In May, Maryland’s Governor Wes Moore signed HB 930 into law, a landmark step in advancing equitable access to abortion in the state. This law creates the Public Health Abortion Grant Program and Fund, a first-of-its-kind program that leverages unused segregated premiums from Marketplace insurers to fund access to abortion services for people with low-incomes, the uninsured and underinsured, and others who face significant barriers to accessing care.
The story of HB 930 actually begins in 2014 with the implementation of the Affordable Care Act (ACA). Section 1303 of the ACA sets forth “special rules” regulating abortion coverage in the Marketplaces, including two requirements that lay the groundwork for HB 930. In addition to prohibiting any federally funded premium tax credits or cost-sharing reductions from being used to pay for abortion coverage, Section 1303 required Marketplace insurers to segregate premiums into two accounts: one to pay for all services for which federal funding is available, and a second account for payment for abortions beyond the narrow exceptions allowed under the Hyde Amendment (i.e., those sought for cases of rape, incest, and life endangerment). Furthermore, Marketplace insurers must collect these abortion premiums on behalf of everyone enrolled in the plan (regardless of age, sex, or family status) and the abortion premium must be estimated at no less than $1 per enrollee per month, irrespective of the actual cost of paying for abortions. Federal law is extremely clear that these segregated funds must be “used exclusively to pay for” abortions sought outside the narrow Hyde exceptions.
It’s important to note that the $1 per enrollee per month premium far exceeds the actual cost of providing this coverage to enrollees, meaning that each year insurers have been collecting significant sums of excess premiums that are left in these accounts. For over a decade, these unused abortion premiums have continued to accumulate in these accounts, garnering significant sums of money. A couple of years ago, Maryland started taking steps to hold insurers accountable by requiring them to report information on the money held in these accounts to the Maryland Insurance Administration. Thanks to this law, we have found that Maryland insurers have collected roughly $25 million in these accounts that have remained unused – until now.
The Public Health Abortion Grant Program gives grants to providers and abortion funds that provide services to individuals who cannot use their insurance for abortion care or face other coverage gaps, such as people who are under-or uninsured, young people, and those enrolled in plans with abortion restrictions (such as religious employer-sponsored plans, etc.) These funds will be used exclusively for abortion services that are not eligible for federal funding, as required by the Affordable Care Act. The inclusion of abortion funds in this program is particularly notable since they perform an increasingly vital role in facilitating access to care as states continue to further restrict access to abortion and insurance coverage. Comprehensive insurance coverage of abortion is the backbone of an equitable abortion access landscape – research shows that cost is often the largest barrier to access. This groundbreaking public health abortion grant program will provide an essential safety net for people who fall into the existing coverage gaps.
HB 930 is an innovative approach to meeting the current moment, leveraging these unused dollars to fund abortion access at a time when the need is high but funding is scarce. Maryland has seen a marked increase in the number of people seeking an abortion in the state, a reflection of the protections the state has enacted in the pursuit of ensuring reproductive freedom for all Marylanders. Providers and abortion funds have struggled to keep up with the demand and the increasing cost, as some patients are forced to travel from further distances in order to obtain care. While abortion funds saw a wave of donations in the immediate wake of the Dobbs decision in 2022, those donations have dwindled while the need for abortion services has not. Similarly, the political will to appropriate new funding for abortion access has diminished, as state budgets have tightened and threats to federal funding rise. HB 930 provides a bold blueprint for other states looking to protect and expand abortion access without requiring new spending.
As Maryland continues to lead in protecting and expanding access to abortion care, NHeLP remains committed to ensuring that all people, regardless of income, insurance status, or immigration status, can get the care they need when they need it. If you’re interested in pursuing similar efforts in your state, please reach out to Cat Duffy ([email protected]).
