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GAO Report Looks at ACA Abortion Coverage Rules

GAO Report Looks at ACA Abortion Coverage Rules

September 16, 2014 — A GAO report released on Monday examines how insurers are dealing with the Affordable Care Act's (PL 111-148) complex rules on abortion coverage in health plans offered through the law's insurance marketplaces, Politico reports (Haberkorn/Everett, Politico, 9/15).


The ACA does not prohibit abortion coverage and lets insurers determine whether they will offer it. However, the law requires health plans to segregate money collected for abortion coverage from other premiums (Women's Health Policy Report, 1/10). Insurers are not required to segregate the money for abortion coverage in cases of rape, incest or endangerment to the life of the woman (Politico, 9/15).

The inclusion of the provisions in the ACA helped gain support of antiabortion-rights Democrats to secure the law's passage.

Critics of the complex payment scheme have long said that it is onerous for insurers (Politico, 9/15). Meanwhile, abortion-rights supporters and opponents have both called for clearer information to help consumers determine whether a particular plan covers abortion and in what capacity, according to the AP/U-T San Diego (Alonso-Zaldivar, AP/U-T San Diego, 9/16).

GAO Report Findings

House Republicans requested the GAO report (Politico, 9/15). It was released by GOP members of the House Energy and Commerce Committee (AP/U-T San Diego, 9/16).

GAO gathered information from the 27 states, in addition to Washington, D.C., that do not restrict abortion coverage in marketplace plans beyond what is required under the ACA.

The report found that 1,036 plans offered in the 27 states and Washington, D.C., included abortion coverage other than for cases of rape, incest or life endangerment, compared with 1,062 that did not include any additional coverage (AP/U-T San Diego, 9/16).

Plan Sample

The report included information from a sample of 18 unidentified insurers that offer multiple plans (AP/U-T San Diego, 9/16). The sampled insurers provided information about plans they offer in 10 states that do not restrict marketplace abortion coverage beyond what the ACA requires. The sampled plans account for 24% of all marketplace plans offering abortion coverage in cases other than rape, incest and life endangerment in the 27 states and Washington, D.C., that do not impose additional restrictions on such coverage.

The report noted that the ACA does not include "requirements on whether or how" insurers should inform consumers of abortion coverage options prior to enrollment. However, six of the insurers in the sample indicated that they made the information available to consumers shopping for coverage. In addition, the report found that two insurers were not aware of a requirement under the ACA to notify consumers at the time of enrollment about abortion coverage beyond cases of rape, incest and life endangerment.

All of the insurers sampled reported that "their abortion services benefit is subject to the same requirements as other benefits, such as enrollee out-of-pocket costs -- including deductibles, copayments, and coinsurance -- and prior authorization, all of which can vary depending on the location where the service is provided" (GAO report, 9/15).

Further, researchers found that 17 of the 18 insurers said that the average cost of providing abortion coverage was less than $1 a month among all policyholders, and in some instances was 10 cents a month (AP/U-T San Diego, 9/16).

HHS Response

In response to the report, HHS said that it has published regulations on these requirements and fielded questions from insurers. HHS noted that "additional clarification may be needed" (GAO report, 9/15).