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                   CONGRESSIONAL BUDGET OFFICE

a                              COST ESTIMATE
                                                                   October 2, 2017


                                     H.R. 36
                  Pain-Capable Unborn Child Protection Act

           As introduced in the Committee on the Judiciary on January 3, 2017


 SUMMARY

 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.)

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