Trump’s latest anti-choice proposal could make insurance coverage for abortion even more difficult

"Added complexity could move more insurers to drop coverage."

Credit: Getty Images
Credit: Getty Images

The Trump administration wants insurers to send Obamacare enrollees two separate, monthly bills if the plan covers abortion services, per a new proposed regulation that creates more administrative burden for patients and companies alike.

It wouldn’t matter if the patient never had an abortion. The administration would require insurance companies to send two different invoices to patients who purchase Obamacare plans: one for the standard monthly fee for the insurance policy and another for the premium attributable to abortion coverage (which could be as low as $1).

“This rule is certain to cause confusion among consumers. They will now receive two separate bills and have to make two separate payments. Again, this is meant to cause confusion,” said Destiny Lopez, co-director of All* Above All, a reproductive justice group aiming to lift abortion coverage bans.

The proposed rule published Tuesday evening is intended to resolve a problem that doesn’t exist. By way of background, federal dollars aren’t allowed to pay for abortion services and this includes Obamacare subsidies. Obamacare, shorthand for the Affordable Care Act (ACA), already requires insurance companies that offer ACA plans and abortion coverage to separate private premium dollars and subsidies on the back end to ensure tax credits or cost sharing reductions don’t pay for the benefit.


This existing rule, which requires insurers to send consumers one itemized invoice showing how much a monthly premium went towards abortion services, was largely seen as a concession to anti-choice lawmakers who wanted to ban abortion coverage in the ACA marketplace altogether. But the Trump administration, packed with anti-choice leadership, believes the current process doesn’t adequately reflect congressional intent.

“None of this is necessary to comply with the requirement that private money be kept separate from the federal money,” said Megan Donovan, a senior policy manager at the Guttmacher Institute.

“But it does further stigmatize abortion, it does increase the burden on the insurer and consumer, and it does frankly speak to the anti-abortion base that this administration is basically playing to.”

Thanks to the Hyde Amendment, a lot of people — particularly low-income people — don’t have access to health insurance that covers abortion, a service that costs anywhere between $400-$1,650 depending on how far along in the pregnancy a person is. Already, 26 states prohibit private plans on the ACA marketplace from covering abortion or a rider to supplement that plan. Fifteen of those 26 states allow private plans sold outside the marketplace to provide abortion coverage, but people then wouldn’t have access to federal subsidies.

If this proposed rule comes to fruition, the administrative burden is likely to discourage insurers from covering abortion services. ThinkProgress reached out to America’s Health Insurance Plans (AHIP), but they are still analyzing the proposed rule and couldn’t immediately provide comment.


“Anything that makes the enrollment process more administratively complex and burdensome can depress enrollment and make insurers think twice about including coverage that makes it harder for them to administer and policyholders to enroll,” director of women’s health policy for the Kaiser Family Foundation, Alina Salganicoff, told ThinkProgress by email.

“We’ve already seen evidence that insurers have opted to drop abortion coverage in states that have no marketplace ban. This added complexity could move more insurers to drop coverage,” she added.

The Trump administration plans to make the changes at next open enrollment period, in November 2019, after it goes through the rule making process.