“Do your health plans on the exchange cover elective abortion?” Since the first Obamacare Open Enrollment Period in November 2013, the Charlotte Lozier Institute has asked this simple question of insurance companies, only to find mostly confusion, an inability to share relevant plan documents, and few companies able to give a direct answer to our simple question. For 2016, CLI and the Family Research Council (FRC) have once again researched plans and updated the ObamacareAbortion.com resource website with the abortion coverage policies for each individual and family plan on the Obamacare exchanges.
In sum for 2016: The abortion coverage remains difficult to discern for many plans without enrolling first; an estimated 59% of Obamacare plans for individuals and families cover abortion on demand; two states still have no plans excluding elective abortion; and compared with last year, there are three fewer states with Multi-State Plans (MSPs) which generally exclude elective abortion.
The importance of transparency regarding elective abortion in Obamacare plans is essential, not just for the sake of transparency itself (people shouldn’t have to buy the plan first to know what it does and doesn’t cover), but because the Affordable Care Act (ACA) requires each member of an exchange plan that covers elective abortion to pay a separate abortion fee. This “abortion surcharge” is then supposedly deposited into a separate abortion account, and used exclusively to pay for elective abortion – i.e., those for reasons other than rape, incest, or life of the mother.
From Section 1303 of the ACA:
In the case of a plan [that covers elective abortion], the issuer of the plan shall collect from each enrollee in the plan (without regard to the enrollee’s age, sex, or family status) a separate payment for… coverage of services described in paragraph (1)(B)(i) [i.e. “abortions for which public funding is prohibited,” or elective abortion].
…The issuer of a plan [that covers elective abortion] shall deposit… all payments described [above]…into a separate account that consists solely of such payments and that is used exclusively to pay for [elective abortions].
As for disclosure of this separate abortion surcharge, Politifact admitted in 2013 that it “turns out to be a hidden fee.”
With this in mind, here are the overall findings CLI and FRC found for 2016 exchange plans:
- 2 states (Hawaii and Vermont) have only plans that cover elective abortion.
- Nationally, an estimated 59% of exchange plans for individuals and families cover elective abortion.
- 8 states including the District of Columbia have 85% or more of the exchange plans covering elective abortion. In order of highest percent: Hawaii, Vermont, California, New York, Washington (state), the District of Columbia, New Hampshire, and Massachusetts
- 8 additional states have about 50% to 85% of the exchange plans covering elective abortion. In order of highest percent: Oregon, Alaska, Rhode Island, Connecticut, New Mexico, Montana, Maine, and Maryland.
- 4 states were dropped from the Multi-State Plan Program (Massachusetts, New Mexico, Oregon, and Utah) though MSPs are supposed to be in all states by 2017. One new state, Alabama, was added for 2016.
- 25 states have opted out of covering elective abortion on the exchanges (i.e., they prohibit exchange plans from including elective abortion). Arizona is a new state for 2016.
- Of the 26 states that allow elective abortion on the exchanges, 14 states are part of the Federally-Facilitated Marketplace, and 12 states (including D.C.) have state-run exchanges.
As for tracking down the abortion-related policies for health plans on the Obamacare exchanges, even though many insurance company representatives wanted to help our research team with a straight answer confirmed by plan documents, they were at a loss either because they did not have the information (they were surprised that the Summaries of Benefits and Coverage did not include the information) or had an internal document with the answer but could not share any official plan document with the information, and especially not prior to enrolling in the plan.
Here are a few examples encountered by our team during the Open Enrollment Period for 2016:
- New York: Insurance company’s customer service agent referred us to the Summary of Benefits and Coverage, and was surprised that it did not disclose the abortion coverage policy. “It’s not online. It’s in the Member Handbook, and we can’t e-mail that to you. We can only mail it and it will take 10-14 days.” As of this writing, three weeks later, we have not received the plan documents.
- New York: Insurance company’s customer service agent: “We may not have it online, but it’s in the Contract.” Agent was unable to share the document prior to enrollment.
- New York: Insurance company’s customer service agent stated plans covered elective abortion, but when asked for the plan documents, the agent said: “I’m not able to give you the [abortion] policy from the company.”
- New York: Insurance company’s customer service agent: “The coverage of this specific service is not listed separately on any documentation. This service is considered an Outpatient procedure and would apply to your deductible or copy for Outpatient services as per whichever policy you select.”
- Maryland: Insurance company’s licensed agent: “It’s from an internal document, a spreadsheet with all of the plans in your state.” Agent was unable to provide a plan document.
- Some links to 2016 plan documents for companies on the District of Columbia and New Hampshire exchanges resulted in 2015 plan documents only.
- One New York company did not have any 2016 plan documents posted a week after the November 1st open enrollment period. An agent stated during a phone call that we should check back in two weeks, and did not address our abortion question.
Clearly, the administration has not deemed the abortion coverage information important enough to require its disclosure with enforceable consequences. Because of the lack of transparency in Obamacare, this translates into a health, financial, and now a moral decision. Congress must consider federal legislation such as the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act (H.R. 7) to correct this. In the meantime, CLI and FRC have done our best to track down the information for the public and share these findings in more detail for each state on ObamacareAbortion.com.
Genevieve Plaster is a research assistant for the Charlotte Lozier Institute.