Rule to drop abortion coverage from state health exchanges: California Q/A and Resources

Yes – you heard right. Take action and submit comments by Jan 8 to oppose this new rule that would restrict coverage for comprehensive reproductive health coverage. 
California Q & As – Proposed changes to Section 1303 of the Affordable Care Act


What does the Affordable Care Act (ACA) say about abortion coverage in the marketplaces? (i.e. Covered California) The Affordable Care Act allows states to mandate or prohibit coverage in the marketplaces.  The ACA also included other notable provisions that affect abortion coverage. Section 1303 of the ACA sets forth “special rules” regulating abortion coverage in the marketplaces (see below). 

Does California cover abortions in the marketplacesYes. Most health plans in California* – whether they are private, public, or marketplace plans – are required to cover abortions. California is one of the four states in the US that mandate abortion coverage. (*Self-funded plans and a narrow group of religiously affiliated self plans are not governed by state benefit requirements.)

What are the “special rules” that plans that cover abortions must followThe Affordable Care Act requires insurance plans to collect a separate premium amount (at least $1 per month) for each enrollee to cover non-Hyde abortion services, and hold it in a segregated account. The ACA prohibits insurers from using exchange subsidies to pay for non-Hyde abortions; therefore all services for non-Hyde abortions (beyond rape, incest, and life endangerment) must be funded from the separate account. The separate payments must be collected on behalf of everyone enrolled in the plan without regard to the enrollee’s age, sex, or family status.   

What do the proposed rules changeThe proposed rule would require issuers to send—and consumers to pay—two entirely separate bills for the amount of the premium attributable to certain abortion services and the amount of the premium for all other services. In essence, qualified health plan issuers must send an entirely separate monthly bill for only the portion of the premium related to the non-Hyde abortion; this means separate billing, a separate mailing, and separate postage. If bills are sent electronically, plans must send two separate electronic bills and possibly provide separate payment links for the portion of the premium related to the non-Hyde abortion services in the electronic bills. In turn, enrollees must pay this premium using a separate check, a separate envelope, and use separate postage.

 What will happen to enrollees if they do not follow these requirements? Will they lose coverage? The proposed rules are unclear about this. The proposed rules maintain that enrollees should not be dropped off coverage if the enrollee sends one combined payment. However, the proposed rules do not indicate what the consequences will be if the enrollee fails to send the second payment for the non-Hyde abortion coverage. It is likely that consumers may get confused or simply refuse to make the second payment. At that point, there is nothing explicit in the rule that prohibits plans from dropping enrollees from coverage. The impact of this rule will fall harshest on low-income individuals, particularly women of color, immigrant populations, and other individuals who struggle to navigate the health care system. 


All Above All Webinar and Toolkit “Fight Back Against Trump’s ACA Abortion Coverage Rule”

Description: Many of you may have heard that the Trump administration recently released a rule on abortion coverage in the state exchanges. The intent of the rule is to force insurers to drop abortion coverage from their policies by making it very difficult, if not impossible to comply. The state exchanges have been an important tool in narrowing racial disparities in health insurance enrollment – this also means that communities of color will be disproportionately impacted by roll backs in abortion coverage in the exchanges. On this webinar, Kelsey Ryland from All*, Kelli Garcia from National Women’s Law Center, and Fabiola Carrion from the National Health Law Program discussed the changes, what it means for states (including California), what tools are available, and how organizations can activate their constituencies. 


Slidedeck from CCRF Member, Fabiola Carrion (National Health Law Program) 

Proposed Rule








The Impact of Public Charge

The NEW Proposed Public Charge Rules
  • The Trump Administration published a Notice of Proposed Rule Making for the “public charge” immigration rule.  
  • Under the current public charge rule, immigrants who are in need of long-term care or cash assistance can be denied visas or legal permanent residency. 
  • The new rule proposes to extend denials to immigrants for a wide range of programs and services including Medicaid, food aid, and public housing. 
  • If approved, the rule could deter millions of low-income immigrant individuals and families from applying for and accessing critical services, including sexual and reproductive health care. 
  • Public comments on the proposed rule can be submitted through December 10th.
CCRF Nov 19  Presentation:  Priscilla Huang, Senior Attorney, National Health Law Program – Los Angeles and Sylvia Castillo, Senior Manager of Government + Community Affairs, Essential Access Health 
Sample talking points 

