Republicans push ahead with plans to hinder insurance coverage for abortions

Republicans in Congress are advancing a bill that imposes a far-reaching ban on private insurance coverage for abortion services for as long as the Affordable Care Act remains in effect and would make permanent a longtime ban on the use of Medicaid to cover abortions.

The bill, H R7, would allow Donald Trump to fulfill a promise that helped his volatile presidential campaign secure the support of major anti-abortion rights activists. In an open letter published in September, he vowed to sign the Hyde amendment, a perennial budget rider that Congress has approved every year for 40 years, into permanent law. Since 1976, the Hyde amendment has prevented millions of women who rely on Medicaid, the government-funded insurance for low-income individuals, from using it to cover their abortions.

But if the bill passes, the most immediate changes will be felt on the insurance exchanges where millions of women purchase healthcare coverage.

HR7 prohibits insurance carriers from offering policies that contain abortion coverage on the exchanges set up under Obamacare to sell insurance coverage to individuals. It prohibits low-income women who qualify for a healthcare subsidy from receiving it if they purchase a healthcare plan that covers abortion. And it would withhold the small business tax credit from employers who offer policies with abortion coverage.

Critics of HR7 fear it could impose a widespread ban on private insurance coverage of abortion by banning abortion coverage in the small subset of private insurance policies that are sold on the Affordable Care Act exchanges.

Because many insurance carriers offer policies to individuals on the exchanges that are similar to the group policies they sell to companies, covering abortion in one case but not the other requires an extra layer of administration.

Health experts said they could not be certain that would be the outcome.

“What that would do to other plans, we don’t really know,” said Laurie Sobel, the associate director for women’s health policy for the Kaiser Family Foundation, a healthcare thinktank. But she noted that after Obamacare began requiring contraceptive coverage in individual policies sold on the exchanges, group policies that did not face the same requirements began to offer identical coverage.

“With very limited exceptions, health insurance companies essentially did the same thing with everybody,” Sobel said. “That is worrisome in terms of, if abortion coverage was restricted in the marketplace, insurance companies might just adopt that policy across the board.”

The ban on using subsidies or tax credits toward policies with abortion coverage could also effect significant changes, because carriers could be reluctant to design plans that so many women or small business owners would be ineligible to purchase. In 2016, there were 871,000 uninsured women eligible to purchase policies containing abortion coverage using subsidies, according to the Kaiser Family Foundation.

Under the bill, tens of thousands more who have already used their subsidies to purchase insurance would lose abortion coverage.

The bill’s restrictions on the health insurance exchanges would cease to apply if and when legislation passed by Republicans in Congress repeals the Affordable Care Act. But the bill is almost certainly a preview of the lengths to which Republicans will go to restrict abortion when they come to replace Obamacare.

“It’s a pretty sweeping bill,” said Destiny Lopez, a director of All Above All, a coalition of abortion rights groups that opposes the Hyde amendment. “It’s an attempt to withhold abortion from nearly all women in the US through burdensome regulation intended to stop insurers from covering abortions. It could restrict abortion for nearly every woman in this country in some way, and do significant harm in particular to low-income women.”

Insurance coverage for abortion is already limited in a way that forces thousands of women to pay for abortions out of pocket. Twenty-five states restrict the sale of insurance policies covering abortion on their state exchanges. And exchanges in six other states don’t offer any plans that cover abortions, possibly because Congress imposed extra administrative hurdles under the ACA for providing abortion coverage.

A 2013 study found that only about a quarter of abortion patients who had insurance used it to cover their procedure. Those who didn’t use their insurance overwhelmingly said their insurance did not cover abortion or they weren’t sure.

The bill would also convert a slew of existing, provisional bans on abortion coverage into permanent law. These include bans on abortion coverage for women on federal insurance, such as many Native American women, women in the Peace Corps, in federal prisons, or those enrolled in Medicare or the Children’s Health Insurance Program, and prohibit the city of Washington DC fromusing its own local funds to subsidize abortion services.

The House of Representatives approved a version of the bill on Tuesday, and the Senate will consider similar legislation next week. But Republicans in that chamber will need to peel off eight Democratic or independent votes for the 60 needed to overcome a filibuster. Unless Republican leaders change the Senate’s rules to eliminate the filibuster, the fate of the bill may lie with Democrats facing re-election in 2018 in states that voted for Trump.

“We’re confident that the Senate will continue to be a firewall on this issue,” said Lopez.

