The Brewing National Abortion Fight That Hinges On Just $1.10


Anti-choice activists are currently stoking controversy around Obamacare’s coverage of abortion in hopes of boosting Republican turnout in the midterm elections, according to multiple reports. The scandal at the heart of the impending fight? Between $0.10 and $1.10 in Americans’ monthly premiums.

That’s how much it costs 18 large insurers to include abortion coverage in their consumers’ plans, according to a new report prepared by the nonpartisan Government Accountability Office (GAO). The report was released this week by Republicans on the House Energy and Commerce Committee. Abortion opponents are upset because the majority of those insurers don’t itemize those charges on Americans’ monthly bills.

Failing to separate out that money violates Obamacare’s complicated rules about abortion coverage, which require insurance companies to collect separate payments for services related to elective abortions. This particular provision of the health reform law was intended to serve as a compromise for anti-abortion lawmakers who worried that Obamacare’s federal subsidies might go toward financing plans that cover the procedure. Since taxpayer dollars are prohibited from funding abortion under the Hyde Amendment, there was concern that Obamacare could end up indirectly circumventing that policy.

As the Associated Press reports, “The new GAO review did not address the fundamental question of whether federal subsidies under the health law are being used for elective abortions, but abortion opponents said the findings underscore their view that the compromise is an accounting gimmick.”

Indeed, right-wing outlets jumped on the news, declaring that the new report “confirms Obamacare subsidizes abortion.” House Speaker John Boehner (R-OH) said in a statement that “today’s GAO report confirms that under the president’s health care law, abortions are being paid for with taxpayer funds by more than 1,000 exchange plans across the country,” adding that “this information has been hidden from the American public for years by the Obama Administration.”

Abortion coverage is routinely included in insurance plans as a gender-based health service, like maternity coverage or birth control. But the political fights over health reform have significantly complicated the landscape. While conservatives typically decry the Affordable Care Act as an expansion of abortion coverage, it’s actually opened up an avenue for state legislatures to further restrict it. As another concession to anti-choice lawmakers, Obamacare allows states to ban abortion coverage altogether in the plans offered on their new insurance marketplaces. Twenty three states have enacted that type of ban.

The GAO report examines insurers in 10 of the 28 states that haven’t taken the extra step to ban coverage altogether. Despite Republicans’ sweeping proclamations, the report is not intended to be extrapolated to the whole country because it doesn’t include a statistically representative sample of states or insurance providers. But there’s certainly been widespread frustration — among both abortion rights supporters and abortion opponents — about the lack of information about whether plans cover these services, and the Department of Health and Human Services acknowledges there’s more work to be done in this area. “CMS will work with stakeholders, including states and issuers, so they fully understand and comply with the federal law prohibiting the use of federal funds for abortions,” HHS spokesman Ben Wakana said in a statement.

Insurers are likely struggling to interpret this Obamacare rule because it represents a departure from the way the industry has traditionally worked. Insurance companies haven’t historically provided detailed information about abortion because it’s simply been covered in consumers’ plans along with other common medical procedures. But, as abortion opponents have insisted on an artificial division between abortion and the rest of women’s reproductive health care, it’s made everything more complicated. The medical community has increasingly complained about the web of complicated abortion restrictions that interfere in their work, especially when they’re particularly complex to implement.

For instance, Obamacare requires insurers to estimate the cost of abortion services at no less than $1 each month. But that requirement doesn’t really make sense in practice because abortion coverage doesn’t actually cost that much. The GAO report found that most insurers estimated the cost of covering those services at under $1 a month per enrollee, and some said it cost as little as 10 cents. They ended up needing to round up to stay complaint under the law.

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.