Last week, the Department of Health and Human Services (HHS) submitted a final rulemaking on the state health insurance exchanges that created yet another accounting shell game, one that could force private citizens to pay for coverage of elective abortions.

Beginning in 2014, individuals forced to purchase health insurance under Obamacare’s individual mandate will look to state exchanges to purchase qualified health plans and avoid federal fines. For millions of low- and middle-income individuals and families, the federal government will provide “affordability tax credits” to cover the costs of participating in the state exchanges.

When legislative efforts failed to apply Hyde amendment language to the entirety of Obamacare, concerns were raised that the new taxpayer-funded affordability credits could be used to fund health insurance plans in state exchanges that included coverage of abortion.

To address those concerns, Obamacare allows states to pass legislation barring private insurance plans that cover elective abortion from their state exchanges. So far, 15 states have passed such laws. A majority of state legislatures, however, have so far left the issue unresolved. In those states, the possibility of using taxpayer dollars to heavily subsidize insurance plans that cover elective abortion remains a concern.

HHS has now finalized a rule requiring insurance plans operating in states that permit elective abortion coverage in their exchanges to segregate premium costs into two separate pools: one to cover abortion services and another to cover all other benefits. That abortion surcharge, which must be at least $1 a month, must be paid with private dollars by every enrollee in plans that cover elective abortion. The affordability tax credits, according to the Obama Administration, can then be used to subsidize other non-abortion-related benefits coverage for eligible enrollees.

With this shell game in place, the Obama Administration has attempted to declare itself free from accusations of using taxpayer funds for abortion. Nevertheless, this new rule will force all enrollees in plans that cover elective abortion to pay the abortion surcharge with private funds—or drop out of the plan entirely and hope a comparable one exists in the state exchange without abortion coverage. In some states, there will be options; in others, there will be few or none.

Moreover, under the rules finalized last week, insurance companies that provide abortion coverage are required only to disclose the abortion surcharge at the time of enrollment. It is possible that many individuals who would otherwise object to paying for coverage of abortion will not even be aware of the surcharge on their insurance, since the rule requires the premium not to be itemized and the required disclosure at the time of enrollment may be as little as a single sentence in a massive plan document.

Americans don’t deserve to have their serious concerns dismissed by the Obama Administration in a bad law and confusing rulemakings. The shell game in this abortion surcharge mandate joins the ranks of the accounting gimmicks proposed by the Administration to cover up the anti-conscience mandate’s violation of religious and individual liberty.

These episodes are rapidly becoming the status quo of Obamacare implementation, with a familiar and predictable plot line: an unaccountable bureaucracy releases complicated rules on morally fraught healthcare decisions, runs roughshod over Americans’ moral concerns and personal freedom, and then tries to obscure the flaws of the legislation with accounting legerdemain and limited disclosure.

The case against Obamacare is lengthy and includes an ever-expanding list of government dictates that restrict freedom, increase costs, and create serious conflicts of conscience for individuals, civil society institutions, employers, and insurance providers. The new abortion surcharge rule is just another reason why Obamacare is broken from the start and must be repealed.