More than a week into the enrollment period for health insurance via the federal-state insurance exchanges, whether existing plan options include elective abortion remains anything but clear. Under Obamacare, a cluster of Multi-State Plans (MSPs) are likely to include elective abortion coverage in 27 states. In each of those states, at least one MSP is required under federal law to exclude elective abortion coverage so that individual subscribers can select an option that squares with this element of conscience. But how to tell an elective-abortion plan from one that does not include it?
The Lozier Institute continued its calls directly to health insurers this week, working from the Office of Personnel Management (OPM) MSP web site, which remains singularly unhelpful. Here is a brief recap of the Rube Goldberg machinery through which our researcher was put this week.
Last week Premera Blue Cross and Blue Shield of Alaska assured CLI that “none of the multi-state plans cover abortions” and that this is the major “difference between the regular plans [they] offer and the multi-state plans.” CLI rephrased the question specifying the 36 MSPs offered in Alaska, and the consultant again confirmed that “none of them [cover abortion],” and proceeded to instruct us on enrolling via the exchange. CLI is making a continued effort to get written confirmation of this in the form of a sample plan we can review without having to enroll, with no success to date since first making this request on October 3. If the Premera consultant’s information is correct, Alaska offers one-fourth of the nation’s total number of MSPs and none of them covers elective abortion. This would mean that the MSP policies differ sharply from Alaska’s general policy of funding elective abortions under its Medicaid program and having no state opt-out from allowing elective abortion plans within its MSP program.
Blue Cross Blue Shield (BCBS) of Illinois. After the automated menu selections, CLI was put on hold briefly and then greeted by a live representative. CLI explained that though our current zip code is “out of the coverage zone,” we were inquiring about a plan in the Chicago area and gave an applicable zip code. The representative then sought a noticeably long list of information from us, which included: our full name, whether we were interested in an individual or family plan, whether we or a family member was eligible for Medicare, whether we were currently insured under BCBS, our birthday, height, weight, gender, use of tobacco products in the last 12 months, and much more. At this point, CLI reiterated that we would only like to ask a question about one of the plans, and the triage representative responded that he had more “basic information” to collect from us first and that “a licensed agent” would be able to help afterwards. He continued, asking for our annual income, how many people were in our household, and how the we had heard about this insurance company – totaling about 10 minutes of information exchange.
CLI was then transferred to a licensed agent and we asked which of the new MSPs do not cover abortion. The response was that “as a general guideline, [BCBS plans] do not cover abortion for the most part . . . only when medically necessary.” We inquired if the agent could specify, to which he replied, “A doctor must say, ‘You must have this [abortion].’ That is, the mother’s life is at risk.” He then placed us on hold to check and “refresh [his] mind” and returned soon after saying that the other two exceptions were in “cases of rape or incest.” CLI asked the agent to confirm that “none of the current MSPs [CLI read aloud the ones offered] cover abortion ‘for the most part.’” The agent replied, “This is the general guideline,” and noted that we would find that this is “common.”
The agent’s response might confirm the existence of an Illinois MSP that excludes elective abortion. But again, it may not. “Medical necessity” in connection with abortion has a long history as a term of art. In the 1970s and 1980s liberal opponents of the Hyde Amendment, which restricts federal abortion funding rather strictly to cases where the life of the mother is truly endangered and instances of rape or incest, tried to replace the amendment with a standard of “medically necessary” abortions. This term has appeal to pro-choice adherents because of its appearance of objectivity, when in typical practice it reflects the view that the abortion decision is exclusively between a woman and her doctor. Anthem Blue Cross and Blue Shield in New Hampshire says today that it will fund elective abortions in its exchange plans for small groups but only ones for “medical necessity” in the individual market, only deepening the confusion.
Tennessee, Blue Cross Blue Shield of Tennessee. After the automated menu, CLI stayed on the line and was connected to a customer service representative in the individual sales department, who immediately asked for our “identification number.” CLI noted that we were inquiring about the new MSPs, so the triage representative collected basic information and transferred us to a live individual after a brief hold. We inquired which of the new MSPs did not cover abortions, and the agent responded that “none of them cover abortion.” After we rephrased the question to confirm, the agent placed CLI on brief hold, saying, “I don’t think [they do], but let me double check.” She returned confirming this. We then asked for a sample MSP. The agent then began to collect our detailed personal information to process an application: city and zip code in Tennessee, our age, whether we have smoked or used tobacco in the last 12 months, marital status, whether we were interested in receiving a subsidy (in which case the caller would need to provide information on annual income), and more besides. The agent then said that “deductibles for individuals start at $1,000” and began quoting a number of plans. Throughout the call the agent complained of computer difficulties and asked for patience. At this point, CLI offered to give an e-mail address to which the agent could send a sample MSP, but the agent replied that the information “was already up” on her computer system for her to read aloud. After the agent began listing the plans’ deductible amounts aloud, CLI thanked her and declined to enroll.
New Hampshire, Anthem Blue Cross and Blue Shield of New Hampshire. After a short, automated menu, CLI reached a live representative who gathered our general information including full name, phone number, current zip code, e-mail address, birthday, whether we were insured, whether our employer offered health insurance, and when we wanted coverage to begin. After this, the representative let CLI know that “all licensed agents are currently helping someone at this time, and that a licensed agent will call back within two business days.” The representative assured us that it would “probably be before that.” This promise was made on the night of October 7 and as of mid-afternoon October 9, CLI has not received a follow-up call.
Florida reports that it will be among the 25 states that will have limited (5 states) or no (20 states) MSPs in 2014.
Throughout these discussions, the representatives of individual companies offering MSPs were courteous and patient with systems that sometimes failed to operate and seldom provided clear and satisfying answers. As of mid-afternoon on October 9, 2013, determining which MSPs offer elective abortion coverage and which do not continues to frustrate the most diligent search. Wheels turn, ramps rise, and levers lift, but the “mousetrap” of verified information remains elusive amidst Obamacare’s colorful contraptions.
Charles A. Donovan is President of the Charlotte Lozier Institute. Genevieve Cervantes is an intern with the Susan B. Anthony List.