Lower Health Care Premiums for All Americans Act

— 473 — Department of Health and Human Services l Rewrite the ACA abortion separate payment regulation. Section 1303 of Obamacare requires that insurers collect a separate payment for certain abortion coverage in qualified health plans that are approved to be sold on exchanges and that they keep those separate payments in separate accounts that are used only to pay for elective abortion services. Neither the letter nor the spirit of the law was enforced under President Obama, and a Trump- era regulation sought to correct this problem. The Biden HHS rescinded this regulation to allow insurance companies once again—contrary to the law—to collect combined payments for what are clearly required to be separate payments for elective abortion coverage. “Separate” does not mean “together.” HHS should reinstate a Trump Administration regulation and enforce what the plain text of Section 1303 requires. That regulation should be further improved by requiring CMS to ensure that consumers pay truly separate charges for abortion coverage. l Audit Hyde Amendment compliance. HHS should undertake a full audit to determine compliance or noncompliance with the Hyde amendment and similar funding restrictions in HHS programs. This audit should include a full review of the Biden Administration’s post-Dobbs executive actions to promote abortion. It should also encompass a review of Medicaid managed care plans in pro-abortion states. l Reverse distorted pro-abortion “interpretations” added to the Emergency Medical Treatment and Active Labor Act. The Emergency Medical Treatment and Active Labor Act (EMTALA)52 prohibits hospitals that receive Medicare funds from “dumping” emergency patients who cannot pay by sending them to other hospitals. It also mandates that hospitals stabilize pregnant women and explicitly protects unborn children. Hospitals or physicians found to be in violation of the statute could lose all of their federal health funding—Medicare, Medicaid, CHIP, and other funds—and face civil penalties of up to nearly $120,000. In July 2022, HHS/CMS released guidance mandating that EMTALA- covered hospitals and the physicians who work there must perform abortions, to include completing chemical abortions even when the child might still be alive. The guidance also declared that EMTALA would protect physicians and hospitals that perform abortions in violation of state law if they deem those abortions necessary to stabilize the women’s health. This novel interpretation of EMTALA is baseless. EMTALA requires

— 473 — Department of Health and Human Services l Rewrite the ACA abortion separate payment regulation. Section 1303 of Obamacare requires that insurers collect a separate payment for certain abortion coverage in qualified health plans that are approved to be sold on exchanges and that they keep those separate payments in separate accounts that are used only to pay for elective abortion services. Neither the letter nor the spirit of the law was enforced under President Obama, and a Trump- era regulation sought to correct this problem. The Biden HHS rescinded this regulation to allow insurance companies once again—contrary to the law—to collect combined payments for what are clearly required to be separate payments for elective abortion coverage. “Separate” does not mean “together.” HHS should reinstate a Trump Administration regulation and enforce what the plain text of Section 1303 requires. That regulation should be further improved by requiring CMS to ensure that consumers pay truly separate charges for abortion coverage. l Audit Hyde Amendment compliance. HHS should undertake a full audit to determine compliance or noncompliance with the Hyde amendment and similar funding restrictions in HHS programs. This audit should include a full review of the Biden Administration’s post-Dobbs executive actions to promote abortion. It should also encompass a review of Medicaid managed care plans in pro-abortion states. l Reverse distorted pro-abortion “interpretations” added to the Emergency Medical Treatment and Active Labor Act. The Emergency Medical Treatment and Active Labor Act (EMTALA)52 prohibits hospitals that receive Medicare funds from “dumping” emergency patients who cannot pay by sending them to other hospitals. It also mandates that hospitals stabilize pregnant women and explicitly protects unborn children. Hospitals or physicians found to be in violation of the statute could lose all of their federal health funding—Medicare, Medicaid, CHIP, and other funds—and face civil penalties of up to nearly $120,000. In July 2022, HHS/CMS released guidance mandating that EMTALA- covered hospitals and the physicians who work there must perform abortions, to include completing chemical abortions even when the child might still be alive. The guidance also declared that EMTALA would protect physicians and hospitals that perform abortions in violation of state law if they deem those abortions necessary to stabilize the women’s health. This novel interpretation of EMTALA is baseless. EMTALA requires — 474 — Mandate for Leadership: The Conservative Promise no abortions, preempts no pro-life state laws, and explicitly requires stabilization of the unborn child. HHS should rescind the guidance and end CMS and state agency investigations into cases of alleged refusals to perform abortions. DOJ should agree to eliminate existing injunctions against pro-life states, withdraw its enforcement lawsuits, and in lawsuits against CMS on the guidance agree to injunctions against CMS and withdraw appeals of injunctions. l Reissue a stronger transgender national coverage determination. CMS should repromulgate its 2016 decision that CMS could not issue a National Coverage Determination (NCD) regarding “gender reassignment surgery” for Medicare beneficiaries. In doing so, CMS should acknowledge the growing body of evidence that such interventions are dangerous and acknowledge that there is insufficient scientific evidence to support such coverage in state plans. l Enforce EMTALA. The undeniable reality of abortion is that it does do not always result in a dead baby, and these born-alive babies are left to die. HHS should use EMTALA and Section 504 of the Rehabilitation Act,53 which prohibits disability discrimination, to investigate instances of infants born alive and left untreated in covered hospitals. CMS, OCR, and OIG should be required to follow through on these investigations with specific enforcement actions. HHS should revive a Trump Administration proposed regulation, “Special Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities,”54 to achieve this end. In addition, Congress should pass the Born-Alive Abortion Survivors Protection Act55 to require that proper medical care be given to infants who survive an abortion and to establish criminal consequences for practitioners who fail to provide such care. l Permanently codify both the Hyde family of amendments and the protections provided by the Weldon Amendment. Congress can accomplish this through legislation such as the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act56 (Hyde) and the Conscience Protection Act57 (Weldon).

