlng down,"' 

T"" """"h. I ..... Mour<locll_,'" Rtpublic.an So.". "".d ;~. from ''''''",_ ,ow not;""ol 

"""""""" for hO.;"Il ... d 'n . debo .. , ... , ,.. 

bo~evod _ona .. , .. uK;OO lrom ...... _ 0' 

"gjft f,om God" and . houId fI<II bo ' '''''';'''''''' ,' 

Tho .. ,.",orb .0<1 tho" . h,moth d~ tl>o 

R . .... bfio ... Po,,. on ' ... n";""ol "ogo. who;i> 

li~". hofpod o.moo<>" .. on _ " Mot •• 0<1 

k_ <00,,'" 01 tt.o So ..... 

Fo< .bon_ righ" ..,.,.,., .... , , ho .. ,,,,,. 0<1 .. ,,, 

o:ommeo" ",O'<OMd . n opon;"Il. In Ooeembo, 

2012. ,rt.-o><>t ...... , •• bIro to mobili,. &u""",,, 

fo< . ..... 11 but tigM i<ont do. "", ;n the 0010 .... 

0. ... "....." ."'1>0<" .. ;.,., bil l fo< 2013. Tho o:hang4 b-r<> ___ 101" .bortion '0"'''''' 

fOl" H<Vi<4r-.. .nd mil ....... d.pondo<tO. ' 0 in· 

cludo ""'. of .. ". 0< i .... ,,--t..yond onI • ...t.e. 

tho wom.on I~. WWId bo "" .... n"" by """,;n"_ 

'''II ho< ","11"'_, n." kth<oug~ brought 

f_,01 obort,on poIky for U,S . .. rvkowomon 

;nt" Ii ...... ith ,he Hy<Io omend","nl whido ",0' 

. ;.;.. 10.- ,1>0 u •• 0I_.11uMo for o.borti"" 

undo< Mod",,"'" only ;n ,,.. .. ,~ ,.. """'''''''_ 

00, K 0"" No . .. _ momontum for ooftoning 

the "";""""on I . .. ,~" ofIo<t. Po"" Co.-po "". 

un_ • • nd for ,.,.;, iI;ng tho .. t. , .... .,;"" 01 tt.o 

_.<Io, .oId ,n,,,.-...,., I ... _n"'ll ,id to 

dovotopr"ll <OIOnto .. 1 ... ,01 .. "" . " id •• __ 9), 

The .. dovoIopmont. ,,_on, "O!" in ,he ' ight 

d;,O<tion. y .. the ""' "";' of ' his ;""", ...... ntol 

' P .. <>O<h ,;,u ~ ....... ",;t.,01 but daunt-

'''II 'n": <oo' ",nt,"Il , ho ,nlu""" 01 , ho Ify<lo 

.morld"",,' itootl, Tho p,O<tieol i"",ad 0( , .. " .,. 

';.,." or> . bon;"" _ .. , goo undo.-~ • .-. 

, .... """ oon bo _ad \>ot~ ,n ,he .-,,"" 

of woman "'''1/11''''11 ,,, lind .notl>o, """eo of 

fU<ld. lor , n • ..",ion .• nd;n,he _',n""" and 

_ """"0''''' 1><"""0 tho .. u",bIro '0 do to. 

AdHovi"ll " uo eQuity ........ '0 .bort,,,,, oovor-

_ f", ~ ... _ .. oman_,o t,.. """of 

who, ~ """ "" '0 ".,. .... 0 r;gh' '0 .. I. and Io{o>I 

.br)rt;"" thot ;, not ...... Iy 1hot>.-.. .,.I. but .1'0 

mH";ngluf_ 

In 'he BeQi".inQ 

0.-.,,"'" .... R"" v. W---'nd _ "''''-'0 

"' ..... bon"'" i,,_, n .. ~ bo.n tho 

. nt;o.bort,,,,, ........ monl·. ",,;mot. go.' 'or I.,., 

_.d .... In ,he ~ .. " ,.......-...:1; ... 1y 1oI1o .... "Il "" 

'973 5<0...-- C.,... ~ <100;'000. ,he .. ,m.", Io<u, 

of "",obort,,,," ad,.; ... · ""blto""" log, .... i •• 

'geMa woo "" on uK,,,,". 1y 1",;10 oIIM '0 ...... 
127 

·hum.., ,/0 ........ ..,.,... '0 ,ho U.s. C<>o";,",_ 

,hoi would .".bh.h ... ,_hood ·hom ' ho mo· 

.,..,. of .~;lifa1ion · AI. ..... ...... 'i ....... ", "boo'. 

,;.,., ""'''' .... ,!>tow ,hoM, ._ .... nd ~Ort . 

'0 Ii"", .".. •• ' 0 . bo<1ion co' •. In 1973. <Mv" " .,."0<1 ,ho """" __ n' . .....,;<tt "'moO ,ho 

.... 01 U.S. Iotoign " ''''.0« ,,, p~ 'ot ,ho .... ~ 

"" ......... of __ ........ hod 0' I,m". ""n' ,""II.· f ... _._ of,h . ... ,""' .mond ....... I.,d 

..... g'O<Jnd_~ 'ot a sim<1 .. dome"", me .. u," 

d>.m"'.,.... by , .... I.,. ~.p, "'n<y Hv<M I~~l) • 

/ow,... .. I ..... 

Tho Ii,,, 1«<';00 0111>0 ~. do .".<><1",.", • .,.aM<! 

'" 1976. b,moO ..... u" 01_, .. funds lot ._ 

'ion .. "'''' ... ox..." "' co ... -"ho lifo of , .... wornan w .... ""'. lot ,II ",ogt __ no 

iot.,od by ..... Do.,.nmon, of He,,,,,. Edu<o'ion 

and Wolf". (now, .... o.portmonl 01 He.~h ond 

Hum. n SMv""I. Tho ""'OOut. h .. , ... oK"", 01 

bonno"ll .bo;xt"", _ .. _ '''' women "'''''''' by 

, .... Modi<oi<I ",ogt.m. 

~ 

Outino dobo,. or. , ..... -..""' •. fIordo him.oK 

.. ,h. bf ..... "'d',.,.;,run .. ""'n ...... 

of , ... p'"""",,,. He .. guod tit .. _io<> """'Id 

bot ~"dod in tho .... ogot"1 oIl".",in ..... ,obl. '0 _1tIty...,.,..,. .. , .... " own • • ".n .. , but not 

'0 , .... ".,.,. with """Ii< funding: ·K rid> wo ....... 

wo", 10 , nlor '''';' IOgh_", ......... , ,10 .. ;, 

">0<' ,_';b., ....... ,h .. i. fino. but not . , 11>0 

,"xpoyor.· ..... n .. ,··Thi. 010"""'" ". ..... i ... in 

C¢ng" .. ;" 1977. whon CO"fII'" , •• <!d, •• M<! 

,he Hy<lo omoondmonl, fIordo 'ofd h" <0110",..-• 

• , ~ •• n'" """,Id . ,,, ". ... m. il 1 <OUId 10· 

g""'. 'nvbo<lv """"II ,n abortion. a rid> womon, 

o ..... ddt...,I ... wom.",. '" • ".,.,. worn. n. 

Un'Oft" .... ",. ,ho on ..... hid. ov"l.bIo " ,,,. .. 

Modio:oid biH.·' 

Tho " ... "" pobfi< lundi"" k>o- . b<H!;"" _. hotl. 

dobo,"" ",,~ 11>0 .... of ,,,. 19700 . • nd 11>0 

bode .nd 'Ofth bOI_ ,ho Houoo ond , ... Sono .. 

<h, .. , ...... '0 . hut rho _ommon, do .... """" 

thon ""'" ""';"11' .... """_ M .. nwhilo • • b<H!_ 

ri"",a doI.nde .. cNIlonge<J ,,,. ""'" .mond· 

mont". _ .. i,,,,iO<\.lit, .. , ... _,I _n., In 1990. , .... U.S, Su", . ..... eo..,n rut", in , ... 

Io ndmotl< .... of I/I"ri. ~ Mc/I .. 'hOI , .... Itv<lo 

_'" .. <OMIrt"', ..... , f ... «>Un .... Id 'hOI 

_ ... -.-,-.. -"-,.,, 

rho lundi"ll ,._."" did not;",ping< on ,,,. 

,;"'h' '0 ON' .b<H!oon ....... "11 ,h .. . . womon', 

I,Mdom 01 """"'. 1_ not oonyl ";,h ~ 0 con· 

OIituI;"".1 .n'.'.mo", to , ,,. fiM<1ci.1 , .. ""'<eo '0 .. oil ...... 11 oJ ,he 'vii ""II' 01 ",_. <1 

""""' .... Tho ' ''''" .. _If.mon, ,ould choo .. '0 

or><o<>'_ m~dbinh.,.., .b<H!ioo lby pr<Niding """" ..... Iot tho..,.,. __ od with ........ "". 

""";10 _"'''II _ _ k>o- ''''''001 bo<.v .. 

chiI<lbo.,ino w .. "'''ion,H, ' ..... d '0 ,,,. Iog"i· 

moto _or ............ o!>jectiv. 01 p,"'octing 

_"'~"' " 

Tho 'u""on< v ..... on 0' ,h. Itv<lo ome1'dmo-no. 'n 

. " '" .inu 1997. bon. '_rolfundi"ll fot obo<· 

bon. o>U<" "' eo ••• 01 " .... ""'." '" whOlO • 

womon'. . ;, "" ... ""'" "" •• """~ d • ..,..· 

dof. ~ .. "''''Y. or phyoi<.al ~I ....... in<lu<fi"ll 

o I_ nd""ll'fi"ll """oi<oI .:ondilion tav,"" by '" .~.it>g 'rom , .... PI __ ".,. ~ .. K'- Be.oou .. 

MO<f;",,<I " • JOint f"""'''.''''' "'0\1'''" ....... m.oV "" ,he;< 0 .... fund. 10 "."" ... ,b<H!io<> _",_'ot Mo<fi<oid ~.pi.nt •. """ 17 ...... 

"'". """ "" o<>----o<o<no V<>lvn,."'",.nd _ by 

coun",dof(_ "-I.· 

fUBLIC COVER"CE FOR _SORlION -_ '-----_ .. _ ...... _--- ..... "'--... ...... '" ..... ... _--_ ............. , .. _-

.' ~ .c--..... __ _ ._._-- -.-.. 
128 

H,de's Proo,eny 0.., , .. last ..".,.1 _ .. Cong, ... hH on_ 

octoo ••• ri .. of poIi<io. '"'' . ,,,,,,.rlV , ... rid 

• ..,..i<>tl """"'000 CK .. "';",. 10< _, "","P' of 

w""",n do".ndon, on ' " _ . rnmont 10< ' ''';' 

... K" ",.,,,onoo 0< .... It" ""'0, ,nd""'''IlI_ .. 

. "'"..",...mh •• 'V ".,""" .... 1oder.1 ",i. "" in· 

mo'" . ""'" ' ... _ of ' ho .... "" .. of COIum"'. 

.nd NOIi"" ....... n"'" _n I." "'''',, 

Thoi ..... """'foder .. irwoIwmontinaborlion 

""""',ogo wont "'goIy dormont until ' '''' dobo.- "'"' ""oil" "',. ,o/<>rm go< underwov in ... ,urn- mof of 2(109, E ...... on. PfooiOonl Obomo.nd pro-

<1>00>0 _ . in Coo>o<- ooughl .o .. "", down 

'ho 1or"';"Il ""n"""", .. by ......... thor ho",h .... ,.torm """'1<:1"'" "" ..,.",,'- 1<>< __ 

"'g''''' obortion dobot •. ""'Nd, "'oy ...... oo ." .. , ...... "'quo._ oppIy. """'" iI .. Kopownod 

. ""' .... "' .. h "' .... """' ....... "'" ......... 

