When it comes to coverage of abortion services in plans sold on the health insurance marketplaces, opponents and supporters of abortion rights are in agreement on one thing: Coverage details need to be clearer.
A recent analysis by the Guttmacher Institute, a reproductive-health research and policy organization that supports abortion rights, found that people in some states would be hard-pressed to find any information about whether the plans they were interested in covered abortion services.
Abortion coverage was one of the key sticking points during the congressional debate on the health law, but lawmakers eventually agreed to allow states to decide whether their marketplace plans could provide coverage for abortion.
Twenty-six states and the District of Columbia allow coverage of abortion in marketplace plans; 24 states do not, although many of them make exceptions in cases of rape, incest or if the mother’s life is in danger, mirroring the exceptions for federally subsidized health care, such as Medicaid.
Guttmacher researchers looked at online coverage descriptions in 12 states that permit marketplace plans to cover abortion services. They focused on the “summary of benefits and coverage” overview, or SBC, that all plans must provide and clicked through to other coverage details if available, just as consumers might do. They found that some plans in only four states noted clearly that abortion services were covered, while in six states they identified at least one plan that did not cover abortion.
The federal government runs the online marketplace in 22 of the states that restrict or prohibit coverage for abortion. Although Guttmacher researchers didn’t examine individual plan documents in those states for the most part, they looked for but couldn’t find a general statement on the federal exchange or the exchanges of the two remaining states explaining that abortion services in exchange plans sold in those states were generally unavailable.
No one is happy with the lack of information.
“Abortion should be considered basic health care, and consumers should know whether it’s covered or not,” says Kinsey Hasstedt, a public policy associate at Guttmacher who wrote the analysis.
Abortion opponents are also frustrated. “We’re hearing complaints about it,” says Chuck Donovan, president of the antiabortion Charlotte Lozier Institute. “The people we communicate with are looking for it.”
Both sides agree that the logical place to include abortion coverage information is in the SBC that all plans must provide under the law. The summaries allow consumers to make apples-to-apples comparisons of health plans’ coverage and costs. Under the health law, plans that cover abortion beyond cases of rape, incest and life endangerment are supposed to disclose that information in the SBC.
But the template that the federal government gave to insurers to use in developing their SBCs didn’t include references to abortion coverage.
“It’s not in the template, and plans are just following that,” says Gretchen Borchelt, senior counsel at the National Women’s Law Center, which supports abortion rights. “I think it’s a lack of awareness on their part, a lack of familiarity with what should be included.”
The Department of Health and Human Services did not respond to requests for comment.
It is unclear how many of the insurers that use the exchanges to sell plans to people without employer-provided coverage offer abortion services. And even in the employer market, where abortion coverage is fairly routine, detailed information about abortion coverage may not be any more accessible than it is on the marketplaces, advocates agree.
For now, whether someone wants to ensure that their marketplace plan covers abortion or restricts that coverage, the only solution may be to call the insurer directly.
This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: firstname.lastname@example.org.