With Roe’s reversal, abortion insurance coverage will become even more complicated

The existing mix of federal and state rules governing abortion insurance coverage will become even more complicated in light of the Supreme Court’s ruling on Friday to overturn Rowe v. Wade, the remarkable case that established a constitutional right to abortion.

Different types of health insurance – including different categories of employers’ health plans, Affordable Care Act market plans and Medicaid – fall into different sets of rules that affect their ability to cover abortion. As state laws change following a Supreme Court ruling, that coverage could become even more uneven, insurance and policy experts say.

“It will be really confusing and more confusing for all participants,” said Fabiola Carion, director of reproductive and sexual health at the National Health Legislation Program, a health rights organization that advocates for insurance coverage for abortion services.

The situation has many employers on the brink, said Sarah Raai, a senior fellow at McDermott Will & Emery. “We have a huge influx of employers who turn up and ask, ‘What should I do?’ Are there any risks? ”She said, adding that many employers are concerned about clearly reporting potential coverage gaps. Employers’ health plans cover about half of the US population.

Lack of insurance coverage is a “big barrier to access”

Due to the limitations of insurance coverage, most people now pay for an abortion out of pocket, according to a recent study by researchers at the University of California, San Francisco.

The average first-trimester abortion fee rose by more than 20% between 2017 and 2020, to $ 575, while the average drug abortion fee – which now accounts for more than half of abortions in the United States – rose by 13 % to $ 560, according to the study. Meanwhile, the share of establishments that accept abortion insurance has decreased.

The lack of insurance coverage has a huge chilling effect and is a major barrier to access for people in need of abortion, “said Thomas Waldrop, a health care associate at The Century Foundation, a think tank.

Some restrictions on abortion insurance coverage emerged shortly after the Supreme Court’s 1973 ruling Roe v. Wade. Hyde’s amendment, first passed in 1976, prohibits federal funding for abortion, except in cases of danger to life, rape, or incest. The Affordable Care Act 2010 also allows states to ban abortion coverage in market plans.

Self-insured health plans are not immune from criminal liability

For people in employers ‘health plans, abortion coverage may depend on whether the plan is self-insured – meaning that the employer pays employees’ claims out of pocket – or fully insured, which means that the employer buys coverage for workers through commercial insurer. Self-insurance plans are usually not subject to state insurance laws and may have more leeway in deciding whether to cover abortion or not.

These plans are subject to federal law governing employee benefit plans and “therefore there is no requirement to include or exclude abortion coverage,” said Lori Sobel, associate director of women’s health policy at KFF, a think tank. for healthcare.

However, self-insurance plans are not protected from potential criminal liability under state law in countries that take a more restrictive stance on abortion.

“In the world of self-financing plans, there would be potential responsibility if a resident of one of these limited states received abortion services and the plan helped in some way,” Raai said. Although some employers have said they will provide travel benefits for employees who may have to travel outside the state for abortions, these steps are “potentially risky,” Raai said. “This is a slightly unknown landscape when it comes to prosecuting and enforcing state law.

Meanwhile, fully secured employer plans usually have to follow state abortion coverage law. Prior to Friday’s Supreme Court ruling, 11 states have already limited abortion coverage to fully secured plans, while six states have required private insurance plans to cover abortion – and additional states may take action after the court ruling, legal experts say.

Restrictions on ACA, Medicaid and Medicare

In many states, people with market plans for the Affordable Care Act are already facing restrictions on abortion coverage. Twenty-six states ban market plans to cover abortion, with some exceptions, according to the KFF, while a handful of states require those plans to cover abortion.

The Supreme Court ruling could prompt a number of states that have not yet taken a position to ban coverage in market plans, require it or regulate it in any other way, says Louise Norris, a health policy analyst for HealthInsurance.org, online. health insurance guide.

Abortion coverage for people relying on federally funded programs, such as Medicaid and Medicare, is usually limited by Hyde’s amendment. (In addition to coverage for the elderly, Medicare covers many people under the age of 65 who have disabilities.) According to the KFF, nearly three dozen states limit Medicaid abortion coverage to life-threatening, rape, or incest cases, according to the KFF.

Because Medicaid is co-funded by federal and US dollars, some other states are using their own funds to offer broader abortion coverage under the program. But “because Medicare is only funded at the federal level, the states cannot intervene,” Norris said.

Leave a Comment

Your email address will not be published.