AI>o<tion ,;g"" aot.-oc.o ••• ,eluct.nll>( 09'"" 

'0 I ..... im ... 0 bon <>tI ' '''' di .. <1 .... 0' lod· 

.,,1 fund. /0, .boni"" """","go. "..,ho f/ydo 

31 HAAS OF RESTRICTIONS AND COUNTING 

omtndn>ont. . nd ", .wtv ' hot bon ' 0 "'''''''"'' _ .. I .ut>oid"' lo< pri ....... 1." in ...... noo. 

AI>o<tion _. by <Mtr .... . ... <>itod !hi. now 

_ ni"ll '" " , .. d> .oOi .. 11>( 1ho ",,",,"pr of ...... 

""" .. iM. .. _.m ....... '"",,i"ll, _.1 ...... "'''''' <100" 0 winning 'h' ;""Iu"'" of 'h' 10· 

oollod Stupa ~ , men_ n,mod olio< ."".bot- """ .p, "'" smp.k U>·MI), """"" would n". 

bon,...! "'i .... in ......... f,om _ .... bortlon 

fo< ' ''1'_ '" pi", ........ 0"1' or><lovidOJ" , ub· 

"",ibot ,.u; •••• ,odo,oI '"bsidv undo,."".a. 

UKi""'''I>(, tho A"ordoblo CO" Aet (AtA!. o;g,...! 

into I.w in MOl"" 2010. ,oft ..... «><nptomi .. 

,n .. _"" ............. now ","""'n, 10< 100· 

,,01 ""_, __ '" ,,,,,,,Oft _ .... go ;n' .. poi. .>1. """"""" m • .l ... Undo, , ho lin. 1 «>n>prO. 

mI .. , _ .. ,Iundo-in ,,, .. « ", .uboi<ly dol .... 

fo< _.;duol. P'oI'''''''ng pions Oft tho "","" ;n_ 

'"" "'" "".l .... """ 0<I>edd00 '0 bo _ .. ion· 

oI ,n .. ,.II-mov "'" "" """ '0 _ lor ,_on 

""""'OOO.""..,.;n « ... of Ido ...... _ ,mon •. 

"". '" .... " . B", m, u ..... or ..... in thoory, .. i. moy ~ .. pI.n. ,,, .. indudo _ion _ ' ''go, 

71 71 'II '11 '1!l TI 'II 11 't3 '!Ill 11 ." '01 '03 ~ '01 '01 '11 '13 

..... ,,- ......... . ..... , .... - _f ........ _ .rr __ "" ..... __ .rr,..., ... ""' ... _ ... _ .. _ ... __ ~ __ ... 
129 

.., ","0 " Ih .. __ .". tho """""flO i • .,.,. f .. 

bI' .... , ub"","'" not w"h _ .. I fu_. 

In ".-"",~,~. tho"..,.,i ... ".-ovio;""ift'ho 

/>CA ""1>1 ;,. .... """'" 001."" .... h;gto ,-dO •• 

'"'' could """,oly hm. womo<!" ocu .. '0 pl • .,. 

' ht1 __ .bo<tion, To ........ tho oeg'og";"" 

of fw ..... , ........... """,,..n", """''''' pI. n. 

, .... _ . """' ... ".....,"". 10< .... ;,."""'. 

WIth , uboO.i...:! ''''""'_ .... , ..... d '0 .. ""...,. 

,ho "'" of ,ho -.<Of>!/O .rod ....... tNll tho! 

.. ".,., .. ,,, .. ..,., hom tho "'''' .". 011 <>tho, 

""".'_. I"... ...... """''''' .... ..;1 .100 .....,. '0 

.... , .... ft " "" .. ,• ..,.,.,.,,,,, ."d ..,tom • • pi ... '0 

tI>o .. .,. ift.",,,,,. co"""';'."",,", "' .. deI .. l •• 

".-_ .. to '""U," th .. lho p""",," ... 10< . bort;.,., """.' __ .. "'x wO" 10<'0<01 'un<I.,' 

kl_ort.'hor .... comp<_i ......... " .. '0 """"tNt _on .,.,...._ .. orivoto 01 .... 

"""",1>1_ """'Y "'" <loloo 00. T_o""" .... ....... h ... 1_ ....... i.,~ ban,.;"g abot!ion 

"""",_;ft pi ..... thO! will bo "" .. od th«>uQh tho 

... oIth ....... nco "",k .. o>/o<o .. ,,,,,,""i,,,, ';ght 

...... th .. boft ....... """" """ ... _ of abot!"", 

mora brNdly .... , priv ... in ... , ........... 'og<>' 

bt ... ".. tho " ... ( ... "",p),' AM. iuot like tho f ... · 

.... _""""". 18 " .... ho.- b .......... abot!;.,., 

""""olIo;" i",",one. P"'''' foo- pubIO:..-..pI<ry-. 

I",.'.nee eo.eragl MlUlrs 

~ ... oo ... Iy '0 know wh ... ho impoet ";N bo.". 

_ "0" , ... ,;cOO!o, ... "';,. ... "' .... _ ,,,,". 

"OlIO "" abot!oon, fIo __ .. ,..".... 3Sve¥< oil..-

,ho ,M .. I p .... g. oj .... Hytle .morodm."" ,he" 

;,. • "'''''Q body oj ",Ode_ ... the imP"'" oj ~ 

.,.;og ;nsu .. nco _ "OlIO of • ..,.,;.,., to I"",·,,,· 

"""'" ....,..,.ft .... " od th,O\jg" M. d",.>d. A 2009 

lit .. "u" , .. >ow publi,hod by tho GutlmodIo, 

"''''''''' ........ ,fiod 38 <hIdi., ""bli.hod botwooft 

1979 . rod 200lI ,h., ...... y>O<l tho ;"'PO<' of ' ho 

Hy<Io ..... rod .... nt on • ' ''''II'' .". "",,,,,,,,,, .. ' Tho 

, ........ condud .. 1I,,,t """ in foIJ, ""'....., wok 

Mo-dRoood <CWr_ ...." ... 10 tho Hy'" . morod, 

mont who ... k on o\o<wt"", ... un.1>Io to o;obtoi " 

..,. duo to .... '''* of """"OIl". Ttu. ""","u.",n 

.... b.oed on "ud'" hom Ii", " .... th.t C«r>-

".,od the , .. '" oj .1>0<1;"". '0 tNrtM _ •• rId 

"". , funding .ndO<I. Tho . tu<Iy wdh tho boot do--

,,;gft . .. ""M<! .I>o<I,Oft .rod binh ,,, .. in NOIt~ 

_ ... -.-,-.. -"-,.,, 

PIIIVATE COVERAGE FOR ABORTION , .... _ .... _____ 00 .. __ _ 

'"'_ .. ___ 00 ... ____ _ 

,,----------.-

-=:::::-.. - .-.... _- -_. 

C""in •• who ...... t •• """ion lurid ' ... "'" .". 

mo<>oy bol ... ,he ond of the Ii",., Y'" "" ........ 

. 1 """.oon. bet .. "" 1978 .rId '9\lJ. "Thi. study 

/"""d that 31'% oj wom .. who would ...". ho<I 

." .bon"'" ~ Mtdi .. id """.rogo .. or. ovtibto. 

<a<riod ,hoi, p,,,,,,,,,,,,,, to t."" d ........ tho ".n . 

od ......... !urod;ng w., un ... i ...... (A oy .... ., 

WOIth ."."".si"og. _vor, IS 'hot " "or""" .". _.1 Modi";d covor_ would r>OI , ..... It 

in . """""'",", ... ;net .... ,,, the incido.-.co of 

.l>o<Iion ""tionwodo. " loodino . ... abot!;.,., 0<:-

ti,.; ... ;"""'''''' .... hove cor.oludod; ... bo"-I 

_"'''''...,..,....., who ... do-tH+d . " _on ' '''-''1\110 moro fo",,"";.lIv th ... """",n who U"-

""110 the ",-"u" , _ing to . "tudy bI' 

, .... -. .. the Univ ... ity.". C04'fomi •. Soft 

F .. ...,;oco. ", ... "'od at the 2012 mootiog .". ,ho 

_"'.n Pu"''' .... "" .... JO<i ... on, "Tho " ..... 

.... b ... od ... d.,.on """,. th .. 800womon 

_ogot.Oltion. ot 30 U,S, foeiliti .. , o:<>mj>¥;"O 

...,..,....., who '-vod . n _"ion ,rod _" 

who WO<e t ....... _ov _ UN thoy ....... "",. 

. n obOltion I>oyorod the ",ovidor'. go.",;on.' 

.{>o 1i ... 1. OM V'" "'01, tho womo<! do"... ... 

."""ion "OI. I ... ~k'" th' n tho womo<! who 

,"";vod 0" • ..,.,,,, .. to bo wootJ"g I ... , t, .... . nd 

mo ... I",oly to '" ' _ lVi"" ""bIic ... ... ..-.eo .rId 
130 

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133 

m ~NARAL Pro-Choice America Foundation 

UNo Taxpayer Funding for Abortion Act" (H.R.7l: 

An Extreme Attack on Women's Access to Abortion Coverage 

Testimony submitted by 

!lyse Hogue 

President 

Also on Behalf of 

NARAL Pro-Choice Arizona 

NARAL Pro-Choice California 

NARAL Pro-Choice Colorado 

NARAL Pro-Choice Connecticut 

Illinois Choice Action Team 

NARAL Pro-Choice Maryland 

NARAL Pro-Choice Massachusetts 

NAI{AL Pro-Choice Minnesota 

NARAL Pro-Choice Missouri 

NARAL Pro-Choice Montana 

NARAL Pro-Choice New Hampshire 

NARAL Pro-Choice New Mexico 

NARAL Pro-Choice New York 

NARAL Pro-Choice North Carolina 

NARAL Pro-Choice Ohio 

NARAL Pro-Choice Oregon 

NARAL Pro-Choice South Dakota 

NARAL Pro-Choice Texas 

NARAL Pro-Choice Virginia 

NARAL Pro-Choice Washington 

NARAL Pro-Choice Wisconsin 

NARAL Pro-Choice Wyoming 

u.s. House of Representatives 

Committee on the Judiciary 

Subcommittee on the Constitution and Civil J Llstice 

January 9, 2014 
134 

Members of the Judiciary Subcommittee on the Constitution: I am honored to submit this 

testimony on behalf of NARAL Pro-Choice America, our state affiliates, and the pro-choice 

Americans we represent. 

