Forum Post: The GOP's New Sneak Attack on Abortion

A group of congressional Republicans is pushing a bill to put key health care decisions in the hands of the states, rather than the federal government. But language buried in the legislation would do the opposite on one key issue: abortion.

Rep. Todd Rokita's (R-Ind.) State Health Flexibility Act, also known as HR 4160, contains a provision that would force 17 states, including California, Massachusetts, and New York, to either discontinue programs that help low-income women pay for abortions, or spend a lot more money to purchase new insurance plans for those women. Thirty House Republicans have signed onto Rokita's proposal since it was introduced in March*, and the Republican Study Committee, a group of conservatives that includes over 70 percent of the GOP caucus, made HR 4160 part of its official budget plan.

If passed, the bill "would block the only avenue left to states that wish to make safe and legal abortions accessible to low income women," says Sara Rosenbaum, a health law expert at George Washington University.

The GOP bill is designed to change the way Medicaid—the federal health care program for the poor—operates. Currently, the federal government reimburses states for a percentage of the money they spend on Medicaid, provided states adhere to basic federal guidelines. But Rokita's bill, like the House Republican budget drafted by Rep. Paul Ryan (R-Wis.), would shift the system to a block grant model, under which states would receive fixed quarterly grants from Washington and have the freedom to set up low-income health care programs largely as they wished. There would be little in the way of minimum standards, the value of federal funding would decline dramatically over time, and states would be free to boot millions of people from their Medicaid rolls. The Republican measure would give states more say over how they spend Medicaid funds, but it forbids them from covering abortions, even with state money—unless they purchase separate abortion-only plans or buy plans that include abortion coverage entirely with state funds. Either option could potentially cost these states millions of dollars.**

A longstanding federal law, the Hyde Amendment, already bans states from spending federal Medicaid money on abortions, except in cases of rape or incest, or when the life of the mother is at stake. The 17 states that would be affected by Rokita's bill have chosen (or been compelled by court order) to cover other abortions with their own money through state health plans that work in conjunction with Medicaid.

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