How the House abortion restrictions would work

Kaiser Health NewsNovember 11, 2009 

WASHINGTON — The health care bill that the House of Representatives has passed would bar insurers from selling policies that cover abortion to anyone who gets a federal subsidy. It does allow insurers to offer optional abortion coverage that consumers could purchase with their own money. Based on some states' experiences, however, it's unlikely that insurers would sell such coverage.

The abortion debate rivals the controversy over the "public option," the proposal to offer consumers in the new insurance exchanges a government-run insurance plan. The fight now moves to the Senate, where Majority Leader Harry Reid, D-Nev., is trying to meld two committees' bills.

Laurie Rubiner, the vice president for public policy at Planned Parenthood, said she was optimistic about blocking a similar amendment in the Senate: "This is a very broad, middle-class abortion ban in the exchange, and once people really understand that, I just don't think there's going to be the support for it."

The U.S. Conference of Bishops, which led the lobbying fight in the House for the abortion amendment by Reps. Bart Stupak, D-Mich., and Joe Pitts, R-Pa., is just as determined. "The conference will remain vigilant and involved throughout this entire process to assure that these essential provisions are maintained and included in the final legislation," the organization's president, Cardinal Francis George of Chicago, said in a written statement.

Here's basic information about the House amendment and private insurance coverage of abortion:

Q: Would the House restrictions apply to all insurance?

A: No. They'd apply only to policies sold to people who qualify for federal subsidies to purchase insurance through the exchanges. They wouldn't affect most job-based insurance, which is how the majority of insured Americans currently get their coverage.

Q: Who could buy through the health insurance exchanges?

A: Initially, the exchanges would be open to the uninsured, people who buy their own coverage and some small businesses. Two years after the exchanges open, Congress could decide whether to allow larger employers to purchase coverage there.

Q: Could consumers using the exchanges buy policies that offer abortion coverage if they use their own money, rather than federal subsidies?

A: Only if insurers decide to offer two types of policies in the exchange: ones made available to subsidy-eligible people that don't cover abortion, and another set, sold only to those who don't get federal subsidies, that would cover it. Insurers may have little incentive to offer both, as the vast majority of the exchange marketplace is expected to be people who are eligible for subsidies.

Q: Are there other options for people to get abortion coverage?

A: Yes. Insurers could opt to create "abortion riders," separate add-on coverage that consumers could purchase with their own money.

Q: Do such policies exist?

A: Five states — Idaho, Kentucky, Missouri, North Dakota and Oklahoma — prohibit insurers from covering abortions except to save women's lives or in cases of rape or incest, but allow them to sell abortion riders. Insurance departments in Idaho, Kentucky and Missouri say they don't track such riders, so it isn't clear whether any are offered. North Dakota and Oklahoma say insurers there don't offer abortion riders to individuals. In Oklahoma, however, one insurer has filed for a rider to offer abortion coverage to small groups. In Idaho, one of the state's major insurers offers abortion coverage to small groups if they pay additional premium charges.

Q: How many people currently have abortion coverage in their health plans?

A: A survey by the Kaiser Family Foundation in 2003 found that 46 percent of workers had insurance that covered abortion. (Kaiser Health News is part of the foundation.) Experts say most people pay for abortions themselves. According to the Guttmacher Institute, which studies reproductive issues, about 13 percent of abortions are billed directly to insurers.

Q: Are there other restrictions on federal funding of abortion coverage?

A: Yes. The 1976 Hyde Amendment bars the use of federal money to pay for abortions, except to save women's lives or in cases of rape or incest. Thirty-two state Medicaid programs, the joint federal-state programs for low-income people, limit abortion funding to those cases, according to the Guttmacher Institute. One, South Dakota, pays for Medicaid abortions only to save women's lives. Seventeen use state funds to offer abortions more widely through their Medicaid programs. Restrictions on payment for abortion coverage are also in place for federal employees, women serving overseas in the U.S. military and women in federal prisons.

Q: How much do abortions cost?

A: First-trimester abortions can cost $300 to $900, according to Planned Parenthood. Later-term abortions or abortions in which women may face higher risks of complications are more expensive, running several thousand dollars if hospital care is required.

(Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy-research organization that isn't affiliated with Kaiser Permanente.)

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