Today you are considering the "No Taxpayer Flmding for Abortion Act" (H.R.7), introduced by 

Rep. Chris Smith (R-NJ), a bill that is misleading in its claim that it ends public funding for 

abortion care. This bill is not about public funding. Current law is clear: sadly, federal fLmding 

of abortion care is forbidden, except in very narrow circumstances. Instead, this bill is an 

attempt to reopen the debate on private insurance coverage of abortion and to continue a long 

series of political attacks against the Affordable Care Ad (ACA). Moreover, contrary to what 

the bill's proponents claim, it is a simple fact (one that a federal appeals court confirmed) that 

no federal dollars may be used to pay for abortion services under the ACA. "The express 

language of the [ACA] does not provide for tax-payer funded abortion," the court wrote. "That 

is a fact, and it is clear on its facc." l 

Instead, the Smith legislation opens an entirely new front in anti-abortion forces' unending 

campai6'11 to ban the procedure. Beyond permanently blocking abortion coverage for lowincome women, civil servants, and military women, this proposal would impose the core 

provision of the failed Stupak-Pitts abortion-coverage ban on the new health system; jeopardize 

the availability of private abortion coverage nationwide; levy tax penalties on any small 

business that provides comprehensive health coverage to its employees; and create a troubling 

new restriction on abortion that could spur the Internal Revenue Service to audit rape 

survivors. 

Coming on the heels of a debate over health-care reform during which anti-choice lawmakers 

claimed they were "merely" trying to ban federal funding for abortion, this bill exposes that 

their view of "public funding" bears no resemblance to reality. In an unprecedented departure 

from current law, the Smith legislation seeks to define public funding as falsely including 

private money that the government has decided not to tax-a politically driven fiction that is not 

supported by existing law2 The Smith bill would extend unprecedented limitations on abortion 

access to a much larger share of the population than any current law and impose sweeping 

changes to tax policy. 

Revives Core Provision of the Stupak-Pitts Amendment 

In an effort to reopen the contentious issue of abortion coverage, the Smith legislation revives 

the core provision of the failed Stupak-Pitts amendment, and effectively would end abortion 

coverage for women in state insurance exchanges who use their OW'11, private funds to pay for 

their insurance. The Smith bill makes it highly unlikely that insurance companies will opt to 

offer abortion coverage in state exchanges: it forbids any plan offering such coverage from 

accepting even one subsidized customer, forcing insurers to choose between offering their 

product without abortion coverage to the entire universe of consumers in a state exchange and 

2 
135 

offering a benefits package that does include abortion services to a small minority of 

unsubsidized customers. (Because a vast majority of participants in state insurance exchanges 

will be subsidized,'it seems clear which choice insurers are likely to make.) As a result, in 

addition to women who will pay part, or even most, of their insurance premium with private 

hmds, millions of unsubsidized individuals and small-businesses employees who obtain 

insurance through a state health-insurance exchange will be denied abortion coverage. 

In addition to restricting who may purchase abortion coverage within state insurance 

exch,mges, the Smith bill would impose crippling administrative burdens on pl,ms that wish to 

cover abortion care. If the Smith bill becomes law, insurance companies that offer abortion 

coverage-absent political interference, research shows that 87 percent of plans do'-would 

face high costs, technical complexities, and onerous administrative requirements.' 

Moreover, the bill's virtual ban on abortion coverage-together with its imposition of tax 

penalties on the purchase of plans that include abortion coverage-will affect not only state 

health-insurance exchanges, but can be expected to have a detrimental, industry-wide impact 

on abortion coverage in the entire private insurance market.' According to health-policy 

experts, as insurance exchanges grow they will have a greater effect on the health-insurance 

industry as a whole, eventually becoming the de facto standard for benefits packages.' Over 

time, the Smith bill's requirements could cause the elimination of coverage of abortion services 

for most women -not just those who purchase plans through a health-insurance exchange. In 

fact, during a congressional hearing on an earlier version of this bill, a witness testifying in 

support of the bill predicted this exact outcome, stating that "the new legislation, when 

combined with other existing laws, may provide a 'tipping point' where coverage without 

abortion becomes the usual norm for health insurance."s 

Imposes Tax Penalties on the Purchase of Abortion Coverage 

We understand that today's hearing and this subcommittee's jurisdiction does not extend to the 

tax-related provisions of this bill; nevertheless, we offer the following remarks about those 

sections so that members have a full picture of the bill's reach and scope. 

The Smith lebrislation interferes with coverage of abortion services within the private-insurance 

market and makes chaotic changes to tax policy. The legislation would force millions of 

families to pay taxes that others do not have to pay on their health-insurance benefits if their 

plan includes abortion. It does so by imposing tax penalties on many individuals and small 

businesses that choose private health plans that cover abortion care. In levying higher taxes on 

plans that include abortion coverage, the Smith bill severely threatens the private market for 

comprehensive insurance coverage that includes abortion care. It seems obvious that the whole 

point of the scheme is to drive consumers away from these plans by increasing the cost of 

health-insurance. 

3 
136 

Specifically, the bill would: 

Force small businesses to choose whether to accept the Small Business Health Tax Credit 

enacted as part of the health-care law or to offer their employees comprehensive 

insurance plans that will cover all their potential health needs, including abortion care. 

Under the Smith bill, insurance plans that include abortion benefits arc ineligible for the 

tax credit. Four million small businesses are estimated to be eligible for the credit if they 

provide health care to their workers9 

Take away tax benefits from self-employed persons if their health-insurance plans 

include abortion coverage. Currently, self-employed persons arc able to deduct the cost 

of their insurance policy from their income taxes. The Smith bill, however, makes all 

plans that cover abortion non-deductible.'" 

Impose tax penalties on many individuals who have high out-of-pocket health-care 

costs. Current law allows individuals to deduct all health-care expenses - including 

insurance premiums-that exceed 7.5 percent of their 6'TOSS income. The Smith bill, 

however, wou ld make insurance premiums for plans that include abortion coverage 

non-deductib1c.ll 

Restrict the use of private dollars placed in tax-preferred Health Savings Accounts 

(HSAs). The Smith bill forbids individuals from using private ftmds saved in HSAs from 

being used to pay for abortion care, except in extremely limited circumstances. 

Potentially spur the Internal Revenue Service (IRS) to audit rape and incest survivors 

who require abortion services. Because, as described above, the bill eliminates medicalexpense deductions for abortion care, with exceptions only for cases of rape, incest, or 

when a woman's life is in danger, tax experts confirm that the I RS would have to enforce 

this provision-and could audit any "questionable" benefit claims.'

° As a result, a 

woman could be forced to defend her abortion claim to tax agents if she were a survivor 

of rape or incest. 

The National Women's Law Center (NWLC) quantified the impact the tax penalties an earlier 

version of this legislation would have imposed on hypothetical individuals and small 

businesses. According to the NWLCs analysis: 

A restaurant with 40 half-time employees whose wages totaled $500,000 and health-care 

costs totaling $240,000 per year would be eligible for a Small Business Health Tax Credit 

under current law. Under the Smith bill, however, that restaurant's taxes would be 

raised by $28,000 if its health insurance plan includes abortion coverage13 

4 
137 

The Smith bill would cost a married self-employed individual who had a combined 

income of $98,000 and $7,000 in annual insurance premiums an additional $1,750 per year 

if that individual's insurance plan covered abortion services. 14 

A woman who makes $25,000 is eligible to deduct from her taxable income any amOlmt 

over $1,875 spent on health-care expenses, including on insurance premiums. If her 

insurance plan covered abortion, however, the Smith bill would take away her $1,731 

deduction.'.i 

Recodifies Existing Bans on Abortion Coverage 

This legislation also would reinforce long-standing discriminatory bans on publicly funded 

abortion care by permanently denying low-income women, federal employees, women in the 

military, and residents of the District of Columbia access to abortion coverage. 

Again, current law already bans public funding for abortion care. Currently, most of these bans 

are renewed annually in appropriations bills. The Smith bill writes the bans into permanent 

law. This would result in permanently denying abortion coverage to the nearly 20 million 

individuals insured by Medicaid,'6 the 7.6 million non-elderly and disabled individuals 

currently enrolled in Medicare,'7 and the 2.1 million American Indians and Alaska Natives who 

receive health insurance through the Indian Health Service (IHS).18 

Additionally, the US government offers health benefits plans to nearly eight million federal 

employees, their dependents, and retirees, 44 percent of which are women. 19 The Smith bill 

permanently bans abortion coverage for these federal employees and their dependents, even 

though these workers pay a portion of their health insurance premiums with their own private 

dollars. 

Similarly, the bill also recodifies the ban on abortion care for women in military hospitals 

overseas, and permanently denies abortion coverage to the 9.6 million individuals who receive 

health insurance through TRICARE, the military health plan."o 

Likewise, the Smith bill would permanently deny abortion coverage to Peace Corps volunteers. 

Of the 7,209 U.s. citizens who are currently volunteers and trainees for the Peace Corps, 63 

percent are women. 21 Finally, the Smith bill also reimposes the ban on Washington, D.C.'s 

ability to use its own local funds to cover abortion services for the 78,200 low-income women 

currently enrolled in its Medicaid program-an unfair restriction that Congress lifted in 2009." 

Overall, the more than 15 million adult women who receive health coverage through all the 

government-sponsored programs described above permanently would lose access to abortion 

coverage, except in in credibl y narrow circumstances."3 

5 
138 

Congress should be repealing these abortion bans, not recodifying them. Disniminatory bans on 

abortion coverage create significant, often insurmountable, obstacles for women seeking 

abortion care. Low-income women often have difficulty raising the money to pay for abortion 

services and research indicates that economic barriers often cause them to obtain abortion care 

two to three weeks later in pregnancy than do wealthier women." This is especially 

problematic because the cost of abortion care increases the longer the pregnancy continues. 

Later abortion care, which is already inaccessible to women in many states, ranges into the 

thousands of dollars, and can pose an insurmountable cost." These burdens also 

disproportionately affect women of color, who, because of the connection between racial 

discrimination and economic disadvantages, arc more likely than white women to be poor, to 

lack health insurance, and to rely on government health-care programs or plans."' Reiterating 

the abortion-coverage bans in permanent law adds insult to already deeply injurious policies. 

Moreover, these disniminatory bans require no bolstering: a CBO report on a previous version 

of the bill's fiscal impact states that gains for the federal government would be negligible"-

confirming yet again that no prohibited dollars arc used to fund abortion services beyond the 

narrow exceptions allowed by law. 

Finally, the Smith bill also recodifies the Helms amendment, a policy that denies some of the 

world's poorest women access to safe abortion care by prohibiting the use of U.s. funds to pay 

for abortion services in developing countries. Not only would the Smith bill jeopardize the 

availability of abortion coverage for American women, it would have detrimental international 

ramifications as well. 

Inadequate Exceptions 

It should also be noted that the Smith bill's ban on abortion coverage in the new health system 

lacks any kind of exception that would protect the health of the woman, or provide care in cases 

of fetal anomaly. While the absence of insurance coverage for abortion care hurts all women, it 

particularly harms those for whom pregnancy threatens their health. Many women welcome 

pregnancy at some point in their lives and can look forward to a safe childbirth; however, for 

some, pregnancy can be dangerous, and abortion restrictions, such as the Smith bill, that make 

no exceptions to protect women's health endanger these women. The Smith legislation would 

limit access even for women in the most desperate of circumstances, whose care is often the 

most expensive and the most urgent. For example: 

Vikki Stella, a diabetic, discovered months into her pregnancy that the fetus she was 

carrying suffered from several major anomalies and had no chance of survival. Because 

of Vikki's diabetes, her doctor determined that induced labor and Caesarian section 

were both riskier procedures for Vikki than an abortion. The procedure not only 

protected Vikki from immediate medical risks, but also ensured that she would be able 

to have children in the future. 28 

Jennifer Peterson was 35 and pregnant when she discovered a lump in her breast. Tests 

showed she had invasive breast cancer. The cancer and its treatment, separate and 

6 
139 

apart from the pregnancy, were a threat to her health. Her pregnancy posed a 

significant added threat to her health during the onset and treatment of her cancer. 

