Health Reform WK-EDGE Abortion riders unavailable in exchanges of coverage-restricting states
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Wednesday, February 28, 2018

Abortion riders unavailable in exchanges of coverage-restricting states

By Kathryn S. Beard, J.D.

In the 10 states that restrict insurance companies from covering abortion in state-regulated private plans, including those sold on the health insurance exchange, no abortion riders are available in the individual or large-group market. The Kaiser Family Foundation analyzed available plans and found that although an argument for such abortion restrictions suggested that riders would be available for women who wanted coverage, in practice the riders do not exist.

Before the passage of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), four states—Idaho, Kentucky, Missouri, and North Dakota—banned abortion coverage in state-regulated private plans. Since then, seven additional states have passed similar bans—Indiana, Kansas, Michigan, Nebraska, Oklahoma, Texas, and Utah. Texas’ law will go into effect in April 2018, and Utah law prohibits the sale of riders for abortion coverage. In the nine states with current restrictions on abortion coverage that do allow riders, however, riders are generally nonexistent. In addition to these 11 states, 15 others restrict abortion coverage in plans sold on the exchange, but not in other private plans. The exchange is prohibited from offering riders for sale, so any available riders are not eligible for tax subsidies or premium assistance.

Under the ACA, abortions are not part of the federally-established essential health benefits package. Section 10104(c) of the ACA gives states the opportunity to opt-out of abortion coverage on the exchange. Therefore, the availability of abortion coverage depends heavily on the state in which the individual resides—overall, in 26 states, women have no option to purchase an exchange plan that includes abortion coverage.

Companies: Kaiser Family Foundation

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