The existing mosaic of federal and state rules governing abortion insurance coverage will be further complicated in light of Friday’s Supreme Court decision to overturn Roe v. Wade, the historic case that established the constitutional right to abortion.
Different types of health insurance, including various categories of employer group health plans, Economic Care Act and Medicaid market plans, are under different sets of rules that affect your ability to cover abortion. . As state laws change as a result of the Supreme Court ruling, that coverage can become even more erratic, insurance and policy experts say.
“It will be very messy and more confusing for everyone involved,” said Fabiola Carrión, director of sexual and reproductive health at the National Health Law Program, a health rights organization that advocates for insurance coverage for abortion services.
The situation has many employers on the brink, said Sarah Raaii, a senior associate at law firm McDermott Will & Emery. “We’ve had a huge influx of entrepreneurs who have gotten in touch and are asking,‘ What should I do? Are there any risks? ‘”He said, adding that many employers are concerned about clearly communicating possible coverage lapses. Employer health plans cover about half of the U.S. population.
Lack of insurance coverage is “a big barrier to access”
Because of insurance coverage restrictions, most people already pay for out-of-pocket abortions, according to a recent study by researchers at the University of California at San Francisco.
The average charge for a procedural abortion in the first trimester increased more than 20% between 2017 and 2020, to $ 575, while the average charge for abortion with drugs, which now accounts for more than half of abortions in the United States, rose 13% to $ 560, according to the study. Meanwhile, the proportion of establishments accepting abortion insurance declined.
Lack of insurance coverage “has a huge creepy effect and is a big barrier to access for people in need of abortions,” said Thomas Waldrop, a health policy member at The Century Foundation, a group of reflection.
Some restrictions on abortion insurance coverage arose shortly after the 1973 Supreme Court decision Roe v. Wade. The Hyde Amendment, first passed in 1976, prohibits federal funding for abortions, except in cases of life-threatening, rape, or incest. The Affordable Care Act of 2010 also allows states to prohibit abortion coverage in market plans.
Self-insured health plans are not immune to criminal liability
For people in employer group health plans, abortion coverage may depend on whether the plan is self-insured, that is, the employer pays out-of-pocket employee claims, or is fully insured, that is, the employer buys coverage for workers through a commercial insurer. Self-insured plans are generally not subject to state insurance laws and may have more leeway in deciding whether or not to cover abortion.
These plans are subject to a federal law that regulates employee benefit plans, and “under that, there is no requirement to include or exclude abortion coverage,” said Laurie Sobel, director associate of women’s health policy of KFF, a health think tank.
Self-insured plans, however, are not protected from possible criminal liability under state law in states that take more restrictive positions on abortion.
“In the world of the self-funded plan, there would be a potential liability if a resident of one of these restricted states obtained abortion services and the plan attended in some way,” Raaii said. While some employers have announced they will offer travel benefits to employees who have to travel out of state to have an abortion, these steps are “potentially risky,” Raaii said. “This is a somewhat unknown landscape in terms of processing and law enforcement.”
Meanwhile, fully insured employer plans generally must follow state law on abortion coverage. Prior to Friday’s Supreme Court decision, 11 states already restricted abortion coverage from fully insured plans, while six states required private insurance plans to cover abortion, and additional states may take a position on the issue. following the court’s decision. say legal experts.
Restrictions under ACA, Medicaid and Medicare
In many states, people with Affordable Care Act market plans already face restrictions on abortion coverage. Twenty-six states prohibit market plans from covering abortion, with certain exceptions, according to KFF, while a handful of states require such plans to cover abortion.
The Supreme Court decision may cause several states that have not yet taken a position to ban coverage in market plans, demand it or otherwise regulate it, says Louise Norris, a health policy analyst at HealthInsurance .org, an online health insurance guide.
Abortion coverage for people who depend on federally funded programs, such as Medicaid and Medicare, is generally restricted by the Hyde Amendment. (In addition to covering the elderly, Medicare covers many people under the age of 65 who have disabilities.) About three dozen states limit Medicaid abortion coverage to life-threatening, rape, or incest cases, according to KFF.
Because Medicaid is jointly funded by federal and state dollars, some other states use their own funds to provide broader abortion coverage under the program. But “because Medicare is only federally funded, states can’t intervene in that,” Norris said.