About one in 3,000 pregnant women also has breast cancer during her pregnancy, and 

for these women, a health exception is absolutely necessary."' 

Gilda Restelli was well into her pregnancy when doctors discovered that her fetus had 

only fragments of a skull and almost no brain. She and her husband had been told by 

medical experts that their baby had almost no chance of survival after birth. Restelli quit 

her job, not because she was physically incapacitated, but because she could no longer 

bear the hearty congratulations of strangers who were unaware of the tragic 

circumstances surrounding her pregnancy. The Restellis made the agonizing decision to 

end the pregnancy.30 

D.)., a federal employee, was 11 weeks into a wanted pregnancy when she learned that 

her fetus had anencephaly, meaning that the fetus would never develop a brain. Her 

doctor provided abortion care at a local hospital. Several months later, she received a 

bill for $9,000 - and was told her insurance would not cover the costs because, as a 

federal employee, she was not entitled to insurance coverage for abortion services unless 

the pregnancy endangered her life. 

Earlier Version of H.R.7 Redefined Rape and Incest 

As a final note, it is worth reminding members that until sponsors were forced to remove it after 

public outcry, the original version of H.R.7 had an additional extreme and mean-spirited 

provision that would have narrowed the already severely limited rape and incest exceptions 

that exist in federal law. Most federal laws that restrict access to abortion services allow 

exceptions for instances of life, rape, or incest. The Smith bill's original language, however, 

limited these exceptions to include only victims of "forcible rape" and "incest with a minor." 

This restriction would have applied to all federal programs, affecting not only low-income 

women in Medicaid, but women in the military and all federal employees, as well. It also 

would have applied to state health-insurance exchanges, and to the tax-benefits restrictions 

applied to the private insurance market. While ultimately the bill's sponsors dropped this 

offensive provision, its inclusion in the original version offers another indication of the bill's 

extreme nature. 

Conclusion 

The Smith bill represents an extreme new anti -choice agenda that drastically alters the concept 

of "public funding." In trying to redefine this term falsely, this proposal not only does further 

injustice to low-income women, but also jeopardizes the ability of private citizens to use their 

own dollars to purchase abortion coverage in the new health system and levies harsh penalties 

on small businesses that choose comprehensive insurance coverage. Reasonable lawmakers, 

7 
140 

even those who may not agree with the pro-choice perspeliive on the issue of public funding 

for abortion, should recognize this bill for what it is: a radical departure from the alreadyunacceptable status quo. 

1 Susan B. Anthony List v. Driehalls, 805 F. Supp. 2d 423, 431 (S.D. Ohio 2(11). 

2 H.R. REP. No. 112-38, at 44,45 (2011). See also Walz v. Tal Comlll'n of City of New York, 397 U.s. 664, 675 

(1970). 

'; Letter fron1 Dougla.;.; Elnlcndorf, Director, Congressional Budget Office, to Rep. John Dingcll (Nov. 6, 

2009), available at 

http://www.ebo.gov/ftpdoes/107xx/doc10710/hr3962Dingell_mgr_amendment_update.pdf. 

4 Adam Sonfield et aI., U.S. Insurance Coverage ofContraCl?ptivcs and the Impact of Contraceptivp Coverage 

Mandates, :!OO:!, 36 PERSP. ON SEXUAL & REPROD. HEALTH 2, 72-79 (2004), available at 

http://www.guttmaeher.org/pubs/journals/3607204.html (last visited Aug. 1. 2013). 

o Sara Rosenbaum et al., An Analysis of the implications of the StllpaklPitts Amendment for Coverage of 

Medically Indicated Abortions 25 (2009), available at 

http://www,midwife ,org/ ACNM/files/ ccLibrary Files/F ilename/000000000311/ dhpPu blication_FED314C 

4-5056-9D20-3DBE77EF6ABFOFED.pdf (last visited Jan. 2, 2014). 

C Sara Rosenbaum et aL, An Analysis of the Implications of the Stupak/Pitts Amendment for Coverage of 

Medicallyilldicated Abortions 9 (2009), availaiJle at 

http://www,mi dwife ,org/ ACNM/files/ ecLibrary Files/F ilename/000000000311/ dhpPublication_FED314C 

4-5056-9D20-3DBE77EF6ABFOFED.pdf (last visited Jan. 2, 2014). 

7 Sara Rosenbaum et aI., An Analysis of the Implications of the Stupak/Pitts Amfndment for Coverage of 

Medically Indicated Abortions 9 (2009), available at 

http://www,midwife ,org/ ACNM/files/ ccLibrary Files/F ilename/000000000311/ dhpPublication_FED314C 

4-5056-9D20-3DBE77EF6ABFOFED.pdf (last visited Jan. 2, 2014). 

3 No TaJ.payrr Fundingfor Abortion Art: Hraring Effore tlw Sllbcomm. on the Constitution of the H. ComJ1l. on 

the Judiciary, 112th Congo (2011) (oral testimony of Richard M. Doerflinger, associate director, Secretmiat 

of Pro-Life Activities at the United States Conference of Catholic Bishops (USCCB)). While the 

testimony pertained to an em'lier version of this bill (H.R.3), H.R.7 includes identical tax-related 

provisions in its current form. 

9 National 'rVolllcn's Law Ccnter, Oppose the Dangerous and !vIisleading "No Taxpayer Funding for Abortion 

Act" (2010). 

10 National Women's Law Center, Oppose the Dangerous and 1I1isieading "No Taypayer Fundingfor Abortion 

Act"(201ll). 

11 National 'rVOlnen's Law Center, Oppose the Dangerofls and Aiisleading "No TaJ.payer FlIfldingjor Abortion 

Act" (2010). 

12 Hearing on the Tax Related Provisions ofH.R.3: Hearing Before fhe Subcomm. on Select Revenue Measures of 

the H. Comm. on Ways and Means, 112th Cong, (2011) (oral testimony of TI'0mas A, Bm·thold, chief of 

staff, the Joint ConU11. on Taxation). While the expert findings pertained to ,m earlier version of this bill 

(H.R.3), H.R.7 includes identical tax-related provisions in its current form. 

11 National Women's Law Center, Oppose the Dangerous and Misleading "No Talpayer Funding/or Abortion 

Act" (2010). 

8 
141 

H National Women's Law Center, Oppose the Dangerons and 1I1isieading "No Ta,payer Fundingfor Abortion 

Act"(201ll). 

1~ National WOlnen's Law Center, Oppose fhe Dangerous and Alislcading "No Ta:.tpaycr Fundingfor Abortion 

Act" (2010). 

J(, Kaiser Family Foundation, "Distribution of the Nonelderly with Medicaid by Age," State Health Facts 

(2012) available at http://kff.orglmedicaid/state-inclicator/distribution-by-age-4/ (last visited Jan. 2, 2014). 

Ie Kaiser Family Foundation, "Distribution of Medicare Benefidaries by Eligibility Category," State Health 

FaLts (2009) available at http://kff.org/medicare/state-indicator!benefidaries-by-eligibility-category / (last 

visited Jan. 2, 2(14). 

18 Indian Health Service (IHS), Indian Health Service; A Quick Look (Jan. 2013), availablr at 

http://ww\v.ihs.gov/newsroom/incl udes/themes/newihstheme/ display _ objects/documents/factsheets/Q 

uickLook_2013.pdf (last visited Jan. 2, 2(14). 

19 U.s. Office of PersOlmel Management, The Facl Book, Federal Civilian Workforce Statistics (2007) 54, 82, at 

http://www.opm.gov/fcddata/factbook/ (last visited Jan. 2, 2014). 

-u TRICARE, Number of Beneficiaries, at http://www.tricare.mil/Welmme/About/Facts/lleneNumbers.aspx 

(last visited Jan. 2, 2014). 

21 PeaL'€ Corps, Fast Facts (last modified Nov. 20, 2013), at http://www.peacemrps.gov/about/fastfacts/ 

(last visited Jan. 2, 2014). 

"Consolidated Appropriations Act of 20lU, P.L. 111-117, 1111h Congo (2009). 

2J Kaiser Family Foundation, "Health Insurance Coverage of Women 19-64," State Health Facts (2012) at 

htlp://www.statehealthfacts.orglmmparebar.jsp?typ~l &ind~652&cat~3&sub~178 (last visited Jan. 2, 

2014). 

"Center for Reproductive Ri!';hts, Women's Reproductive Rights in the United States: A Shadow Report (2006). 

Rachel K. Jones et ai., Abortion in the United States: incidence and Access to Services, 40 PFI{SI'. ON SI'.XUAI. & 

RFPROD. HFALTH 6,14 (2110H), availablc at htlps://www.gutlmacher.org/pubs/journals/4011116I1H.pdf (last 

visited Jan. 2, 2014). 

'" NARAL Pro-Choice America & NARAL Pro-Choice America Foundation, The Reproductive Rights and 

Health of Women of Color (2000). 

'7 Congo Budget Office Cost Estimate, H.R.3: No Taxpayer Funding for Abortion Act (Mar. 15, 2011), 

available at http://www.cbo.gov/sites/default/files/ cbofiles/ftpdocs/121xx/ doc12105/hr3. doc. pdf (last 

visited Jan. 2, 2014). While the report's findings pertained to an earlier version of this bill (H.R.3), H.R.7 

includes identical tax-related provisions in its current form. 

W Partial Birth Abortion Ban of1995: Hearing on H.R.1833IS.939 Before the Senate CO/mn. on the Judiciary, 

104th Congo (1995) (testimony of Vikki Stella). 

-9 The National Cancer Institute, Generallnfonnation abollt Breast Cancer and Pregnancy (Sept. '19, 2(113), 

available at hltp://www.cancer.gov/cancertopics/pdqltreatment/breast-cancer-and-pregnancy/patient 

(last visited Jan. 2, 2014). 

William Raspberry, Abortion; A Tough Case, WAS] 1. POSl, Aug. 31, 1998, at A21; Felice J. Freyer, Hospital 

Agrees to End Tragic Pregnancy, I'TTTSBURCH I'OST-GA7F.TTF, Aug. 311, 199H, at A3. 

9 
142 

---

.. 

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NCJ . 

N~~I Courl(il of Jew.sIIWomen 

SUt_eM of National Coun<~ of J"w;oh Wome" on 

HR 1, No Taxpaye r Fundi". for Abortion Au 

Writt"" Testimony ,ubmineO by 

NOlI<)' Klumun. Otirf Exoc~ OIroc .... No_I Cou.d of J"";<h Wcm<tI 

us Ho ... oI~tIw< 

Committee on the JudK:iuy 

Subcornmj[, .. "" the ConnJrutIon >n<! CNiI )u,d<_ 

J .... ....., 9, 201~ 

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145 

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Robert e, G"'ifi"ller. MD 

John Joy College 01 

Cn....," ..... ,,,. 

