A Maine-based health insurer that sells plans on an Affordable Care Act (ACA) (PL 111-148) marketplace announced that for the 2017 coverage year, it will drop coverage for abortion care except in limited circumstances, Maine Public/Bangor Daily News reports (Wight, Maine Public/Bangor Daily News, 10/26).
The move has come under scrutiny from women's health advocates, who say it presents a serious problem for Maine women who have coverage through the ACA marketplace.
Insurer drops abortion coverage
The insurer, Community Health Options (CHO), has 65,000 policyholders, making it the state's "top provider of individual and small-group health insurance plans," the Portland Press Herald reports. Eighty-six percent of Maine policyholders with ACA marketplace coverage are insured through CHO (Anderson, Portland Press Herald, 10/26).
CHO officials cited financial concerns as the reason for cutting abortion coverage. According to CHO CEO Kevin Lewis, the insurer accumulated a deficit of $31 million last year. Lewis said the decision to cut abortion coverage is part of several decisions the insurer has made to offset high premiums (Maine Public/Bangor Daily News, 10/26). However, Lewis said he could not estimate exactly how much CHO would save from the decision to cut abortion coverage, as well as a separate decision to cut coverage for adult vision care. He said that both services "are outside what the federal government will reimburse with subsidies."
According to the Maine Bureau of Insurance, Harvard Pilgrim Health Care will be the only insurer in Maine to sell individual and small group plans that include comprehensive abortion coverage.
Women's health advocates respond
Eliza Townsend, executive director of the Maine Women's Lobby and Maine Women's Policy Center, said of the decision, "We are disappointed. Abortion is a safe and legal procedure that women should be able to access as part of a comprehensive approach to health care." She continued, "There is no reason to single this procedure out, and we encourage (CHO) to rethink their decision" (Portland Press Herald, 10/26).
Andrea Irwin, executive director of the Mabel Wadsworth Women's Health Center in Bangor, said, "It's always a step back when abortion is singled out as other. It should not be other. It's pregnancy-related care, and it's part of comprehensive women's health care" (Maine Public/Bangor Daily News, 10/26). Calling the decision "absolutely troublesome," Irwin added, "I'm disappointed that we weren't given a heads-up that this was even being considered" (Portland Press Herald, 10/26).
Separately, Nicole Clegg, a spokesperson for Planned Parenthood of Northern New England, stated, "It's not clear to me that eliminating this coverage is going to make a difference in terms of the circumstances that they're dealing with."
Clegg added that shifting the cost of abortion care to women would impose financial strain on those most in need of support. "For a number of people who are purchasing their plans through the marketplace, they qualify for subsidies because their incomes are so low," she said.
A broader trend
Laurie Sobel, a senior policy analyst with the Kaiser Family Foundation (KFF), noted that CHO's move is in line with a broader trend of abortion coverage limitations.
Twenty-five states have laws that explicitly ban ACA marketplace plans from covering most abortion care. Further, according to Sobel, six of the states that do not ban abortion coverage in marketplace plans did not have a marketplace plan that offered abortion coverage in 2016. She also pointed out that when insurers do offer abortion coverage, they are required under the ACA to segregate those funds, which imposes an administrative burden (Maine Public/Bangor Daily News, 10/26).
A KFF report released earlier this year found that while "the number of women gaining access to health insurance coverage is rising, an increasing share of women are facing limitations in the scope of that coverage when it comes to abortion services." According to the report, "The impact of the abortion coverage restrictions disproportionately affects poor and low-income women who have limited ability to pay for abortion services with out-of-pocket funds" (Portland Press Herald, 10/26).
