California has long recognized that reproductive health care is a critical part of a person’s wellbeing. In fact, California’s Constitution and the Knox-Keene Health Care Service Plan Act require that abortions must not be treated differently from other health care services. The Trump administration recently introduced a proposal that requires insurers on the Affordable Care Act (ACA) exchanges, including Covered California plans, to send enrollees a separate monthly bill for abortion coverage. Under the proposed rule, insurers must issue — and consumers must pay — two separate bills for the amount of the premium attributable to certain abortion services and the amount of the premium for all other services. The proposed changes seek to undermine legal protections in states like California, and if implemented, will significantly increase overhead costs for issuers and confuse enrollees who will likely not realize they have to send two separate payments every month.
As allowed by federal regulations and guidance, Covered California plans already send enrollees a single monthly bill that itemizes the premium amount for abortions in cases of incest, rape, and life endangerment. The Trump administration’s proposed changes will add more burdens – like issuing and processing payments from multiple instruments for each enrollee, adjusting for systems changes, notifying enrollees, and modifying appeals processes. While the administration estimates that insurers will only incur $1.6 million annually to comply with this rule, it fails to take into account other costs associated with increasing customer service and addressing consumer confusion or loss of coverage due to failure to pay two premium bills. Health care consumers may also experience delays in coverage as they try to understand how to make their premium payments. This would force Covered California plans to waste additional resources, while consumers lose coverage. Ultimately, these costs will be passed on to consumers in the form of higher premiums. This proposal puts Covered California in an untenable position.
The Trump administration’s intentions here are all about sabotaging the ACA and to continue stigmatizing abortion care. In fact, the Department of Health and Human Services already admits that people will lose coverage if they accidentally miss the second bill in the mail: “[C]onsumers may inadvertently miss or discard a second paper bill included in a single envelope, increasing terminations of coverage for failure to pay premiums.” These consumers are the 1.3 million Californians who are enrolled in Covered California.
The proposed rule diminishes California’s flexibility and conflicts with the state’s efforts to ensure abortion coverage is available to those who need it through their health plans. It further authorizes the administration to enforce these new provisions if states elect not to follow these requirements. Such authority seriously undermines all states’ regulation of insurance companies that operate in the state. It would erode the collaboration and partnership that the state exchanges have with the government.
The Trump administration continues to abuse its administrative powers to gut access to the full range of health care services established by Congress under the ACA. The National Health Law Program urges the withdrawal of this wildly flawed proposal, as it would put onerous burdens on both issuers and health care consumers that will result massive loss of health care coverage and reduced access to comprehensive health care plans, including reproductive and sexual health services. This proposal is not only a cruel health care policy; it also subverts the California Constitution, state law, and interferes with the state’s regulation of its health plans.