Ma,lIyn Holle 

ProteclJon & Act.otOq' Inc 

Robe.., N. Wel""r 

ArllOld & POIler, LLP 

January 8, 2014 

The Honorable Trent Franks 

Chairman 

Subcommittee on the 

Constitution 

and Civil Just>ce 

Committee on the Judiciary 

U.S. House of Representatives 

2136 Raybum House Office 

Building 

Washington. DC 20515 

The Honorable Jerrold Nadler 

Ranking Member 

Subcommittee on the 

Constitution 

and Civil Justice 

Committee on the Judiciary 

U.S. House of Representatives 

2138 Rayburn House Office 

Building 

Washington, OC 20515 

RE: January 9, 2014 Hearing on "The No Taxpayer Funding 

fOf" Abortion Act" (H.R. 7) 

Dear Chairman Franks. Ranking Member Nadler. and Members 

of the House Judiciary Committee's Suocommittee on the 

Constitution and Civil Justice: 

The National Health Law Program (NHeLP) strongly opposes 

H.R. 7. "The No Taxpayer Funding for Abortion Act," which would 

impose dangerous and unprecedented restrictions on women's 

access to abortion services. and. for the most vulnerable women. 

may put their lives at risk. H.R. 7 would permanently ban abortion 

coverage with only extremely narrow exceptions for low-income 

women who access their health care in publicly funded programs, 

and would make insurance coverage for an abortion almost 

impossible to obtain for any woman, The National Health Law 

Program is a public interest law firm working to advance access 

to quality health care and proted the legal rights of Iow-income 

and underserved people. H.R 7 is harmful to all WOOlen, but this 

testimony focuses on the public funding restrictions that 

disproportionately affect the low-income and women of color 

NHeLP serves. 

H.R. 7 would make permanent the harmful Hyde Amendment. 

which discriminates against and disadvantages women who may 

most be in need of abortion services. It robs low-income women 

of the ab l~y to make I~e decisions in the best interest of 

themselves and their fam ilies. A woman who is denied abonion 

services is more likely to have income below the federal poverty 

level and to receive public assistance than a woman who can get 

OTHER OFFICES 

2639 S La Cienega Blvd Los Anseles, CA 90034 • (310)204·6010 . Fa . (310) 204·0891 

101 East Weaver Street, Suite G-? . Carrboro. NC 27510 . (919) 968·6308 Fa. (919) 968-88SS 

www.healthlaw.or8 
146 

the service. ' The ban on abortion coverage in all but the very narrow circumstances of rape, 

incest, and life endangerment put the most vulnerable women at risk, jeopardizing their health 

and the financial security of their families. 

Low income women, particularly low income women of color, already experience severe health 

disparities in reproductive health, maternal health outcomes, and birth outcomes. More than 

half of all women will have an unintended pregnancy and low-income women are more than 

twice as likely as the national average to have an unintended pregnancy Unintended 

pregnancies present a public health concern as they are associated with problematic maternal 

and birth outcomes2 African-American and Latino women have the highest unintended 

pregnancy rates, and relatedly, the worst maternal and birth outcomes. For example, AfricanAmerican women are three times more likely than their white counterparts to die from 

pregnancy-related complications.' H.R 7 would exacerbate those disparities by denying 

women access to abortion services that may be necessary to protect their health and their 

lives. 

Every person expects that the care they receive from their health care provider will meet 

established standards of care. Clinical guidelines and generally agreed upon medical practices 

are baseline practices that are accepted in the profession and codified in professional policies 

and position statements. Accordingly, several leading health professional and medical 

societies in the United States and Western Europe have issued accepted standards of care for 

reproductive health, which include providing medically accurate contraceptive information, 

services, and supplies, as well as abortion care. This is particularly important for women with 

emergent health issues and those whose management of chronic health conditions requires 

preconception and interconception care, which is care provided to a woman before and 

between pregnancies4 Specifically, accepted standards of medical care advise that women 

suffering chronic conditions - such as pregestational diabetes, lupus, and cardiovascular 

disease that could lead to adverse health and birth outcomes should avoid pregnancy until 

their conditions are under controLS H.R 7's denial of funding for low-income women with these 

complications could mean that a woman cannot afford to receive health care that meets the 

1 Diana Greene Foster, Bixby Center for Global Reproductive Health, Department of Ob/Gyn, University 

of California, Address Socioeconomic consequences of abortion compared to unwanted birth, at Am. 

Public Health Assoc. Meeting (October 30,2012), available at 

fit!'Q'il&el2fL:2!d~}/:_\'- ,i~(\'r:3i.:f.}])£!il.J i !3f;j\\i:ti t!:,n;!:;Ji~.m{(:!DIJi2;.2£; 1d~:iLbf?} ,f. 

2 Guttmacher Institute, Unintended Pregnancy in United States (Dec. 2013); National Health Law 

Program, How the Threats to Medicaid Impact Reproductive Health Disparities 1 (April 2011). 

3 Ctr. for Disease Control and Prevention, Reproductive Health: Pregnancy Mortality Surveillance 

System, Y&iL~~Lt~~o:::2S~1:~;'t!1PG?_Q1J.Dttd ~0J]'::ft:~:'Lt~Lllf?~=~1,}Enfru.Jtl<~b1.sjXbiE'~Y!S~21J1.':Li· 

4 For example, the American College of Obstetricians and Gynecologists, The American Medical 

Association, The Royal College of Obstetricians and Gynaecologists of the United Kingdom, The World 

Health Organization, The U.S. Preventive Services Task Force, and HHS' Centers for Disease Control 

and Prevention. 

5 National Health Law Program, Health Care Refusals: Undermining Quality Care for Women, 

Standard of Care Project, 2010 (citing Johnson K., Posner SF, Biermann J, et al. Recommendations to 

Improve Preconception Health and Health Care - United States. A Report of the CDC/ATSDR 

Preconception Care Work Group and the Select Panel on Preconception Care, MMWR Morbidity and 

Mortality Weekly Report Recommendations and Reports, 2006, 55: 1-23). 
147 

appropriate standards of care, and effectively interferes with a woman and her doctor's 

recommendation. 

Similarly, a number of emergent medical conditions may put her or her fetus at serious risk 

even when a woman has decided to carry her pregnancy to term. As a result, access to safe 

and timely abortion services becomes critical. These conditions include but are not limited to: 

premature rupture of membranes, preeclampsia and eclampsia, anencephaly (fetus 

incompatible with life), and chronic conditions for which pregnancy termination may be 

medically appropriate. In these situations, accepted medical standards and guidelines from the 

American College of Obstetricians and Gynecologists, Royal College of Obstetricians and 

Gynaecologists of the United Kingdom, and the Cochrane Collaboration acknowledge that the 

patient must then decide to balance her health and life with the prospects of fetal survival. 

These standards and guidelines all recognize that a woman must make this decision. HR. 7 

deprives low-income women of the ability to make important personal life decisions about their 

families. Moreover, it puts at risk the health and lives of women with particular medical 

conditions for which pregnancy is counter-indicated. 

Accordingly, we encourage the Subcommittee on the Constitution and Civil Justice, and your 

colleagues in the House of Representatives to protect the health of women and their right to 

quality and comprehensive reproductive health information and services. 

Respectfully, 

Emily Spitzer 

Executive Director 
148 

House Judiciary Subcommittee on the Constitution and Civil Justice 

H.R. 7, "No Taxpayer Funding for Abortion Act" Hearing Testimony 

January 8, 2014 

Dear Members of the House Judiciary Subcommittee on the Constitution and Civil Justice: 

We write today to express our opposition to H.R. 7, the "No Taxpayer Funding for Abortion 

Act," and our deep concerns about the drastic harms it would cause. H.R. 7 is a sweeping 

ban on abortion coverage and another mean-spirited attempt to interfere with a woman's 

personal decision-making. The measure would fall hardest on women who are struggling to 

get by, who are disproportionately women of COIOf, including Asian American and Pacific 

Islander CAAPI} women. 

The National Asian Pacific American Women's Forum CNAPAWF} is the only national, multiissue AAPI women's organization in the country. OUf mission is to build a movement to 

advance social justice and human rights for AAPI women and girls. Since 1996, we have 

represented AAPI women, who are overwhelmingly pro-choice, 1 in pushing back against 

abortion bans that disproportionately impact women of color. 

I. Harmful Impacts of Restrictive Abortion Bans 

H.R. 7 is an extreme abortion ban that permanently blocks abortion coverage in public 

insurance, the District of Columbia, and the military. It also includes a ban on private market 

insurance in the new healthcare exchanges. These restrictions create a real impact on 

women and their families by limiting their ability to access abortion care when they need it. 

All health insurance plans, whether paid for by individuals, employers, or with government 

funds, should provide coverage for a full range of pregnancy- related medical care, including 

abortion care. 

Our current laws impose unfair limitations on insurance coverage of abortion, and the No 

Taxpayer Funding for Abortion Act would make existing legislation like the Hyde 

Amendment permanent. The Hyde Amendment is extremely harmful for low income 

women and women of color who depend on programs like Medicaid for their health 

insurance. These restrictions makes abortion care unaffordable and out of reach for many of 

1 Nearly 7()% ofAPA \VOmeIl support a \\'Oman's decision to havc an abortlOIl. Anothcr 2()% statcd that they woulJ 

sllpporl a \\'ollllin's Jecision to hi.n-t: an abortion in certain cases such as rapt: or incest. National Asii.ill Women's Health 

Orgmuzauoll. E;"-Pffildlllg OptIons: A RcproductJ.\'c alld Sexual Health Surve ..... ofAsWll 

American Womt:n (.Ian 19lJ7) 
149 

these women. Women struggling to make ends meet should not have limited access to 

health care services simply because of their income. 

Policies that restrict insurance coverage of abortion, like the Hyde Amendment, are a very 

real concern for women in AAPI community. 1 in 10 Asian Americans, 1 in 7 Native 

Hawaiian and Pacific Islanders, and 1 in 5 Southeast Asians rely on Medicaid? Additionally, 

27% of Hmong and 21 % of Bangladeshis live below the poverty line. i For communities 

struggling to make ends meet, it can be impossible to pay for abortion services out of 

pocket. Without the ability to access it, the right to abortion becomes meaningless. A 

woman should have access to abortion care regardless or her income or type of insurance. 

II. Health care Barriers and Health Disparities of AAPI women 

Many AAPI women face significant barriers to healthcare and have substantial health 

disparities. This measure would make healthcare outcomes for AAPI women even worse 

than they already are. 

Many AAPI women are concentrated in low-wage employment that does not provide 

employer-based health insurance, and a high percentage of AAPI women are self-employed. 

Financial barriers also prevent many low-income women from purchasing private health 

insurance. Rates of public insurance in 2010 showed that 19% of all Asian groups enrolled 

in public insurance, with particularly high rates among the following: 28% of Native 

Hawaiians and Pacific Islanders, 37% of Bangladeshis, and 43% of Hmong . ..J- Un-insurance 

rates of AAPIs exceed 18.1% compared with 16.3% of all Americans. The rate is even higher 

for Korean Americans at 25.5%.5 

AAPI women have some of the highest rates of cervical cancer, and studies show that 24.1 % 

of AAPI women have not had a pap test in the last three years6 Additionally, coronary 

disease is a leading cause of death among AAPI women, responsible for more than a quarter 

of all deaths? AAPI women do not need another barrier to health care, and making abortion 

harder to obtain will exacerbate health outcomes for us. 

