This week, the Trump administration proposed a new rule for abortion coverage under the Affordable Care Act (ACA).
It would require all insurers in the ACA marketplace to send separate monthly bills to customers for the portion of their premium that was used for coverage of abortion services. The Trump administration also finalized a rule that makes it easier for employers to opt-out of contraception coverage. Maine abortion providers are criticizing the changes as attempts to make it harder to access abortion services.
Insurance providers who offer plans in the Affordable Care Act marketplace are already required to notify customers how much of their premium covers abortion services. That cost in Maine, says Nicole Clegg of Planned Parenthood of Northern New England, is about a dollar per month.
"It actually included eye care and a few other things, so, I mean, it's a very small cost,” says Clegg.
Under a new proposed rule, the U.S. Department of Health and Human Services now wants insurers to collect that portion of the premium in a separate monthly bill. That means customers would get two bills and have to write two checks.
Kate Brogan of Maine Family Planning says that's an onerous requirement for both insurance companies and consumers.
"The end result of that for the consumer is that if the consumers doesn't make any of those premium payments, two separate checks every month, then they run the risk of losing their coverage,” says Brogan. “And what that means on a broader scale, is that it becomes harder and harder and harder for insurance providers to make that coverage available."
Brogan points out that Maine insurance co-op Community Health Options dropped elective abortion coverage last year. At the time, the co-op said that the decision was economic, and driven by the fact that it was trying to dig itself out of a $31-million hole. THat coverage has since been restored, but Brogan thinks this proposed rule could change that.
"With all of these new hoops, it's likely that they may drop it again,” Brogan says.
Community Health Options declined to comment on the proposed rule. Anthem and Harvard Pilgrim directed comment to the national trade organization America's Health Insurance Plans, which says it is reviewing the rule.
The U.S. Department of Health and Human (DHHS) Services did not respond to a request for comment by air time. But in its proposal, DHHS says the rule change better aligns with federal requirements to separate funding for abortions that aren't covered by federal dollars. Federal money can be used only if the pregnancy is the result of incest or rape or if the mother's life is in danger.
As that rule opened for public comment this week, another new federal rule regarding birth control was finalized. It's now easier, says Clegg, for employers to opt out of contraceptive coverage for religious or moral reasons.
"The Affordable Care Act was designed to ensure that all people had access to birth control with no copay,” she says. “And what we've seen is the Trump administration just constantly trying to pull away at that mandated coverage."
Clegg says Maine consumers will be largely shielded from that rule because state law requires health insurance sold in Maine to cover birth control.
There is at least one other rule change to reproductive health care coming down the pike. Last spring, the Trump administration announced it wanted to make changes to the Title X program, which provides funding for reproductive health care for low income patients. Title X money can't be used for abortions. But Brogan says the new rule would require providers that offer abortions to separate that service physically and financially from other services.
"That will prevent federally-funded family planning providers like Maine Family Planning from providing abortion care, or from even discussing the word 'abortion' with our patients,” says Brogan.
Another element of the proposal blocks providers from discussing abortion as an option unless a patient specifically asks. If the rule is finalized, Maine providers will likely find a champion in the state's newly-elected governor, Janet Mills. Mills was asked during a women's forum on the campaign trail whether she would support using state funds to keep family planning clinics open if federal funding is denied.
"The answer is yes, absolutely,” she said at the time.
The final rule could be released at any time.
Originally published 5:59 p.m. Nov. 9, 2018