The GOP health care overhaul barreling toward a possible Senate vote this month would restrict abortion coverage for some people as early as next year.
Most of the major changes included in the package, from Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, wouldn’t take effect until 2020. That’s when the legislation would end the subsidies currently available to consumers who don’t get their health insurance through their job or a government program. It’s also when the legislation would overhaul — and cut — government contributions to state Medicaid programs.
But beginning in 2018, the Graham-Cassidy legislation would make it illegal for insurers to offer plans that cover abortions on the Obamacare exchanges. More than 9 million people who rely on the Obamacare exchanges would be explicitly denied the coverage, as would any new customers who try to sign up during this year’s open enrollment period, which begins in November.
“For women who need an abortion, they’d have to pay for it out of pocket, and that’s upwards of $400-500 for a first trimester abortion,” said Alina Salganicoff, director of women’s health policy at the Kaiser Family Foundation. “But a later abortion, for a woman who has fetal anomalies or medical complications and needs a second-term abortion, she could be facing expenses upwards of $1,000 to $2,000, easily. And those are real choices that women must make, and real expenses.”
Not all of the health insurance plans offered on the Obamacare exchanges include abortion coverage. The Affordable Care Act doesn’t make it mandatory, and in fact the law expressly allows individual states to ban insurers from offering abortion coverage in their ACA marketplaces. Twenty-five have implemented a ban, and in another six, there are no plans that cover abortions available, according to the Kaiser Family Foundation. Where plans are available, that coverage must be paid for using private dollars to ensure no federal money goes toward abortion coverage, per a 1997 federal law.
Still, the change would have widespread repercussions in states that offer the coverage. In California, New York and Oregon, the state requires that plans cover abortion services. Massachusetts encourages the same but don’t explicitly require it. Those state laws would directly contradict the Graham-Cassidy language.
If Graham-Cassidy becomes law, insurers would have to scramble to change the plans they will offer in 2018 to make sure they are compliant. Right now, insurers have to tell the federal government by Sept. 27 how much they will charge for 2018 plans, and what those plans will include. If Graham-Cassidy passes after that deadline, as is likely if it passes at all, some of the plans insurers have submitted will almost immediately be out of step with the new law — just a month before the 2018 sign-up period begins.
“That means that Graham-Cassidy would immediately make thousands of insurance policies [illegal] … for an enrollment period which starts just 32 days later,” writes Charles Gaba, a left-leaning blogger who has closely tracked the ACA’s implementation and who first highlighted the abortion coverage provision.
The legislation would have much more wide-ranging effects for women’s health coverage after 2020, much of which mirrors proposals included in earlier Republican efforts to repeal and replace the ACA, like one that effectively defunds Planned Parenthood. But the legislation also would mandate that states that want to accept federal Medicaid and insurance money — which, under the new rules, would basically come in the form of a so-called block grant — require that no insurers in either Medicaid or the private market offer abortion coverage.