Also on Tuesday, Republicans introduced a federal “heartbeat” bill that they say would effectively “eliminate” abortion, but is less likely to pass even the House.

Despite Hyde’s longevity, progressive lawmakers in recent years have adopted efforts to see it overturned. Even Hillary Clinton, in her 2016 bid for the presidency, promised to attempt to remove Hyde from future budget bills. HR7, although it does not change the fact that women on Medicaid have long been forced to pay for any abortion services out of pocket, would make it harder for a future Democratic Congress or president to do so.

HR7 is titled the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2017. Republican congressman Chris Smith of New Jersey introduced the bill in early January, as he has for several years running.

At an event to announce the bill, Smith said he supports repealing and replacing the Affordable Care Act, but that it is necessary to restrict the ways in which the law facilitates abortion coverage until that time.

“No one knows how quickly the replace part will actually occur,” Smith said. “In the meantime, the unborn child is about to be killed with public funding. We need to enact a statute that takes abortion out of [Obamacare].”

Republicans push ahead with plans to hinder insurance coverage for abortions

Failure to curb junk food ads ‘will hinder parents’ in fight against obesity

A failure to limit the way the junk food industry promotes itself to young people will make life far harder for parents trying to give children a nutritious diet, according to the royal society set up to improve public health.

Related: Theresa May’s climbdown on obesity is her first big mistake | Jackie Ashley

Experts in child health had hoped that the government’s long-awaited plan for fighting childhood obesity would include a comprehensive commitment to rein in the power of the food industry to advertise its more unhealthy products to children.

But, while the Department of Health is understood to have been supportive of the commitment, it was omitted from the plan unveiled last week during the summer recess following intervention by No 10. The decision dismayed many in the public health sector.

The watered-down plan, nine months in the making, was seen as a major victory for the fast food and fizzy drinks industries which have lobbied vigorously against measures that would stop them advertising at key times. Originally due to be unveiled by David Cameron, the revised plan under Theresa May’s new government has been savaged by TV chef Jamie Oliver and health bodies for not going nearly far enough.

Public Health England had produced a large body of evidence that suggested tackling the way the food and drinks companies target children was vital if the plan was to have an impact. But the government’s decision to ignore the evidence represents a huge missed opportunity, according to Shirley Cramer, chief executive of the Royal Society for Public Health (RSPH), which conducted interviews with children and their parents on what needed to be done.

“Everybody was advocating very hard for a ban on advertising junk food before the watershed and for family-based programmes like The X Factor,” Cramer said. “We’ve done quite a lot of research talking to young people who tell us that this – the stuff they see online, on bus tickets on posters near their school – makes an enormous difference. People are worried about the promotions, about the advertising. It’s all about pester power – 75% of parents we spoke to said their kids had seen an ad and they’d give in after half an hour of pestering.”

Cramer described the government plan as a good one but with “some big bits missing”. Only if a range of relevant government departments were to commit to preventative measures could the mounting problem of childhood obesity be adequately tackled, she suggested.

“If you look at teen pregnancies, that was a committed, longstanding strategy that went on for 10 years and now we’ve got the outcomes that are much better than predicted. If you really mean to do something about childhood obesity you can, but you need to get all these things working at the same time.”

The failure to constrain the advertising power of the fast food industry would make the job of councils trying to fight obesity all the more difficult, Cramer said. “For a local authority trying to take action against child obesity it doesn’t make their life easier. Junk food will still be advertised everywhere. It means the fight against childhood obesity will be much harder.”

She also echoed concerns expressed by some supermarket chains that voluntary plans to reduce sugar amounts in food would fail. “If you make it mandatory then, in a competitive sense, everyone knows where they stand. If it’s voluntary then the companies who do something will feel, ‘well the other guys aren’t doing it’. It needs to be a level playing field. We’ve got to do what we did with salt. The evidence is clear: most kids who are overweight or obese get their calories from sugar-sweetened beverages.”

Nearly 10% of all four- to five-year-olds and almost 20% of 10- to 11-year-olds are obese ,according to official figures. Obesity-related health issues now cost the NHS almost £5bn a year. The RSPH reports that half of all adults are predicted to be obese by 2050, more than doubling NHS costs to £10bn a year and with wider economic costs to the nation of almost £50bn.

“If we can reduce the number of children who are obese and therefore the number of adults who are obese we will not only be saving lives but saving the NHS money,” Cramer said.

Failure to curb junk food ads ‘will hinder parents’ in fight against obesity