More than seven million Americans have now selected a new insurance plan on Obamacare’s state-level marketplaces, and the people who signed up last year are already using their new coverage. But there are some aspects of the new plans that remain confusing. It’s difficult for enrollees to figure out whether their insurance covers abortion services.
According to a recent analysis from the Guttmacher Institute, the lack of national standards for conveying information about abortion coverage on the marketplaces has left a confusing landscape for Americans who want to know where their Obamacare plan stands. Making matters more complicated, a growing number of restrictions limiting insurance coverage for abortion ensure that it’s different in every state.
Thirty four states have imposed some kind of limits on which insurance plans are allowed to cover abortion care. Lawmakers can accomplish this through two major avenues, either by restricting public programs or the private market. For years, the federal Hyde Amendment has prevented low-income women from using their public Medicaid plans to help pay for the cost of an abortion. And now, the health reform law has actually given states a new opening to limit access to private abortion coverage as well.
Under Obamacare, each state is allowed to decide whether to offer plans on its marketplace that cover abortion care. States are also allowed to enact explicit bans on this type of coverage, so more than 20 states have taken the opportunity to outlaw it. That’s had a big impact on the insurance market. By the Kaiser Family Foundation’s estimations, about half of the U.S. women of reproductive age who are gaining insurance under Obamacare won’t have coverage for elective abortions.
In the states where abortion coverage is banned, women signing up for marketplace plans must purchase an extra insurance rider if they want to avoid paying out-of-pocket for the full cost of an abortion. But it’s not entirely clear these riders even exist. Several investigations into state marketplaces have revealed that insurers aren’t prepared to sell separate riders for abortion, and the laws on the books don’t specify how this should work in practice. “Most of these states that have some kind of restriction on private health plans allow for these riders, but there’s no evidence they exist,” Elizabeth Nash, the state issues manager at the Guttmacher Institute, explained to RH Reality Check last summer.
But it isn’t necessarily much easier for the women who live in states that haven’t banned abortion coverage. Guttmacher’s new analysis found that, in many of the states that do allow Obamacare plans to cover abortion, information about these services is still elusive. The majority of the 12 states that Guttmacher examined don’t provide easily accessible conformation about which plans include this coverage.
The health law requires insurers to provide their consumers with a “summary of benefits and coverage” (SBC) that explains what’s covered in plain English. The whole point of the SBC is to make insurance plans easier for Americans to understand. But according to Guttmacher researchers, eight states don’t have information about abortion in any of their marketplace plans’ SBCs. Two of those states, Colorado and Connecticut, do make the information about abortion coverage available in separate documents — but the researchers had to search for it. Similarly, it was difficult to find out which plans didn’t offer abortion coverage, for the state residents who may be interested in picking a plan that excludes those services.
That may be because the SBC template the federal government provided to insurers doesn’t include a category for abortion. Other sections intended to guide consumers are entitled “if you have a hospital stay,” “if you get pregnant,” and “if you need help recovering or have other special health needs.” But most insurers haven’t thought to add a section on abortion. The Guttmacher researchers believe the Obama administration can help address this issue by re-issuing a new template that includes “if you need an abortion” right under the category related to pregnancy.
“Consistent fact-based transparency about whether or not a plan covers abortion would benefit all consumers — those seeking a plan that includes abortion coverage, as well as those seeking a plan that excludes it,” Kinsey Hasstedt, who authored the Guttmacher analysis, concludes.
Indeed, this is an issue that unites people on both sides of the reproductive rights debate. Abortion opponents, and particularly groups that frequently accuse the health reform law of seeking to expand access to abortion, agree that Americans need more information in this area. The right-wing Susan B. Anthony List, the Heritage Foundation, and the National Review Online have all accused the administration of failing to provide adequate details about which marketplace plans cover abortion.
But this is a situation that was directly created by abortion opponents. By insisting on an artificial division between abortion and the rest of women’s reproductive health care, anti-choice activists have attempted to shift the insurance market away from its traditional approach to abortion services. Insurers haven’t historically provided detailed information about abortion because it’s a procedure that’s been routinely covered. But now, a web of abortion restrictions is directly interfering in the medical community, segregating abortion in a way that makes everything more complicated.
That’s contributed to the fact that many women who have insurance simply assume their plan must not cover abortion, and pay for the total cost out of pocket because they think they have no other choice. Unfortunately, Obamacare has ended up making these dynamics worse.