• A government report reviewing insurance coverage of abortions in 27 states and Washington, D.C., found that 1,036 insurance plans covered elective abortions while 1,062 did not. 
• The report raises concerns about taxpayer dollars going toward elective abortions, which is against the law. 
• Tax funds cannot be used to pay for abortions except in cases of rape, incest or to save the mother's life. 
• The Department of Health and Human Services "acknowledges that additional clarification may be needed" in the Affordable Care Act's coverage of abortions. 

Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the "Priests for Life v. US Department of Health and Human Services (HHS)" case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. (SAUL LOEB/AFP/Getty Images)

WASHINGTON (TheBlaze/AP) — A nonpartisan congressional agency is raising new questions about compliance with a key compromise on abortion that allowed the federal health care law to pass in 2010.

The Government Accountability Office said in a report released late Monday that only 1 of 18 insurers it reviewed was separately itemizing a charge for coverage of elective abortions on enrollees' bills.

That detail is important because the original compromise that President Barack Obama sealed with anti-abortion Democrats stipulated that no federal funds would be used to pay for elective abortions. Instead, private health plans covering the procedure would collect a separate premium, which would be segregated from federal subsidies for other medical services.

Although abortion is a legal medical procedure, longstanding federal laws prohibit taxpayer funds from being used to pay for it, except in cases of rape, incest or to save the life of the mother.

The new GAO review did not address the fundamental question of whether federal subsidies under the health law are being used for elective abortions, but abortion opponents said the findings underscore their view that the compromise is an accounting gimmick.

The report, which was released by Republicans on the House Energy and Commerce Committee and was obtained by Politico, said that the government has acknowledged the need for clarification in the law (emphasis added):

We provided a draft of this report to [Health and Human Services, for [Centers for Medicare & Medicaid Services], and to [Office of Personnel Management] for comment. In its written comments, reproduced in enclosure III, HHS stated that, in addition to issuing a regulation governing the provision of health insurance coverage by QHPs, CMS also had answered individual questions from issuers and provided limited guidance to help ensure that stakeholders, including states and issuers, understand and follow the rules relating to coverage of abortion services in QHPs. However, HHS stated that, based upon our findings, additional clarification may be needed and CMS will use our findings to address issues of concern to better ensure that stakeholders understand the laws and regulations governing the provision of non-excepted abortion services coverage. 

The report also found that some insurers were unaware of a requirement in the law that they notify policyholders if they cover elective abortions. Abortion opponents have complained that it's very difficult for average consumers to determine whether or not their plan covers the procedure. Abortion supporters say they would also like clearer information.

Most health plans offered through employers routinely cover abortions. The health care law created new state insurance markets where people who don't have access to job-based coverage can buy a government-subsidized policy. The flow of taxpayer dollars to insurers in the new exchanges created another battleground for opponents and supporters of abortion.

A look at healthcare.gov. A recent GAO report found that some insurers are covering elective abortions, which raises concerns about taxpayer dollars going toward the procedure, which is against a provision in the Affordable Care Act. (AP/Jon Elswick)

The compromise on abortion allowed Obama to secure votes from a small group of Democratic lawmakers who traditionally voted in favor of restrictions on abortion funding. Their support was critical in the face of overwhelming Republican opposition to the legislation.

The GAO report focused on 27 states, plus Washington, D.C., that do not have laws restricting access to elective abortions in the new health insurance markets. Another 23 states restrict or bar coverage.

This figure from GAO's report shows the different coverage that states are offering for abortions. (Image source: GAO)

The GAO found that 1,036 plans in these 27 states covered elective abortions, while 1,062 did not.

The 18 insurers that the agency reviewed accounted for nearly one-fourth of the plans that covered abortion. Each insurer offered multiple plans. None of the companies or plans were identified in the report.

All but one of the insurers said the cost of providing abortion coverage averaged out to less than $1 a month across their entire group of policyholders. In some cases it was as low as 10 cents a month.

The one insurer that itemized the abortion coverage charge on its monthly bill said it describes it as being "for coverage of services for which member subsidies may not be used."