Marketplace plans hazy on abortion coverage
By Adam Sonfield
Senior Public Policy Associate
Guttmacher Institute
Washington, DC
Insurance coverage of abortion was one of the final sticking points during enactment of the Affordable Care Act (ACA), and it has continued to be a rallying cry for ACA opponents in the years since. Now that the major components of the ACA are in full effect, the question of whether consumers have the option of plans covering abortion — and whether they can even figure that out — has become a topic of great interest to policymakers and advocates on both sides of the abortion debate, as well as the public at large.
Under the ACA, states are allowed to ban coverage of abortion within plans sold through the new online marketplaces, and 25 states have done so, typically with exceptions for the extreme cases of rape, incest, and endangerment of the woman’s life.1 In the remaining states, the decision about whether to cover abortion is left to the plan issuer. Plans that do cover the service must follow specific accounting mechanisms designed to prevent any federal subsidies received by enrollees from being used for abortion coverage and care, which must instead come from enrollees’ own premium payments. In a further concession to antiabortion lawmakers, the ACA requires that at least one of the "multi-state" plans, which are federally contracted plans that must be sold through every state’s marketplace by 2017, as a way to expand consumer choices, must exclude abortion coverage. There is no parallel requirement that any plan cover the service. So far, of the more than 150 multi-state offerings in 30 states and the District of Columbia in 2014, only two cover abortion, both of which appear to be specific to Alaska’s marketplace.2
According to my colleague, Kinsey Hasstedt, who reports on the subject in far more detail than I can cover here, consumers on the marketplaces often have inadequate information to identify plans that do or do not cover abortion.3 Guttmacher staff reviewed available plan documents — the standardized summary of benefits and coverage (SBC) forms and additional documents for consumers available through links on the marketplaces — in 12 of the state marketplaces where abortion coverage is permitted (Alaska, Illinois, Rhode Island, Washington, Colorado, Connecticut, Georgia, Nevada, Minnesota, New Hampshire, New Jersey, and West Virginia). Issuers in only four of the states (Colorado, Connecticut, Rhode Island, and Washington) clearly offer plans covering abortion (beyond cases of rape, incest, or life endangerment). Issuers in only two of those states (Colorado and Washington) and four others (Alaska, Illinois, Georgia and Nevada) clearly offer plans excluding that coverage. In fact, most plan documents, including those for all of the plans in the remaining four states, say nothing at all about abortion, which leaves consumers in the dark.
Transparency is no better in the states that have barred abortion coverage in their marketplaces. Almost all of those states rely on the federal government’s HealthCare.gov website. That portal includes no information about the state abortion coverage bans. Similarly, in the two states barring such coverage that run their own marketplaces (Idaho and Kentucky), there is no notice to consumers that abortion coverage is unavailable.
Clarity is achievable
Antiabortion lawmakers and activists have taken political advantage of the dearth of information about abortion coverage in marketplace plans. For example, the U.S. House of Representatives passed a so-called disclosure measure in late January 2014. However, it was included within a broader bill designed to drive abortion coverage out of the marketplace plans altogether, making the issue of disclosure irrelevant.4 The measure also would require plans to emphasize whether or not they cover abortion in their marketing materials — treating it differently from other covered services — and would require plans to incorrectly describe an "abortion surcharge." In fact, that "surcharge" is an amount related to the accounting mechanisms set up by the law specifically to appease antiabortion lawmakers’ insistence that federal dollars not go toward abortion. Given the Senate leadership’s refusal to take up the House-passed legislation and the president’s veto threat, this bill has no chance of becoming law anytime soon.
Meanwhile, a lawsuit filed in May 2014 in Connecticut by antiabortion activists follows the same line of attack. It asserts that federal and state officials have violated their religious rights in the following ways:
• by requiring them to purchase insurance through which their premiums will subsidize abortion coverage that may be used by other plan enrollees;
• by apparently not providing them with any plan options that exclude abortion (in part because no multi-state plans are yet offered on Connecticut’s marketplace);
• by denying them the information about abortion coverage and "surcharges" they would need to identify a plan that excludes abortion coverage, if one exists.5
In truth, transparency for consumers about abortion coverage is legal already under the ACA and could be guaranteed in an unbiased manner through several simple government actions. Already, the ACA requires plans that cover abortion to disclose that in their SBCs, and more generally requires SBCs to include any major coverage exclusions. Simple changes to the SBC form and instructions could make information about abortion coverage universal and appropriately situated among other services related to common medical events.3 The marketplaces, including HealthCare.gov, also could easily provide notice about state laws prohibiting abortion coverage. Given the ongoing national debate, confusion, and interest about abortion coverage under the ACA, it is in everyone’s interest that the government take these steps before the next open enrollment period this fall.
- Guttmacher Institute. Restricting insurance coverage of abortion. State Policies in Brief; May 2014. Accessed at http://bit.ly/1g5pfvR.
- Office of Personnel Management. Letter to Rep. Chris Smith. Nov. 8, 2013. Accessed at http://1.usa.gov/1oOBSLZ.
- Hasstedt K. Abortion coverage under the Affordable Care Act: the laws tell only half the story. Guttmacher Pol Rev 2014; 17(1):15-21.
- H.R. 7, 113th Congress, No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2014.
- Radelat A. Couple sues over abortion coverage in Access Health CT plans. Connecticut Mirror; May 5, 2014. Accessed at http://bit.ly/1sNoXfs.
