By Peter Slevin
Washington Post Staff Writer
Sunday, March 14, 2010; A04
CHICAGO -- In North Dakota, where insurers can cover abortions if customers pay a separate premium, the state's largest provider says it sells no abortion policies because no one has asked to buy one.
Amid a high-stakes debate over abortion that could determine the fate of President Obama's health-care initiative, North Dakota's law offers a test because it is much like the language favored by antiabortion lawmakers on Capitol Hill, notably Rep. Bart Stupak (D-Mich.).
"There's not a lot to tell. We have no member who elected to have abortion riders," said Denise Kolpack, vice president of Blue Cross Blue Shield of North Dakota, which covers about 80 percent of the North Dakota market. "We would be legally bound to provide an offering, but we have no groups that have requested it."
Similar policies are in place in Kentucky, Missouri, Idaho and Oklahoma.
"It is rare that we hear in the market that an employer would request a rider for this coverage," said Anthem Blue Cross and Blue Shield spokesman Tony Felts, whose territory includes Kentucky.
In congressional discussions about health-care reform, the debate over how abortion would be treated has been fractious, particularly among Democrats. Stupak and others threaten to oppose a Senate bill that they say falls short of maintaining the three-decade-old ban on federal funding for abortion.
Stupak's amendment to the House bill, passed 240 to 194 in November, with 64 Democrats voting yes, would prohibit insurers from including abortion coverage for anyone who receives a federal subsidy. Much like laws in North Dakota and the four other states, however, insurers could offer coverage if customers buy a separate rider.
In the Senate, language drafted by Sen. Ben Nelson (D-Neb.) would allow companies to offer abortion coverage, without a rider, in policies sold on new insurance exchanges. But customers would need to send a separate check for the portion that covers abortion, perhaps $1 a month. Individual states could also bar from their exchanges any policies covering abortion.
In the five states where abortion coverage is prohibited except with a rider, it is unclear how customers who purchase group insurance, typically for their employees, learn about the abortion coverage option.
"I'm not sure if an employer would know that or not," Felts said of customers in Kentucky, when asked whether Anthem Blue Cross and Blue Shield advertises its policies. He said that if a customer requested abortion coverage, the company would offer it "in compliance" with state law.
Blue Cross of Idaho spokesman Stewart Johnson said, "I don't know that we would mention it. They would probably ask about it." He said the company does not track how often a group purchases abortion insurance.
"There's an information gap, clearly," said Elizabeth Nash, a researcher at the Guttmacher Institute, which supports abortion rights. "A lot of people don't know if their health plan covers abortion because nobody wants to be in that situation."
Since 1983, Missouri law has required an extra premium for coverage of any abortion that is not "spontaneous," meaning a miscarriage, or is not necessary to prevent the woman's death.
"We do not know how many of our clients take the rider," Anthem Blue Cross and Blue Shield spokesman Deb Wiethop said. "It is rare, but clients do ask for it."
In Congress, antiabortion forces contend that the Senate approach contains loopholes and unclear language that would allow federal money to support abortion coverage. A vote for the Senate bill would be a "career-defining pro-abortion vote," the National Right to Life Committee said this month.
The House language, by comparison, "keeps the federal government out of the abortion business," said Richard Doerflinger, associate policy director at the U.S. Conference of Catholic Bishops. "It allows other funds, whether individual or state funds, for plans that include abortion, as long as they don't draw on federal funds."
Supporters of abortion rights are equally unhappy with the Senate language.
A coalition of 57 groups, including Planned Parenthood and NARAL Pro-Choice America, wrote House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) last week to say that the Senate language "imposes unacceptable new restrictions on abortion coverage that could result in most private health insurers no longer offering coverage for abortion."
The Senate approach "goes far beyond current law, which already prohibits federal funding of abortion, and is unworkable," the group wrote.
Doerflinger disputes that view. "There's a built-in incentive for insurers to include abortion. To put it crassly, they probably think that abortion saves them money."
An abortion, he said, means no childbirth costs and no added child on the family policy.