Abortion coverage on the health-care exchanges: still a fine mess.
Several health-insurance companies across ten states are not in compliance with the Affordable Care Act when it comes to handling elective abortion coverage, according to a new report from the Government Accountability Office. The investigation, which was requested last winter by several members of the U.S. House of Representatives—including Speaker John Boehner—did not set out to measure whether insurance companies were following the law. Rather, it was intended to discover which health plans on the exchanges cover elective abortion, how they charge for that coverage, and how enrollees can determine whether the plans they’re considering cover such abortions. But over the course of its research, the GAO discovered that many of the insurance companies they surveyed—eighteen total—fell significantly short of the law's requirements. And some of them didn’t even realize it.
The Department of Health and Human Services has promised that it will soon issue further guidance to bring insurance companies into full compliance with the law.
The ACA allows insurers to sell policies that cover elective abortion on the state health-care exchanges—unless state law says otherwise—but it governs key aspects of those policies. The law and its implementing regulations prohibit the use of federal subsidies to pay for elective abortion coverage. To make sure that doesn’t happen, insurers selling such plans on the health-care exchanges must do three things: They have to estimate the monthly cost of elective abortion coverage on an average actuarial basis, which cannot be less than $1 (that prevents insurers from giving it away). Then they must collect from enrollees a separate payment equal to that cost. Finally, after they receive that payment, issuers have to segregate it from any other premiums collected from the enrollee. But before the insurer even gets to the billing stage, regulations require that potential customers be able to tell whether the policy they’re considering covers elective abortions. That was the plan, anyway. But it doesn’t look like things are proceeding according to plan.