J11e Impat:l of Health Care Reform on Heallh Coverage for 

2011). aVailable a/ 

hllp"il\\\\w apiahf org/~ilcddefaultJfiled PA-Faclsheel12-2011 pdf 

3 Natronal CoahtlOn tor ASlan PaCltic Amencan C0Il11111UUty Development, Spothght: ASIan Amencan & Pacrl"ic 

Tslander Po"erly, al 11 (2013), avmlahle at http Iinalionakapard org/siles/defmtlLlfi1eslu1 2/aapi_poverlYJeporl-

\\ eb _ compressed. pdf 

-1 Rose Chuetal .. Assistant Secretary for Planning & 1 :valuation, I II IS. rhe Affordahle Care Act and Asian Americans 

and Pacltic Islanders, at 2 

D The Henry J Kaiser Famil} FoundallOn, Pulling Women's Health Care Disparilies on the Map E,amining Rat:wl and 

Dhllic Dlspanties at the State Level, Table 2.7 (June 10, 2()(),:)), aVailable a/ 

hllp:ll\\\\w kllorg/minorilyheallhluploadn886.pdf 

~ Facts. ,VOlllCll of Color Ullltcd tor HCt'llth Refollll. hrtp:II" .... V\v.,\'OlllCIlotcolonulltcd.nct/lcmu-lllorc-tact:sJ (last vlSltcd 

Jan 17,2(13) 
150 

III, Women's Personal Decision-making and Well-being 

A woman's health insurance should enable her to take care of her health and well-being. 

Providing insurance coverage for abortion care ensures a woman will be able to see a 

licensed, quality health provider and receive safe care, Withholding insurance coverage for 

abortion care can endanger a woman's health due to serious medical conditions that can be 

related to pregnancy. When people can plan if and when to have children, it is beneficial for 

them and for society as a whole, 

The decision about whether to choose adoption, end a pregnancy, or raise a child must be 

left to a woman, with the counsel of her family, her faith, and her health care provider. And 

yet, because of the Hyde amendment, the poorest women in this country are often unable to 

make this decision without government interference. 

IV, Conclusion 

Politicians should not interfere with a woman's ability to make her own personal health 

care decisions. We do not always know a woman's circumstances. When public insurance 

covers pregnancy care but denies coverage for abortion, we're taking away a woman's 

ability to make important personal decisions based on what she knows is best for her and 

her family. Unjust obstacles are created for millions of women struggling to get by because 

of bans on public funding for abortion. These bans severely restrict their ability to make the 

best health care decisions for themselves and their families. 

We ask the committee to oppose the "No Taxpayer Funding for Abortion Act" and all 

restrictions that place restrictions on women's health. 
151 

national """" partnership 

for women & families a.c..... OCI ..... "'"" _"-wood!.. 

.......... J 

" No Tallpayer Funding for Abortion Aer' (HR 7) 

Testimony submitted by 

Debra Ness, President 

Andrea Friedman, Director of Reproductive Health Programs 

U.S. House of Representatives 

Committee on the Judiciary 

Subcommittee on the Constitution and Civil Justice 

January 9, 2014 

1875 conne:ticut --..e, "'" ~ suilll! 6SO ~ .. ~. de 20009 ~ pIIa1e: 202.986.2600 ~ r"", 202.986.2539 _:~,ortI __ :..,.,.·_~·org 
152 

2 

The National Partnership for Women & Families is a nonprofit, nonpartisan 501(c)(3) organization 

located in Washington, D.C. We have worked tirelessly for over forty years to expand access to 

quality, affordable health care for all Americans that includes comprehensive reproductive health 

services; to eliminate discrimination in the workplace; and to enable women to meet the dual 

demands of work and family. The National Partnership vehemently opposes H.R. 7, the deceptively 

titled "No Taxpayer Funding for Abortion Act," and we urge Congress to reject this legislation. 

This radical proposal represents an extreme attack on abortion access. It would permanently codify 

the unjust and harmful restrictions on federal funding of abortion care that have long burdened 

low-income women and women who rely on the federal government for their health insurance, 

including those serving in the military and the Peace Corps, federal employees, and women served 

by the Indian Health Service. H.R. 7 would also prevent women with private insurance from using 

their health savings accounts and flexible spending accounts to pay for abortion care, increase 

taxes on small businesses that want to keep the health plans they already have that include 

abortion coverage, and prevent women purchasing private insurance through the health insurance 

marketplace from choosing a plan that includes abortion coverage if they are eligible for premium 

assistance. This unprecedented restriction on insurance coverage of abortion further harms women 

who already have their abortion coverage restricted and ultimately threatens the availability of 

abortion coverage in the entire private insurance market. 

H.R. 7 Would Raise Taxes on Individuals and Small Businesses and Subject Women to "Rape 

Audits" 

H.R. 7 would eliminate tax benefits for many small and individual private health plans solely 

because those plans include coverage of abortion care. For example, H.R. 7 would prohibit the use 

of health savings accounts and flexible spending accounts from being used for abortion care unless 

the pregnancy resulted from rape or incest or endangers a woman's life. These restrictions would 

effectively raise taxes on individuals by prohibiting them from using pre-tax dollars to pay for 

abortion care, penalizing the women and families who need this care in a way unprecedented for 

other legal medical care. Additionally, if a woman deducts the cost of an abortion that falls within 

one of the exceptions under H.R. 7, she could be audited for proof that the exception applies - an 

IRS agent could demand proof from a sexual assault survivor that her pregnancy was the result of 

rape. 

Today, a majority of private health plans offer coverage that includes abortion care. H.R. 7 would 

eliminate tax benefits for private plans if those plans include abortion coverage, which means many 

small businesses that want to continue to offer comprehensive health coverage would not be able 

to take advantage of the Small Business Health Tax Credit, enacted as part of the Affordable Care 

Act (ACA). This tax credit for small businesses will be worth up to 50 percent of premium costs in 

2014. Eliminating tax credits for small businesses that provide abortion coverage to their workers 

would force businesses to choose between facing significant tax increases and dropping their 

current insurance plans. 
153 

H.R. 7 Would Impose Unnecessary Restrictions on Private Plans in the Health Insurance 

Marketplaces and Threaten the Availability of Abortion Coverage 

H.R. 7 bans any federal expenditure to private health plans that include abortion coverage. This 

means that low and moderate income individuals and families eligible for premium assistance to 

purchase health plans through the health insurance marketplaces would be unable to select private 

plans that include abortion care. Because the majority of consumers purchasing plans in the new 

marketplaces will be eligible for premium assistance, health plans would be faced with a reduced 

consumer pool and the administrative burdens of offering multiple plans, and would likely drop all 

abortion coverage in plans sold through the marketplaces. This would make insurance coverage of 

abortion unavailable even for consumers not taking advantage of premium assistance. 

Moreover, the ACA already includes a provision that requires insurers choosing to offer plans that 

include abortion coverage to adhere to stringent accounting procedures to segregate federal funds 

from private dollars used to cover abortion care. While the National Partnership strongly opposes 

this provision in ACA, there is widespread agreement that the ACA already ensures that no federal 

funds can be used to pay for abortion coverage. To claim that further restrictions are needed is 

untrue and is only a ploy to promote an extreme attack on access to abortion care. 

Since more Americans and small businesses are expected to purchase insurance through the 

marketplaces each year, over time, the size of employers eligible to participate is expected to grow 

as well. Because ofthe widespread impact, this bill would create an incentive for insurers to 

standardize insurance products and quickly eliminate coverage of abortion even outside the 

marketplaces. This marks an unprecedented restriction on the use of private funds and impedes 

the ability of women to choose health plans that cover their health care needs. 

H.R. 7 Makes Existing Federal Restrictions on Abortion Coverage Permanent 

H.R. 7 would codify existing restrictions on federal funding for abortion that prohibit abortion 

coverage in health insurance provided by the government, with few exceptions. These restrictions 

impact women covered through Medicaid, women serving in the military and dependents of 

military personnel, women receiving veteran's benefits, women serving in the Peace Corps, women 

covered through the Indian Health Service, federal employees, and women in federal correctional 

facilities. The bill would also make permanent a ban on the District of Columbia from using its own 

funds to pay for abortion care. 

The National Partnership remains adamantly opposed to abortion funding bans because they 

threaten women's health by making it harder to obtain abortion care. They are especially 

burdensome for low-income women who do not have the funds to pay for care that is not covered 

by their health insurance. These women may go without enough food, utilities, and other 

necessities in order to gather enough money for their abortion, and they are often forced to seek 

abortion care later in pregnancy when the cost of the procedure is higher and poses a greater risk 

to a woman's health. 
154 

4 

Conclusion 

The National Partnership for Women & Families urges Congress to reject H.R. 7, the "No Taxpayer 

Funding for Abortion Act." The bill goes well beyond codifying the unjust restrictions on access to 

abortion care that have long burdened low-income women by taking away health coverage women 

already have and threatening to end all insurance coverage for abortion. 
155 

fP Planned 

Parenthood" 

Act.Noo _ ......... 

lIou •• Judiciary ubtommitt~ on the Con~titution and ( ivillu.tice Bearing Testimony 

Congressional Il ea ring on II.R. 7.lh" "No Taxpayer Funding for AbortlonAct" 

Jaou,3ry9.20IJ 

Plann...:! Pa~nthood Federallonof America ("Planned Parenthood") and Plant>e<i Parenthood Actlon fund 

rlh"Actlon Fund") are pl .... sOO t"submlt lhe", comments regarding CMgr .... m.n Chrl. Smith',' KR. 7.th. 

"No Ta.p.yer Funding for Abortion Act", which IS being considerod In a he.ring today before the U. S. Ho .. .., 

Judiciary S"bcommltt"" on the Con,tll .. !!on and Civil Justice. 

Planned Parenthood Is the nation', leading provlde,- and adv"".,. of hlgh.quality, affordable health care for 

w<>men. men, and young ~ple. as well as the nation', larges, provider of sex educ~lion. With more than 

750 health ",nter< """' .. the <"untry. Plann"" Parenthood he.lth centers provide .ffordable birth contrOl, 

IIfe •• vin, cancer >creenlngs, testing and treatments for STDs and other .... ntl.1 car. to ""arly three million 

patients every year. Ne .. ly8~ofPI.n""d Parenthood patients have Income. at or below 150 percent of 

the [£'delOl poverty level. and are among ttw. mo<l ""lnelOble. factng limited ac"" .. to reliable and affordable 

health ear. 

Planned Parenthood Federallon of America strongly oppose, the "No Taxpayer Funding for Abortion Act 

H.R. 7",. misleadi ngly nam£'d pi".;. of legislation that represent. a d.n,erou, .ssault on women', health 

and a harmful attempt to take away the romprehenslve private hea lth insurance coverage that millions of 

women have today. The ultimate goal of this legislation I, to restrict women', access to safe and legal 

abortion by fund. mentally altering the health Ins.lOn", market from a market where abortion coverage Is 

the Industry standard to one where lnsulOlICe covelOge for abortion I, eliminated. Instead of pUl'Sulng 

additional barrier< for women '''''king ... fe and legal abortion, we urge Congres' to shift focus toward, 

mea.ure. th.tex!"'nd women', acass to comprehe",ive health care 

If enacted. 1l.R. 7 would threaten the availability of abortion coverage In the ."tlre prtvate In,ulOn"" market. 

Today, absent .tate I.w. health plan. !"'rtld!"'ting in the Marketplace may determine for them.elves 

whether or not to orr. r roverag. of abortion, a, w. 1I a. a wide arlOY of other health "Mee, beyond the 

.... ,,11.1 re<julremen". Ilowever, thiS bill will . ff"""lvely b.n aborti"" roverage In the new health Insurance 

Markotpla", by prohibiting Individual. who buy insurance roverage In the M .. rkttplace from ..sing thei' own 

private fund., ,upplemented by a federa l,u"'idy. 10 purcha .. a plan that rov .... abortion beyond tbe 

narrow, dire drcum.ta""". ofllf .... endangermen~ rape, and Incest At" time when the Affordable Core Act I. 

e'pandlng coverage to million. of American., Congre •• $hould not leo!"'rdi.e the health of wOmen. Health 

In,urance Industry "'peru have repeatedly stated th.t this type of restriction rould result In private health 

In,uran"" companies dropping abortion coverage altogether, leaving mllllon< of women _ many of whom 

""ver thought they might need an .bortion- without coverage.' Furth.rmor., fedelOllaw already requires 

thatln,urallCe plans with hold federalsu",idie, from going toward .bonlon .. rvice, In. Marketplace plan. 

