Also in this issue of Guttmacher Policy Review:

"Contraceptive Coverage at the U.S. Supreme Court: Countering the Rhetoric with Evidence," by Adam Sonfield

"A Surge of State Abortion Restrictions Puts Providers— And the Women They Serve—in the Crosshairs," by Heather D. Boonstra and Elizabeth Nash

"Implementing Postabortion Care Programs in the Developing World: Ongoing Challenges," by Sneha Barot

Consumers purchasing health coverage through the marketplaces created under the Affordable Care Act (ACA) have no easy way—and often no way at all—to find out whether a health plan covers abortion care, according to a new Guttmacher analysis. The analysis lays out how this lack of transparency can be addressed by the Obama administration, which has the authority to ensure health plan issuers make such information readily available to consumers nationwide.

"The reality is that abortion is basic health care and insurers should cover it to the full extent of the law," says Kinsey Hasstedt, author of the analysis. "Consumers should have access to information about whether and to what extent that coverage is available to them. Importantly, this should happen in a way that appropriately includes abortion alongside other health services enrollees may need—and that is accurate and easily accessible so individuals have the information they need to choose the plan that best fits their needs."

The issue of private insurance coverage for abortion care became highly politicized during deliberations over the ACA. As a result, the ACA explicitly allows states to enact—or repeal—laws restricting coverage of abortion within marketplace plans. Currently, 26 states and the District of Columbia permit such coverage, while 24 states have banned marketplace plans’ coverage of abortion, usually with only very limited exceptions. Even living in a state that does not ban abortion coverage, however, is no guarantee that coverage is available or that if it is, consumers can easily find out about it before enrolling in a plan.

To get a sense of whether information on abortion coverage is accessible to consumers, Guttmacher staff searched state marketplaces and plan documents. The key findings from this review include:

• Among states allowing abortion coverage in marketplaces: Guttmacher searched online marketplaces in a geographically diverse selection of 12 of these states, finding varying levels of transparency. However, the majority of plan documents Guttmacher searched were silent on abortion coverage; in eight of the 12 states, none of the summary of benefits and coverage documents available to consumers in the state’s most populous county provided any information on abortion coverage.
• Among states restricting abortion coverage: Guttmacher found that none of these states’ marketplaces (including those that rely on the federal government to facilitate their marketplaces) adequately disclose to consumers that such coverage is not available, or what limited exceptions might exist.

The analysis also makes clear that legislation passed earlier this year by the U.S. House of Representatives that purports to achieve greater transparency on abortion coverage in the exchanges is unacceptable on several grounds. Among other major problems, the legislation contains misinformation, falsely asserting the existence of "abortion surcharges" on top of enrollees’ premium costs. The legislation also aims to further stigmatize abortion care by inappropriately isolating it from other covered health services.

In contrast, the Guttmacher analysis makes detailed recommendations on how the Obama administration can ensure issuers consistently include abortion among the health services for which coverage and exclusion details must be made clear within each plan’s summary of benefits and coverage.

"Abortion foes are less interested in conveying information about insurance coverage of abortion than in discouraging plans from covering abortion care and steering consumers away from buying plans that do. It’s a bad-faith attempt at disclosure that rightfully went nowhere in the Senate and drew a veto threat from the White House," says Hasstedt. "Instead, the Obama administration should use its authority to help make such important information clear to consumers in a fair and appropriate way—it’s a goal that should transcend politics."

Read the full analysis here: "Abortion Coverage Under the Affordable Care Act: The Laws Tell Only Half the Story," by Kinsey Hasstedt

For more information:

State Policies in Brief: Restricting Insurance Coverage of Abortion

Analysis: Insurance Coverage of Abortion: Beyond the Exceptions for Life Endangerment, Rape and Incest