H.R. 36 would ban abortions from being performed 20 weeks or more after fertilization, except when the pregnancy is a result of reported rape or reported incest against a minor, or is necessary to save the life of the mother. Violators of the act’s provisions would be subject to a criminal fine or imprisonment, or both.
CBO estimates that enacting H.R. 36 would increase direct spending, primarily for Medicaid in order to cover the costs of additional births under the act. Because the number of abortions that would be averted due to the act is very uncertain, the extent of that additional Medicaid spending is also very uncertain. Depending on the number of additional births under H.R. 36, such Medicaid costs could range from about $65 million over the next 10 years to about $335 million over that period. Using an assumption that, under the act, about three-quarters of the abortions that would occur 20 weeks or more after fertilization under current law would instead occur earlier, and the remaining one-quarter would not occur so those pregnancies would be taken to term, CBO estimates that federal spending for Medicaid would rise by $175 million over the 2018-2027 period.
Pay-as-you-go procedures apply because enacting the legislation would affect direct spending and revenues; however, H.R. 36 would have a negligible effect on revenues.
CBO estimates that enacting the legislation would not increase net direct spending or on-budget deficits by more than $5 billion in any of the four consecutive 10-year periods beginning in 2028.
H.R. 36 would impose both intergovernmental and private-sector mandates on physicians who perform abortions and would preempt state and local laws that regulate abortions. The bill also would impose a mandate on women seeking abortions. CBO estimates that the direct costs of the mandates would fall below the annual thresholds established in UMRA for intergovernmental and private-sector mandates. (Adjusted for inflation, those thresholds are $78 million and $156 million in 2017, respectively.)