Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and Affordable Care Act

Executive Order 13535 of March 24, 2010

Ensuring Enforcement and Implementation of
Abortion Restrictions in the Patient Protection and
Affordable Care Act

By the authority vested in me as President by the
Constitution and the laws of the United States of
America, including the “Patient Protection and
Affordable Care Act” (Public Law 111-148), I hereby
order as follows:

Section. 1. Policy. Following the recent enactment of
the Patient Protection and Affordable Care Act (the
“Act”), it is necessary to establish an adequate
enforcement mechanism to ensure that Federal funds are
not used for abortion services (except in cases of rape
or incest, or when the life of the woman would be
endangered), consistent with a longstanding Federal
statutory restriction that is commonly known as the
Hyde Amendment. The purpose of this order is to
establish a comprehensive, Government-wide set of
policies and procedures to achieve this goal and to
make certain that all relevant actors--Federal
officials, State officials (including insurance
regulators) and health care providers--are aware of
their responsibilities, new and old.

The Act maintains current Hyde Amendment restrictions
governing abortion policy and extends those
restrictions to the newly created health insurance
exchanges. Under the Act, longstanding Federal laws to
protect conscience (such as the Church Amendment, 42
U.S.C. 300a-7, and the Weldon Amendment, section
508(d)(1) of Public Law 111-8) remain intact and new
protections prohibit discrimination against health care
facilities and health care providers because of an
unwillingness to provide, pay for, provide coverage of,
or refer for abortions.

Numerous executive agencies have a role in ensuring
that these restrictions are enforced, including the
Department of Health and Human Services (HHS), the
Office of Management and Budget (OMB), and the Office
of Personnel Management.

Sec. 2.  Strict Compliance with Prohibitions on
Abortion Funding in Health Insurance Exchanges. The Act
specifically prohibits the use of tax credits and cost-
sharing reduction payments to pay for abortion services
(except in cases of rape or incest, or when the life of
the woman would be endangered) in the health insurance
exchanges that will be operational in 2014. The Act
also imposes strict payment and accounting requirements
to ensure that Federal funds are not used for abortion
services in exchange plans (except in cases of rape or
incest, or when the life of the woman would be
endangered) and requires State health insurance
commissioners to ensure that exchange plan funds are
segregated by insurance companies in accordance with
generally accepted accounting principles, OMB funds
management circulars, and accounting guidance provided
by the Government Accountability Office.

I hereby direct the Director of the OMB and the
Secretary of HHS to develop, within 180 days of the
date of this order, a model set of segregation
guidelines for State health insurance commissioners to
use when determining whether exchange plans are
complying with the Act's segregation requirements,
established in section 1303 of the Act, for enrollees
receiving Federal financial assistance. The guidelines
shall also offer technical information that States
should follow to conduct independent regular audits of
insurance companies that participate in the health
insurance exchanges. In developing these model
guidelines, the Director of the OMB and the Secretary
of HHS shall consult with executive agencies and
offices that have relevant expertise in accounting

principles, including, but not limited to, the
Department of the Treasury, and with the Government
Accountability Office. Upon completion of those model
guidelines, the Secretary of HHS should promptly
initiate a rulemaking to issue regulations, which will
have the force of law, to interpret the Act's
segregation requirements, and shall provide guidance to
State health insurance commissioners on how to comply
with the model guidelines.

Sec. 3. Community Health Center Program. The Act
establishes a new Community Health Center (CHC) Fund
within HHS, which provides additional Federal funds for
the community health center program. Existing law
prohibits these centers from using Federal funds to
provide abortion services (except in cases of rape or
incest, or when the life of the woman would be
endangered), as a result of both the Hyde Amendment and
longstanding regulations containing the Hyde language.
Under the Act, the Hyde language shall apply to the
authorization and appropriations of funds for Community
Health Centers under section 10503 and all other
relevant provisions. I hereby direct the Secretary of
HHS to ensure that program administrators and
recipients of Federal funds are aware of and comply
with the limitations on abortion services imposed on
CHCs by existing law. Such actions should include, but
are not limited to, updating Grant Policy Statements
that accompany CHC grants and issuing new interpretive
rules.

Sec. 4. General Provisions. (a) Nothing in this order
shall be construed to impair or otherwise affect: (i)
authority granted by law or Presidential directive to
an agency, or the head thereof; or (ii) functions of
the Director of the OMB relating to budgetary,
administrative, or legislative proposals.

    (b) This order shall be implemented consistent with
applicable law and subject to the availability of
appropriations.
    (c) This order is not intended to, and does not,
create any right or benefit, substantive or procedural,
enforceable at law or in equity by any party against
the United States, its departments, agencies, or
entities, its officers, employees or agents, or any
other person.

    (Presidential Sig.)

THE WHITE HOUSE,

    Washington, March 24, 2010.