Group Health Cooperative will not cover abortion in its individual health-insurance plans being offered through the Washington state marketplace put in place by the Affordable Care Act, but says women who buy them will be able to access the service without paying more.
Group Health said it made the decision not to include the coverage because of murky regulations about how it would have to account for federal money in plans that offered abortion.
But the HMO (health-maintenance organization) has long supported women’s reproductive options, officials said, and so it will provide access.
Group Health’s workaround did not satisfy abortion-rights and women’s-rights groups, who reacted angrily to the decision not to cover abortion.
“Group Health asserts that abortion care will be made available to patients in Group Health clinics, but the lack of coverage in the plan creates confusion and presents a barrier to access, while showing an alarming disregard for women,” NARAL Pro-Choice Washington, Legal Voice and Planned Parenthood Votes Northwest said in a statement.
Group Health said it made the decision earlier this year in the face of confusing regulations about how insurers should handle abortion premiums and costs.
The Affordable Care Act requires insurers that cover elective abortion to segregate premiums and expenditures because federal law bars abortion services from being funded by the federal premium subsidies for plans offered through state marketplaces known as exchanges.
“At the time Group Health filed our products, we lacked further regulatory guidance,” Group Health said in a statement. “Group Health determined that in order to ensure full compliance with all requirements, it was advisable to not include pregnancy termination services in our individual products offered through the exchange for 2014.”
Of those plans that have passed muster with state insurance officials, only Group Health’s did not include abortion coverage.
At least 31 plans will be sold inside the exchange, including Group Health’s four, and other companies are now appealing rejections.
BridgeSpan Health Company, Premera Blue Cross and its subsidiary, Lifewise Health Plan of Washington, all said their plans offered abortion coverage, with the exception of eight Premera plans that are among BlueCross/Blue Shield Association multistate plans forbidden by federal law to include abortion coverage.
Stephanie Marquis, spokeswoman for the state Office of the Insurance Commissioner, said revisions flew back and forth earlier this year over Group Health’s plans for the exchange.
“Unfortunately, they made the change to take that benefit away from women, and we can’t require them to include it,” she said. “It’s an unfortunate decision for consumers.”
Group Health spokesman Ed Boyle said women who buy plans in the exchange may still access abortions services because Group Health is not only an insurer but a medical provider.
Although women who buy those plans and seek abortions won’t be covered by their insurance, Boyle said, they will not be at risk financially: “In 2014 our members who enroll through the exchange can be assured they will have access to pregnancy termination services through Group Health medical centers, with no greater financial burden than as if this was a covered benefit,” Boyle said.
Boyle said now that federal and state regulators have clarified rules regarding federal subsidies, Group Health intends to add the benefits to plans sold through the exchange in 2015, and is committed to “providing women access to the full spectrum of reproductive health services that are safe, affordable and accessible.”
Women’s-rights groups said the HMO’s decision was “inconsistent with Group Health’s own record on reproductive rights,” which has been twice affirmed by leadership and consumer members of the consumer-governed cooperative, the groups said.
Rachel Berkson, executive director of NARAL, said it was “particularly galling to see one of the most progressive, pro-women health-care providers in our state placing limits on abortion coverage.”
It’s not clear there will be limits. But Lisa Stone, executive director of Legal Voice, said she was worried that without coverage specified in the policies, women might face administrative burdens or, if they need inpatient care in a non-Group Health hospital, additional charges.
This is the kind of issue anticipated by backers of the Reproductive Parity Act (RPA), a bill that failed to gain approval in the Legislature this year. The bill would have ensured abortion coverage after the federal law took effect. Late in the session, despite backing from both sides of the aisle, Senate Health Care Committee Chairwoman Randi Becker, R-Eatonville, refused to schedule a vote.
Said Elaine Rose, CEO of Planned Parenthood Votes Northwest: “The need for the RPA has never been more apparent. Women can’t trust insurance carriers to protect all of their pregnancy options.”KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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