Under the ACA. health plans are required to allocate a portion of the con,umer's premium (funded entirely 

with private fund.) toward rovo:rlng abonlon. 

In addition. 1l.R. 7 I, more than a ,Imple restatement of obj«tlonable exl,tlng law, .uch as the Ityde 

. mendmenL which wlthhQld. federal funding from abortion e:a;ept In the ea~ of rare, l""esL Or other 

fedelO l prohibition •. Through various amendments, federal law withhold. fedelOl dollars from rovering a 
156 

woman's abortion. As a result, millions of women who rely on public health insurance, such as Medicaid and 

the Federal Employees Health Benefit Program, are unable to access comprehensive reproductive health 

coverage, even if they face severe danger to their health. Current law also prohibits the District of Columbia 

from using local funds for abortion-related services. This bill would make all these unfair, harmful 

restrictions permanent. 

This bill is dangerous to women's health because it would deny millions of women the coverage she needseven when her health is at risk. A woman's health insurance should enable her to take care of her health and 

well-being. Decisions about whether to choose adoption end a pregnancy, or raise a child must be left to a 

woman, with the counsel of her family, her faith, and her doctor or health care provider. The bill will also 

deny access to abortion by banning abortion as part of any health care service furnished in a health care 

facility owned or operated by the federal government or by any employee of the federal government. 

H.R. 7 takes away important tax benefits for American families and small businesses across the country 

solely because the health insurance they choose includes coverage of abortion. Under the bill, individuals 

who choose to enroll in health insurance that includes abortion will not be able to receive federal subsidies 

to help pay for the cost of their health care. In addition, small businesses that offer their employees 

comprehensive health insurance coverage that includes abortion will no longer be able to claim existing 

deductions or claim the Small Business Health Tax Credit - placing an unworkable burden on a key driver of 

the American economy. Denying these important tax benefits to families and small businesses solely because 

of the insurance they choose is a drastic and far-reaching move, especially because the majority of private 

employer-based health plans and health plans in the private insurance market cover abortion. The bill also 

prohibits a woman from using her privately-funded, tax-preferred account, such as a flexible spending 

account or health savings account, for any costs associated with an abortion. This is a departure from 

current tax treatment of medical expenses and insurance coverage, and yet another attempt by politicians to 

interfere in a woman's personal decision-making and undermine women's access to health care. 

_A recent 2013 nationwide poll conducted by Hart Research Associations on behalf of Planned Parenthood 

Federation of America showed that a strong majority of voters - Republicans (62 percent), Democrats (78 

percent), and Independents (71 percent) - say these issues are the wrong issues for Congress and their state 

legislatures to spend time on. Instead of focusing on important issues like jobs and the economy, sponsors of 

this bill are trying to unfairly single out abortion at a time when the country has urgent problems to deal 

with. The United States continues to have some of the highest rates of teen pregnancy and maternal and 

infant mortality rates in the developed world. There are significant gains to be made in increasing women's 

access to comprehensive health care. H.R 7 does nothing to address these needs, and instead creates 

additional obstacles for women, often in vulnerable situations, who are seeking safe and legal health care. 

We strongly urge Congress reject H.R 7 and instead increase access to preventive health services and protect 

women's access to safe and legal abortion. 

Sincerely, 

Dana Singiser 

Vice President of Public Policy and Government Relations 

Planned Parenthood Action Fund 

Planned Parenthood Federation of America 

1110 Vermont Avenue NW, Suite 300 

Washington, DC 20005 
157 

I Rosenbaum, Sara, et. ai, "Testimony before the House Energy & Commerce Committee," February 9, 2011. 
158 

PHYSICIANS m.

_ 

HEALTH 

-

"''''',.'''',-

_.-

,. .. _ ... .. 

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Testlmonv of Nancy Stanwood, MD, MPH 

Board Chair, Physlcl3ns for Reproductive Health 

Submitted to the House Judiciary Committee 

Subcommittee on the Constitution and Civil Justice 

January 9, 2014 

Physicians for Reproductive Health (Physicians) is a doctor·led national 

.dV<K~CV organilation that use. eviden<:,, b~5e<l medicine to promote ,""und 

re productive health poiicie., A large nllmrn.r aline doctor, Physician. 

rep'esent, practice in the field 01 Db.re!fk~ and I\'t'necolo8Y, but many are 

pe jatricjan~, fenility doctors. family physici<lns. cardiologist •. neurologist';, 

radiologists. and others. Physicians unites the medica l community ~nd 

conce rned supporters. Together, we wor'< to improve ~ccess to 

compreheO)Sive reproductive he~lth care, including contrlception lnd 

lbortion, especilliy to meet the hulth care needs of economically 

disao:lvanuge.:l patients. 

Physicians welcomes the opportun~yto submit testimony on H.R. 7, 

misleadingly named the "No Taxpayer funding for Abortion Act." This 

dangerous bill would effectively ban insurance coverage lor abortion, even!O 

protect a woman's health. This could put access to abortion out or reach for 

countless women. A woman's hellth insurance should meet a ll her health 

needs and cover a full range of medical procedu res, including abortion. 

H.R. 7 would decimate private insurance coverage for abortion by raising 

taxes on individuals and businesses to discourage coverage. H.R. 7 al~ 

~odilies harmful rid"" that Ireadydeny "ores 01 unde""rved women 

insurance coverage for abortion. If e nacte.:l, millions more women could be 

deprived of coverage for abortion. Moreover, H.R. 7 contains very limited 

exceptions th~t are inadequate to protect ~ woman's health. This bill ignores 

the very real situations women face and, if enacted, would have a 

devastating impact on their ability to access sale and legal abortion care. 

Every day my collugues and I treat women who are able to use their 

insurance to obuin needed medical care. Sadly, we al~ see patients without 

the financial re~urces to pay for an abortion. for a woman to be ab le to 

make a real decision based on wh at's best for her and her family, she nee-ds 

to be able to afford her care. 
159 

In my practice, I had a patient, Carol ' , who was excited to give birth to her first child. Her husband, a 

Marine, was serving in Afghanistan. They received health insurance through the military. Sadly, in Carol's 

second trimester, she learned that her baby had anencephaly; it would be born without a brain. After 

much deliberation, she and her husband decided to terminate the pregnancy. They were shocked to 

learn that their health insurance would not cover the abortion and would only cover a situation in which 

Carol's life was in danger.' Her husband was outraged, telling me, "I'm over there defending my country, 

and they won't even take care of my family?" The law treated this family terribly during a time of great 

stress and need. Under H.R. 7, other families would be forced to repeat Carol's painful experience. 

I remember Melissa, the youngest in a large tight-knit family and a high school Reserve Officers' Training 

Corps (ROTC) graduate, who was 19 years old when she went to enlist in the Marines. The intake testing 

revealed that she was pregnant. She had been careful to use condoms with her boyfriend, but the 

condoms had failed. Melissa was clear about her plans for the future, which included starting a family 

once her military career was well established. She and her mother were fortunate not to have to worry 

about insurance coverage for her care, as their private insurance covered the procedure. This allowed 

Melissa to pursue her dreams and serve our country. 

Dr. Douglas Laube of Madison, Wisconsin, immediate past board chair of Physicians, had a patient, Beth, 

who was pregnant with her first child and looking forward to becoming a mother. Three months into her 

pregnancy, she developed dangerously high blood pressure. Without an abortion, Beth might have 

suffered a stroke or kidney damage. She made the decision to end her pregnancy. Beth's medical 

condition is just one of many that can complicate pregnancy. But H.R. 7 would leave women like Beth 

without insurance coverage for abortions necessary to protect their health. 

Physicians consulting medical director Dr. Anne Davis of New York cared for a patient named Liza, who 

had insurance through her low-wage job at a hospital. Liza was married with two children, and became 

pregnant while taking the pill. Although it was an unintended pregnancy, Liza and her husband wanted 

to have the baby. But then Liza's husband lost both of his jobs. They decided to have an abortion. 

Because of complicated health circumstances, Liza's abortion cost $10,000-an amount that would have 

destroyed her family's already strained finances if they had been required to payout of pocket. 

Fortunately, her insurance covered the procedure. 

Physicians Leadership Training Academy Fellow Dr. Kristina Tocce of Denver treated a patient with a 

complicated pregnancy. An ultrasound showed that her patient Consuela's fetus was not developing 

kidneys. Most infants with this problem do not live more than a few hours. Also, Consuela's placenta was 

covering the opening of her cervix. This condition, if left untreated, can result in life-threatening bleeding 

during delivery and requires a cesarean section. Conseula and her husband wanted to terminate the 

pregnancy, but her insurance was through Medicaid. Because Consuela's medical condition did not 

endanger her life, she did not qualify for abortion coverage under Medicaid's life exception. Out of 

pocket, her abortion would have cost more than $4,000, an impossible sum. Consuela continued to carry 

her pregnancy and suffered tremendous emotional turmoil. Six weeks later, her fetus died in utero. The 

legislation under consideration would force women allover the country into situations like Consuela's. 

~ Please note that all patient names are changed to pr.ot~ct confidentiality 

In 2012, federal law was changed to allow coverage In Instances of rape and incest. 
160 

In Seattle, Dr. Deborah Oyer saw a patient, Allison, a 34-year-old mother of three with an unintended 

pregnancy. She was still deciding whether to continue her pregnancy when she learned her youngest 

child had leukemia. She and her husband quickly realized that they could not have another child at that 

time. Allison needed to take leave from work and stay at the hospital with their daughter for medical 

treatments. Her husband needed to stay at home, two hours away from the hospital, to work and care 

for their two other children. Fortunately, Washington State Medicaid covered her abortion. But Allison 

and her family would have faced great hardship if they had had to payout of pocket. Access to 

affordable insurance that covers abortion is essential for women and their families. 

For these real women and their families, the decision to have an abortion was made after consultation 

with their health care providers and consideration of all the issues involved. Abortion was a critical 

medical procedure that protected their health as well as the well-being of their families. H.R. 7 threatens 

millions of American women by trying to make insurance coverage for abortion impossible to obtain. 

Health insurance should take care of women; not abandon them. If H.R. 7 were passed, real women like 

Beth, Melissa, Liza, Consuela, Allison, and Carol would suffer as a result. It is critical to the lives and 

health of American women that this bill be defeated. Please vote against H.R. 7. 
161 

Til e Ad uocate of S ou til Carolina S mall Business 

1717 Gervais Street. Columbia. SC. 29201 

www.scsbc.org. (803) 252-5733 

January 14, 2014 

The Honorable Robert Goodlalte, 

Chairman 

Committee on the Judiciary 

2138 Rayburn House Office Building 

Washington. DC 20515 

The Honorable John Conyers, Ranking 

Member 

Commiaee on the Judiciary 

BJ51 Rayburn House Office Building 

Washington. DC 20515 

Re: H,R.7 

The Honorable Trent Franks. Chairman 

Subcomminee on Constitution and Civil 

Justice 

2138 Rayburn House Office Building 

Washington. DC 20515 

The Honorable Jerry Nadler, Ranking 

Member 

Subcomminee on ConstitU!ion and Civil 

Justice 

B351 Rayburn House Office Building 

Washington, DC 20515 

Dear Chairman Goodlatte, Chairman Franks, Ranking Member Conyers and Ranking 

Member Nadler, 

After decades of escalating group health insurance premiums and demands for 

Congressional action for relief, our smallest of businesses finally were given the 

opportunity for federal health insurance tax credits through the Affordable Care Act. 

