March 23, 2010 — Some experts say that restrictions on health plans' ability to offer abortion coverage in new health insurance exchanges could discourage health insurers from offering the coverage, the Wall Street Journal reports. Under the Senate health reform bill (HR 3590) -- which the House passed Sunday and President Obama signed into law Tuesday morning -- insurers selling policies which include abortion coverage that participate in the health insurance exchanges would be required to collect two separate premium payments from customers: one for abortion coverage and one for other costs. Insurers must create separate accounts to maintain the separation of abortion-related and non-abortion funds after the payments are collected.
Kristin Binns, spokesperson for insurer WellPoint, said logistical challenges could make the system "a little bit nightmarish" for insurers. She added that insurers would have to establish and market different products, one that offers abortion coverage and one that does not. Binns said that the market for such plans -- women who think they may need an abortion someday - is practically "non-existent" because women do not anticipate needing such coverage.
Five states prohibit insurers from offering abortion coverage as part of comprehensive health plans and require customers to purchase riders. For example, Binns noted that Kentucky's market leader, WellPoint, is unaware of any individual or company that has opted for abortion coverage.
Adam Sonfield, a senior public policy associate at the Guttmacher Institute, said, "There are a lot of complications, practically speaking, that would lead one to believe insurance companies won't bother" with offering abortion coverage. One such challenge is determining how much to charge for the abortion riders, he said.
On Monday, groups on both sides of the abortion-rights debate said they would lobby insurance companies after the exchanges begin operating in 2014, which could put the industry "in an awkward political position," the Journal reports. Many abortion-rights advocates argue that abortion should be treated the same as any other medical service.
According to the Journal, it is unclear how many privately insured U.S. residents have abortion coverage. A Guttmacher survey found that 87% of typical employer-based policies cover abortion services, while a Kaiser Family Foundation survey found that 46% of employees had abortion coverage. Another Guttmacher survey found that 13% of abortions were paid for by private insurance, partly because many women seeking abortion care are uninsured or enrolled in Medicaid. Most states do not cover abortion services through Medicaid, the Journal reports (Meckler, Wall Street Journal, 3/23).