National Asian Pacific American Women’s Forum (NAPAWF), National Latina Institute for Reproductive Health (NLIRH), In Our Own Voice: National Black Women’s Reproductive Agenda and National Women Law Center (NWLC)

Writing Comments: Tips and Best Practices
  • Make 30 percent of your comments unique.
  • Don’t mention programs that are not included in the NPRM.
  • Don’t suggest fixes.
  • Attach/upload the research, data, etc. you cite.
  • Comments must be submitted in English or accompanied by an English translation.
  • Commenting is not a lobbying activity.
  • You are an expert!
Citing your Research

It has been brought to our attention that any cited research should now be attached to your comments. In addition to the inserting links, you should have as an appendix digital copies of the actual reserach papers, reports, etc. (Yes, that means that your comments can be dozens of pages long). 


Hospital Mergers Restrict Repro. HealthCare: Action Guide and Resources to Push Back Against Mergers


Dignity Health and Catholic Healthcare Initiatives are creating a mega Catholic health entity that would forbid all reproductive health services, including all birth control methods, sterilization, miscarriage management, abortion, the least invasive treatments for ectopic pregnancies, and some infertility treatments.

No exceptions for risks to a patient’s health or even life. LGBTQ patients would face discrimination and be denied health services at some of these hospitals, too. (The NYT just did a story on these issues, which you can read here.)  We have concerns that Dignity will try to reduce its commitment to emergency services, charity care, and other services that are of particular importance to low-income and uninsured or underinsured communities.NHeLP, the ACLU, and other advocates across the state have been working together for years to push back against health care restrictions at these and other hospitals.

The ACLU has sued Dignity Health in particular twice in California over denial of reproductive health services and health care for transgender patients. This proposed merger, affecting Dignity Health hospitals across California, could further restrict access to essential health care. 

The California Attorney General will be holding a total of 17 public meetings across the state, at each of the counties where a Dignity hospital is located. These counties are Kern, Los Angeles, Merced, Nevada, Sacramento, San Bernardino, San Francisco, San Joaquin, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Tehama, Ventura, and Yolo. 
Upcoming Actions
 Nevada           Yolo           San Mateo           
Merced          San Joaquin          Shasta          Siskiyou

There will be over a dozen more meetings across the state, throughout September and possibly into October, at the fourteen other counties that contain a Dignity hospital (possibly: Calaveras, Kern, Santa Cruz, and Tehama). 

Email Karen Camacho at with your name, organizational affiliation if any, email address and/or phone number, and the public meeting(s) that you are interested in attending.  We will circle back with you when we have more information about your county.


Some Things to think about

  • Depending on how many people attend, the meeting will last between 2-5 hours. 
  • You should expect to speak for 3-5 minutes (so far, no one has been cut off from speaking)
  • We recommend submitting your public comment card early. If you arrive late, you’ll still have the opportunity to submit your card and make public comment closer to the end of the meeting.
  • We highly recommend personalizing your public comment, mentioning your expertise and experiences, if possible.
  • You can print out the attached signs to increase your visibility in the room.

February Membership Meeting – CCRF in Los Angeles

Our February membership meeting was held in Los Angeles (Burbank- actually) with over 30 members in attendance.
Thank you all for being so present and engaged during our CCRF meeting. Amy Chen, Fabiola Carrion (NHELP) and Amy Moy (Essential Access Health) provided us a thorough presentation of the Threats to Medi-Cal, ACA, and FPACT. We left the meeting with a level understanding of the programs and how cuts will impact CA (and nation).
Myra Duran (CLRJ) and Cammie Dodson (PWN) also led us in a discussion on how we can more actively practice and recognize intersectional issues affecting communities.
Finally, we finished the day lifting up messages and strategies that acknowledge the threats, which are much clearer and specific, yet are not solely reactionary.
See you all in Sacto in April!