Americans United for Life | States Opt Out
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States Opt Out

Following the passage of health care reform, signed by President Obama on March 23, 2010, AUL began implementing a strategy to respond to the anti-life provisions in the bill.  The cornerstone of our response is the “Federal Abortion Mandate Opt-Out Act.”


The new health care reform law requires individual States to operate and maintain “health insurance exchanges.”  Health insurance plans offering abortion coverage are allowed to participate in a state’s exchange and to receive federal subsidies unless the State legislature affirmatively opts-out of offering these plans.  Individuals whose income falls between 150 and 400% of the federal poverty level receive tax credits to apply towards health insurance plans in the new exchanges.  If one chooses a plan that covers abortion, his or her tax credit cannot be used to directly pay for abortions; however, the tax credit subsidizes the insurance plan which covers abortions.

Specific language in the new health care reform law (commonly referred to as the Nelson-Reid compromise) permits a state to opt-out of allowing insurance plans that cover abortions to participate in that state’s exchanges.

Contrary to some perceptions, President Obama’s March 24, 2010 Executive Order does not make the new health care reform law conform to the longstanding principle of the Hyde Amendment – that the federal government will not pay for abortions or for insurance plans that cover abortions.

While the text of the Executive Order addresses the health insurance exchanges, it utterly fails to apply the language of the Hyde Amendment to them.  Section 2 of the Order provides guidelines for “strict compliance” with the provisions in the new law that address how federal subsidies are handled in plans that cover abortions in the exchanges.  However, these guidelines do nothing to prevent federal subsidies from going to plans that cover abortions, and therefore fail to prevent the new law from directly violating the principles embodied in the Hyde Amendment and other federal law.

Additionally, even if the Executive Order were sufficient to address pro-life concerns, it is not permanent law.  The order can be repealed by the Obama Administration or a future administration easily.

The Federal Abortion Mandate Opt-Out Act

To assist state legislators in opting-out of providing health insurance plans with abortion coverage through their exchanges, AUL has developed “The Federal Abortion Mandate Opt-Out Act.”

Currently, more than thirty states have either introduced an opt-out bill, are planning to introduce a bill shortly, or are laying the groundwork to introduce a bill as soon as their legislative calendars permit. Those that have passed such legislation into law include Arizona, Florida, Idaho, Indiana, Kansas,  Louisiana, Mississippi, Missouri, Nebraska, Ohio, Oklahoma, South, Carolina, South Dakota, Tennessee, Utah, and Virginia.

Additional Limitations on Insurance

Some states, with our help, are going even farther than preventing insurance plans that cover abortions from participating in their state exchanges.  One positive outcome from the 2009-2010 health care reform debate is that many more Americans are now aware that a large number of private insurance plans, even their own, cover elective abortions.  In fact, according to the Guttmacher Institute, “87% of typical employer-based insurance policies in 2002 covered medically necessary or appropriate abortions.”

As a result, many pro-life citizens and state legislators are now seeking a way to prohibit insurance coverage of elective abortions in their states.  Currently, five states have laws, dating back as far as 1978, that prohibit private insurance plans operating within their states from covering elective abortions.  To assist legislators from other states in prohibiting health insurance coverage of elective abortions within their states, AUL has developed “The Abortion Coverage Prohibition Act,” which is modeled after existing state laws on the topic.

State legislators are also seeking to prohibit abortion coverage for state employees.  Only fourteen states currently prohibit the use of state funds for abortion coverage (with no or limited exceptions) for state employees.  To assist state legislators in prohibiting the use of state taxpayer funds to pay for health insurance coverage of elective abortions for state employees, AUL has developed “The Employee Coverage Prohibition Act,” which is also modeled after existing state laws on the topic.

To order a copy of the AUL model bill “Federal Abortion Mandate Opt-Out Act” or other AUL model legislation, click here.

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