Roman Catholic healthcare leaders have received some encouraging news about their quest to get in on the burgeoning Medicare managed-care business, even though Catholic health plans won't cover abortions.
Catholic healthcare organizations have been concerned they will be denied the right to become Medicare provider-sponsored organizations because of their refusal to cover abortions (June 15, p. 2). Medicare has paid for abortions under fee-for-service in the past, an HHS spokesman said recently.
But HHS Secretary Donna Shalala, in a recent letter to Sen. Don Nickles (R-Okla.), tried to allay some of those fears. Nickles has been working with the St. Louis-based Catholic Health Association to resolve the matter.
Shalala confirmed that Medicare is restricted from paying for abortions for its nonelderly disabled beneficiaries except in cases of rape, incest or when a mother's life is in danger.
Those restrictions are contained in the "Hyde amendment," named for Rep. Henry Hyde (R-Ill.). The amendment has been successfully attached to Department of Labor-HHS appropriations bills to restrict the use of federal money for abortions.
Despite those assurances, the CHA is concerned that Catholic providers will have to certify to HCFA that they will cover abortions if they want to become PSOs. Even though the Hyde amendment protects them in most cases, the church doesn't allow its providers to perform abortions in cases of rape or incest. According to Catholic directives, only when the life of a mother is at stake can "operations, treatments and medications" be given that might result in the death of an unborn child.
In her June 22 letter, Shalala told Nickles that HHS is committed to working through "a number of administrative actions" so plans that object to providing abortion coverage can participate as PSOs in Medicare+Choice.
Medicare+Choice was created under the Balanced Budget Act of 1997 to provide new Medicare managed-care options to beneficiaries.
The CHA, which represents 1,200 Catholic healthcare providers, hopes to resolve the issue by getting legislation passed to clarify the matter. That's because an administrative fix would leave the situation at the mercy of the next administration, which could reverse course, said William Cox, CHA executive vice president.
"I just don't think we want to be subject to that unpredictability," Cox said.
Recently, the House Appropriations HHS subcommittee passed its version of the HHS appropriations bill for fiscal 1999. The version includes the current abortion funding restrictions and adds new Hyde language specific to Medicare.
Abortion coverage by Medicare is an issue for the 1.9 million nonelderly disabled women who make up about 1.7% of the nation's 38 million Medicare recipients. Of those women, about 627,000 are under the age of 45.