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