Roman Catholic healthcare leaders are worried that their hospitals and systems might be shut out of the burgeoning Medicare managed-care business because Catholic health plans won't cover abortions.
The St. Louis-based Catholic Health Association wants lawmakers to make clear that providers can refuse to cover abortions without jeopardizing their ability to contract directly with Medicare through new Medicare+Choice plans.
Medicare+Choice was created as part of the Balanced Budget Act of 1997 to provide managed-care options to Medicare recipients, such as through newly formed provider-sponsored organizations.
In fact, a Catholic hospital system in New Mexico was the first to file an application to become a federally certified PSO (June 8, p. 6). Four-hospital St. Joseph Healthcare System in Albuquerque is part of Denver-based Catholic Health Initiatives.
"It's a huge fear," said William Roach, an attorney with Gardner, Carton & Douglas in Chicago. "It's a small string that unravels the whole Medicare fabric for Catholic healthcare providers."
While primarily regarded as health insurance for the elderly, Medicare does cover about 1.9 million nonelderly disabled women, who make up about 1.7% of the nation's 38 million Medicare recipients (See chart). Of those women, about 627,000 are under the age of 45 and another 541,000 women are between the ages of 45 and 54.
The CHA, which represents about 1,200 healthcare providers and sponsors, said it believed existing protections were in place to restrict the use of federal money to pay for abortions.
Those protections, the CHA said, are included in the "Hyde amendment," named for Rep. Henry Hyde (R-Ill.). That provision has been attached successfully to Department of Labor-HHS appropriations bills to restrict federal money from being used for coverage of abortions.
But association officials said HHS told them the Hyde amendment may not apply to Medicare. If that's the case, the CHA is concerned HCFA will require Medicare+Choice plans to certify they will cover abortions.
That would be a blow to Catholic healthcare providers, who, like their secular counterparts, are anxious to get into direct Medicare contracting as PSOs.
"Obviously, Catholic health plans cannot certify that they will pay for or provide abortions to nonelderly Medicare beneficiaries, and so run the risk of exclusion," CHA wrote to its members in a briefing paper outlining the issue.
Exactly how serious a threat this is to Catholic providers isn't clear. A HCFA spokesman would only confirm the agency is looking at the issue. He also said there may have been some abortions covered under Medicare fee-for-service in the past, although he was unsure whether they were abortions in cases other than rape, incest or to save the life of the mother-the exceptions for federal coverage allowed by the Hyde amendment.
According to some providers familiar with Medicare coverage, abortions are a covered benefit under Medicare fee-for-service programs. If Catholic providers want to get in on Medicare managed care, they've got to include abortion services in their covered benefits, said Vicki Saporta, executive director of the Washington-based National Abortion Federation, a trade association for abortion providers.
"If they want funding from Medicare, they should provide reproductive healthcare that's covered under Medicare," she said.
At its annual meeting in New Orleans last week, the CHA launched a grass-roots advocacy campaign aimed at clarifying federal legislation. The CHA also wants to strengthen existing federal law to clarify that discriminating against healthcare providers that refuse to provide abortions is prohibited.
"What we're asking for is tolerance," said William Cox, CHA executive vice president.