Trump rule forces insurers to bill for abortion services
While threatening to cut off federal health care funding to California because it requires insurers to cover abortion, the Trump administration has quietly enacted a separate rule ordering insurers to bill separately for abortion and nonabortion services — a mandate that could lead to cutoffs of coverage.
Under the rule, which took effect this month, the 1.4 million recipients of insurance under Covered California, the state entity overseeing coverage under the federal health care law sponsored by former President Barack Obama, will start receiving two bills a month as of June 27: one for the small amount of their premium that pays for abortion, the other for nonabortion care.
Those who don’t pay both bills — because of confusion, personal views or any other reason — could lose their entire health insurance coverage until the next period of open enrollment this fall. Cancellation would apparently be up to individual insurers, though the state Department of Managed Health Care could try to step in with regulations. The department said it was reviewing the federal rule.
In announcing the plan in November, U.S. Health and Human Services Secretary Alex Azar noted that the Hyde Amendment, passed by Congress in 1976 and renewed every year since then, prohibits most federal funding of abortions for poor women.
“The separate billing requirement fulfills Congress’ intent and reflects President Trump’s strong commitment to preventing taxpayer funding of abortion coverage,” Azar said.
But Shannon Hovis, director of NARAL ProChoice California, said the new rule “only serves to push abortion care further out of reach and is likely to result in confusion for individuals and families who rely on the ACA (Affordable Care Act) for insurance.”
Jodi Hicks, president of Planned Parenthood Affiliates of California, said the new billing rules would also increase costs for insurers, who would then raise premiums to their customers.
Besides California, four other states — Illinois, New York, Oregon and Washington — require health insurers to cover abortion, and Maine has a similar requirement for insurers that cover prenatal care. California is also among the states that use their own funds to pay for poor women’s abortions under Medicaid, called MediCal in California.
Twentysix states prohibit insurers in the Affordable Care Act marketplace from covering abortion, according to the National Women’s Law Center. The new insurancebilling rule will have its greatest potential impact in the remaining states that make abortion coverage optional for insurers in the ACA.
Some insurers, when required to send separate bills, “might eliminate abortion coverage from their plans altogether because of the additional cost and administrative requirements,” the Kaiser Family Foundation said in an analysis of the new rule.
The Trump administration’s Centers for Medicare and Medicaid Services indicated that the billing change would also send a message to antiabortion customers in optionalcoverage states.
The new rule “will alert customers that their health plan covers abortion services, allowing them to make fully informed decisions about their coverage,” the agency said.