Now H.R 7 threatens to erase this benefit for small businesses because it would eliminate 

the heahh insurance !aX credits for any existing or new plans that provide coverage for 

abortion. 

The problems H.R. 7 would cause for small businesses that are trying to do the right thing 

and ofTer heahh insurance have nothing to do with the ideological iruent of this bill . 

Even if a small business owner were to agree with the intent, the cost in rime, money and 

continuity of policy is very significant. 

I. Small business owners do nO! have the expertise to closely examine healthcare 

plans to determine if abortion coverage is included. Such services are not labeled 

"abortion" but rather fall into numerous clauses in a health care policy from 

prescription drugs to outpatient surgery to maternity care that includes unforeseen 
162 

complications. Small business owners are no more prepared to completely 

understand the fine print of their health insurance policies than are members of 

Congress. 

2. Requiring a small business owner to try to understand the intricacies of their 

health insurance policies would require considerable time on their own or with an 

insurance agent (who also probably has no idea how to interpret the verbiage in 

the policy as it relates to abortion). Essentially HR. 7 will cause a small 

employer to divert time from running the business. And if time is money, as we 

are all told, then H.R. 7 will be an increase in cost for small businesses offering 

health insurance. 

3. Small businesses that finally detennine that their health insurance policy does in 

fact cover even one abortion service will be financially punished in one of two 

ways. Either they can keep their present policy and lose thousands of dollars in 

hard won tax credits or they will give up their current health plan and most likely 

have to pay higher premiums for a new plan. 

H.R. 7 is simply a slap in the face to the millions of small businesses now offering health 

insurance to employees and eligible for the new tax credits. Targeting small businesses 

for such punitive action, while ignoring big businesses that also receive tax benefits when 

offering health insurance, demonstrates a callous disregard for the "backbone of our 

economy," as members of Congress love to proclaim about small businesses. 

Sincerely, 

Frank Knapp, Jr. 

President & CEO 
163 

j,NATIONAL 

" " ... W 0 MEN' 5 

LAW CENTER EXP ANDI N G TH E POSSIBILIT IES 

TESTIMONY OF JUDY WAX1\IA N. VICE PRESIDENT FOR HEALTH AND 

REPROD UCTI VE RIGHTS 

NATIONAL WOM.EN'S LAW CENTER 

BEt'ORE TilE SUBCOi\l i\UTIEE ON THE CONSTITUT ION AND CIVIL 

JUST ICE OJ,' TnE HOUSE COMMllTEE ON HIE JUDICIARY 

UEARING ON H.R. 7 

JanlUlry 9, 2014 

Mr. Chairman, members of the Committee, I am Judy Waxman, Vice President of Health 

and Reproductive Ri ghts at the National Women's Law Center (NWLC). Since 1972, the 

National Women's Law Center has worked to protect and advance the progress of 

women and their families in core aspects of their lives, with an emphasis on the needs of 

low-income women. The Center utilizes a wide range of tools- including public policy 

research. monitoring, and analysis: litigation, advtXacy, and coalition-building: and 

public education- to achieve gains for women and their families, including to protect and 

advance women's reproductive health and rights. Thank you for the opportunity to 

submit testimony on H.R. 7. 

H.R. 7 is a dangerous and misleading bill that imposes a devastating tax increase on some 

families and small businesses that want comprehensive insurance plans that include 

coverage of abortion. Though the bill 's supporters argue that it "merely codifies" federal 

law-which itsel f is already highly restrictive--such clai ms are false. H.R. 7 will 

increase specific taxes and costs in order to prevent women from obtaining abortion care 

and will eliminate abortion coverage for millions of women 

This bill twists the tax code into a tool to take abortion coverage away from women. By 

imposing tax increases on women and small businesses that purchase insurance plans that 

cover abortion, H.R. 7 will likely force them to drop the abortion coverage from their 

otherwise comprehensive plans, with potentially devastating results for women and their 

families. 

H.R. 7 could render millions of individuals and small businesses ineligible for a wide 

range of tax credits and deductions simply because their insurance plans include coverage 

of abortion , For example, H.R. 7 could make millions of small businesses ineligible for 

the Small Business Health Tax Credit, which is worth up to 50 percent ,; Currently, a 

small business can choose a health insurance plan for its employees, and the employer 

and employees each make contributions to pay the premium out of their private dollars. 

At the end of the year, the employer can claim the Small Business Health Tax Credit, 
164 

which refunds a portion of the employer's contributions. Under H.R. 7, the employer 

would not be eligible for the tax credit if the plan included coverage of abortion-even 

though the premiums were paid entirely by the employer and employee with their own, 

private dollars. IfH.R. 7 results in the elimination of private insurance coverage of 

abortion altogether, it would go even further in restricting what individuals can purchase 

with their own, private dollars, preventing anyone from being able to purchase inclusive 

coverage---even if they receive no tax-preferred treatment at all. 

H.R. 7 will also make millions of individuals otherwise eligible for the premium 

assistance available under the Affordable Care Act ineligible if their insurance plans 

include coverage of abortion. Under current law, certain individuals are eligible for 

Premium Tax Credits to help pay for health insurance." H.R. 7 makes any insurance plan 

that includes coverage of abortion ineligible for Premium Tax Credits. This is true even 

though the AfIordable Care Act already includes substantial rules to ensure that no 

federal funds are used to pay for abortion coverage. 

H.R. 7 would impose income taxes on money in tax preferred savings accounts, such as a 

flexible spending or a health savings account, if it is used to pay for abortion care. Under 

current law, individuals and employers can contribute to these accounts a portion of their 

wages,which are exempt from taxation so that such funds will be available for medical 

needs.1ll Under H.R. 7, a woman who uses funds from a flexible spending or health 

savings account to pay for an abortion must pay income tax on the funds she uses to 

cover the procedure. 

H.R. 7 would also raise taxes on a woman who spends a large percentage of her income 

on health needs if part of her needed health care is abortion care. Currently, medical 

expenses that exceed 7.5% of a taxpayer's gross income are deductible." Under H.R. 7 a 

woman with serious medical complications requiring an abortion that cost tens of 

thousands of dollars would not be able to deduct the cost of her abortion. She would have 

to pay higher income taxes than a person with a similarly serious and expensive medical 

problem because her treatment required that her pregnancy be tenllinated. 

By substantially raising taxes and costs on millions of individuals and employers, H.R. 7 

could force not only those individuals and employers to drop abortion from their health 

insurance plans, but would close down the entire private insurance market coverage of 

abortion. H.R. 7 prohibits health plans that include coverage of abortion from receiving a 

range of tax credits. Private insurers are therefore incentivized to exclude coverage of all 

abortions in order to ensure that they will be able to accept customers who receive federal 

subsidies. v Similarly, H.R. 7 pushes individuals and small businesses to switch to plans 

that do not cover abortion by only of Ie ring tax-favored treatment to plans that exclude 

such coverage. This distorts the private market by driving customers away from plans 

that include abortion coverage, which would likely result in plans dropping abortion 

coverage. Some have argued that H.R. 7 and related legislation could result in the entire 

private market dropping abortion coverage, eliminating abortion coverage from the 

private insurance market altogether and making such coverage unavailable to anyone." 

2 
165 

H.R. 7 does not even make any exceptions for abortions that are necessary to save a 

woman's health. Under H.R. 7, women would be left without coverage for pregnancy 

termination necessitated by medical complications, which can cost thousands of dollars. 

Under a hypothetical example, which could be all too true, a pregnant woman who is 

diagnosed with a serious and rapidly spreading cancer could be in grave danger if she 

does not terminate her pregnancy so she can immediately begin chemotherapy and 

radiation treatment. Unfortunately, because of her current health status, the abortion 

procedure she needs to protect her health and possibly her life is expensive. Because of 

H.R. 7's limitations on tax credits, she would be forced to drop the inclusive policy she 

had for years, which included abortion coverage. So, ifH.R. 7 passed, her health 

insurance policy would not cover abortion. Nor would it allow her to use monies she had 

put into a flexible spending account to help her cover unexpected health expenses without 

paying additional taxes, even if her pregnancy termination cost a substantial portion of 

her salary that year. Such barriers could force the woman into bankruptcy or remain 

pregnant at great risk. 

Even the bill's narrow exemption can hurt the very women it seeks to protect from H.R. 

7's onerous provisions. Under the exception, women who were raped can include the 

costs of the abortion as a deduction for high medical expenses and can pay for the 

abortion with funds from a tax-preferred account. However, a woman doing so would 

have to demonstrate to the IRS that she was ra~ed and subsequently had an abortion. 

During a hearing on this legislation in the Iii Congress, the Joint Committee on 

Taxation testified that this was indeed the case as the burden of proof would be on the 

taxpayer. Vll 

In addition to twisting the tax code to deny women comprehensive health insurance, H.R. 

7 further harms women by making certain restrictions on abortion coverage permanent. 

Currently, federal restrictions on abortion coverage require renewal every year as they are 

imposed through the appropriations process. H.R. 7 makes these restrictions permanent 

law. Thus, women covered under Medicaid, women serving in the US. military, federal 

employees, residents of the District of Columbia, women in federal prisons, and women 

covered by the Indian Health Service would permanently be denied health insurance that 

includes abortion coverage except for very narrow circumstances. These harmful 

restrictions endanger women's health and place particular burdens on low-income women. 

Finally, offending the principles underlying D.C. home rule, H.R. 7 permanently 

prohibits the District of Columbia from using locally raised funds to otTer abortion care 

for women who otherwise could not afford it. If H.R. 7 were to become law, anti-choice 

members of Congress would strip the District of Columbia of the power that all 50 states 

currently have: the power to make decisions about how to spend locally-raised revenue. 

The government has used economic coercion to prevent women who depend on the 

government for health insurance from getting abortions for over 30 years. Now this 

harmful policy is being vastly expanded by using the tax code to prevent millions of 

additional women from obtaining health insurance that covers abortion. The National 

Women's Law Center urges the Committee to reject this dangerous and misleading bill. 

3 
166 

Æ 

i I.I<..C. § 45R (2010). 

il IRe. § 36B (2010). 

m IKC. § 106 (2011). 

w I.RC § 213 (2010) 

, See No Taxpayer Fundingfor Abortion Act: IIearing Before the Subcomm. on the Constitution of the II. 

Comm. on {he JudicialY. 112th Congo (2011) (testimony of'Sara Rosenbaum. Chair. Dept. of Health Pol'y. 

George Washington Univ. Seh. Pub. Health and Health Sen·s.) 

" See generally it! 

vii .. ')'ee ,"l\lo Taxpayer Pundingjhr Ahor1io12 Ad: Hearing He/ore fhe Suhcmnm on .. \.,'elecL Revenue IHeasures 

o.lthe. Comlll. all Ways and Means, I 12th Cong (2011) (testimony of ]'om Barthold. Chief of StalT of the 

Joint Commiltee on Taxation.) 

4