Advocates for access and coverage of health care for low-income individuals and families, particularly reproductive health services, have had to respond to numerous regulatory attacks since the inception of the Trump administration. Though we have suffered many setbacks, we do have one reason to celebrate.
Every year, the Department of Health and Human Services (HHS) releases the Notice of Benefit and Payment Parameters (NBPP) regulation to make technical changes and improvements to the Affordable Care Act health care marketplaces. During the last two iterations of the NBPP, the administration has hijacked this process to undermine protections of the ACA. This year, the administration included a provision to erode reproductive health services by requiring marketplace plans offering broad abortion coverage to offer “mirror plans” that would only provide coverage of abortion in certain restrictive circumstances (rape, incest, or life endangerment). The proposal would effectively require an issuer who wanted to provide abortion coverage to offer two plans, one with full abortion coverage and a second “mirror plan” essentially without it. Because of the overwhelming opposition to the so-called mirror plans, and the need for issuers to make changes before the 2020 plan year, the administration did not implement this provision.
This NBPP came on the heels of another proposed regulation that attempts to increase onerous burdens on issuers and consumers. In November of 2018, HHS proposed to require all marketplace plans to issue two different billing statements: one for all services and abortions under limited circumstances, and another one for other abortions. Should it take effect, this requirement will result in massive loss of health care coverage when enrollees fail to make the second payment and are dropped from their plans. Although the comment period ended in January, the proposal has yet to be finalized.
Jointly, the administration’s attacks on marketplace plans would put more people, particularly the most underserved, without health care coverage, including abortion services. The ACA is a critical tool in expanding coverage to women, LGBTQ individuals, and people of color. Yet these recent administrative actions threaten these gains. Indeed, the regulatory efforts, if implemented, will worsen access to abortion coverage in the marketplaces. Following the ACA’s allowance for states to prohibit abortion coverage in the marketplaces, 26 states implemented such bans. The administration’s attacks on abortion coverage make it harder for the rest of the states that have decided not to impose these restrictions on reproductive health access. Any restrictions on insurance coverage of abortion place individuals, particularly low-income people, LGTBQ people of color, and women of color, in extreme financial distress, with long-term effects for themselves and their families. With much effort, we have impeded one set of harmful restrictions, and hope for the same result with the double billing requirement.
The administration could not push through the NPBB provision at this time because too many organizations and individuals took the time to make their voices heard. We won this round. Let’s remember that we can continue to win and move forward in building a world where each person has coverage for the health care they need.