Few employers choose abortion coverage in health insurance plans

Customers may not know if policy covers procedure

By Peter Slevin
Washington Post / March 15, 2010

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CHICAGO — In North Dakota, where insurers can cover abortions if customers pay a separate premium, the state’s largest provider says it sells no abortion policies because no one has asked to buy one.

Amid a high-stakes debate over abortion that could determine the fate of President Obama’s health care initiative, North Dakota’s law offers a test because it is much like the language favored by antiabortion lawmakers on Capitol Hill, notably Representative Bart Stupak, Democrat of Michigan.

“There’s not a lot to tell. We have no member who elected to have abortion riders,’’ said Denise Kolpack, vice president of Blue Cross-Blue Shield of North Dakota, which covers about 80 percent of the North Dakota market. “We would be legally bound to provide an offering, but we have no groups that have requested it.’’

Similar policies are in place in Kentucky, Missouri, Idaho, and Oklahoma.

“It is rare that we hear in the market that an employer would request a rider for this coverage,’’ said Anthem Blue Cross and Blue Shield spokesman Tony Felts, whose territory includes Kentucky. In congressional discussions about health care reform, the debate over how abortion would be treated has been fractious, particularly among Democrats. Stupak and others threaten to oppose a Senate bill that they say falls short of maintaining the three-decade-old ban on federal funding for abortion.

Stupak’s amendment to the House bill, which passed 240 to 194 in November with 64 Democrats voting yes, would prohibit insurers from including abortion coverage for anyone who receives a federal subsidy. Much like laws in North Dakota and the four other states, however, insurers could offer coverage if customers buy a separate rider.

In the Senate, language drafted by Senator Ben Nelson, Democrat of Nebraska, would allow companies to offer abortion coverage, without a rider, in policies sold on new insurance exchanges. But customers would need to send a separate check for the portion that covers abortion, perhaps $1 a month. Individual states could also bar from their exchanges any policies covering abortion.

In the five states where abortion coverage is prohibited except with a rider, it is unclear how customers who purchase group insurance, typically for their employees, learn about the abortion coverage option.

“I’m not sure if an employer would know that or not,’’ Felts said of customers in Kentucky, when asked whether Anthem Blue Cross and Blue Shield advertises its policies. He said if a customer requested abortion coverage, the company would offer it “in compliance’’ with state law.

“There’s an information gap, clearly,’’ said Elizabeth Nash, a researcher at the Guttmacher Institute, which supports abortion rights. “A lot of people don’t know if their health plan covers abortion because nobody wants to be in that situation.’’

Since 1983, Missouri law has required an extra premium for coverage of any abortion that is not “spontaneous,’’ meaning a miscarriage, or is not necessary to prevent the woman’s death.

“We do not know how many of our clients take the rider,’’ Anthem Blue Cross and Blue Shield spokesman Deb Wiethop said. “It is rare, but clients do ask for it.’’

In Congress, antiabortion forces contend that the Senate approach contains loopholes and unclear language that would allow federal money to support abortion coverage. A vote for the Senate bill would be a “career-defining pro-abortion vote,’’ the National Right to Life Committee said this month.

The House language, by comparison, “keeps the federal government out of the abortion business,’’ said Richard Doerflinger, associate policy director at the US Conference of Catholic Bishops.