— 500 — Mandate for Leadership: The Conservative Promise 32. Owcharenko Schaefer, “Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve the Health Care Safety Net.” 33. Brian Blase, “Managed Care in Medicaid: Need for Oversight, Accountability, and Reform,” Paragon Health Institute Policy Brief, October 13, 2022, https://paragoninstitute.org/wp-content/uploads/2022/10/20221012- Managed-Care-in-Medicaid-Need-for-Oversight-Accountability-and-Reform-FOR-DISTRIBUTION-V2.pdf (accessed February 13, 2023). 34. Owcharenko Schaefer, “Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve the Health Care Safety Net.” 35. 42 U.S. Code § 1315, https://www.law.cornell.edu/uscode/text/42/1315 (accessed March 17, 2023). 36. Chad D. Savage and Lee S. Gross, “Direct Primary Care: Update and Road Map for Patient-Centered Reforms,” Heritage Foundation Backgrounder No. 3635, June 28, 2021, https://www.heritage.org/sites/default/ files/2021-06/BG3635.pdf. 37. H.R. 133, Consolidated Appropriations Act, 2021, Public Law No. 116-260, 116th Congress, December 27, 2020, Division BB, Title I, https://www.congress.gov/116/plaws/publ260/PLAW-116publ260.pdf (accessed March 17, 2023). 38. Doug Badger, “On Surprise Medical Bills, Congress Should Side with Consumers, Not Special Interests,” Heritage Foundation Commentary, January 31, 2020, https://www.heritage.org/health-care-reform/ commentary/surprise-medical-bills-congress-should-side-consumers-not-special. 39. Edmund F. Haislmaier and Abigail Slagle, “Premiums, Choices, Deductibles, Care Access, and Government Dependence Under the Affordable Care Act: 2021 State-by-State Review,” Heritage Foundation Backgrounder No. 3668, November 2, 2021, https://www.heritage.org/sites/default/files/2021-11/BG3668.pdf. 40. U.S. Department of the Treasury, Internal Revenue Service; U.S. Department of Labor, Employee Benefits Security Administration; and U.S. Department of Health and Human Services, “Transparency in Coverage,” Final Rule, Federal Register, Vol. 85, No. 219 (November 12, 2020), pp. 72158–72310, https://www.govinfo.gov/ content/pkg/FR-2020-11-12/pdf/2020-24591.pdf (accessed March 17, 2023). 41. David N. Bernstein and Robert E. Moffit, “New Price Transparency Rule Will Help Transform America’s Health Care System,” Heritage Foundation Commentary, November 1, 2020, https://www.heritage.org/health-care- reform/commentary/new-price-transparency-rule-will-help-transform-americas-health-care. 42. Sluzala and Haislmaier, “Lessons from COVID-19: How Policymakers Should Reform the Regulation of Clinical Testing.” 43. Ibid. 44. Most recently enacted in H.R. 2471, Consolidated Appropriations Act, 2022, Public Law No. 117-103, 117th Congress, March 15, 2022, Division H, Title V, §§ 506–507, https://www.congress.gov/117/plaws/publ103/ PLAW-117publ103.pdf (accessed March 17, 2023). 45. President Joseph R. Biden Jr., Executive Order 14079, “Securing Access to Reproductive and Other Healthcare Services,” August 3, 2022, in Federal Register, Vol. 87, No. 154 (August 11, 2022), pp. 49505–49507, https:// www.govinfo.gov/content/pkg/FR-2022-08-11/pdf/2022-17420.pdf (accessed March 16, 2023). 46. Planned Parenthood, 2020–2021 Annual Report, p. 27, https://www.plannedparenthood.org/uploads/ filer_public/40/8f/408fc2ad-c8c2-48da-ad87-be5cc257d370/211214-ppfa-annualreport-20-21-c3-digital.pdf (accessed March 22, 2023). 47. Ibid., pp. 30 and 31. Total revenue of $1,714.4 million (p. 30) minus $1,580.7 million in total expenses (p. 31) yields $133,7 million. 48. Ibid., p. 28. 49. Ibid., p. 30. 50. H.R. 372, Protecting Life and Taxpayers Act of 2023, 118th Congress, introduced January 17, 2023, https://www. congress.gov/118/bills/hr372/BILLS-118hr372ih.pdf (accessed March 17, 2023). 51. 42 U.S. Code § 18023, https://www.law.cornell.edu/uscode/text/42/18023 (accessed March 17, 2023). 52. H.R. 3128, Consolidated Omnibus Budget Reconciliation Act of 1985, Public Law No. 99-272, 99th Congress, April 7, 1986, Title IX, Subtitle A, Part 1, Subpart B, § 9121, https://www.congress.gov/99/statute/STATUTE-100/ STATUTE-100-Pg82.pdf (accessed March 17, 2023). 53. H.R. 8070, Rehabilitation Act of 1973, Public Law No. 93-112, 93rd Congress, September 26, 1973, https://www. congress.gov/93/statute/STATUTE-87/STATUTE-87-Pg355.pdf (accessed March 17, 2023).