Maine’s insurance co-op, Community Health Options, is dropping elective abortion coverage for 2017. Co-op officials say it’s a cost-saving measure, but abortion advocates are decrying the move as a step backwards for women’s health.
The backdrop to eliminating elective abortion coverage, says Community Health Options CEO Kevin Lewis, is that the co-op is still digging itself out of a $31 million deficit it accumulated last year.
“This decision was really driven by economic considerations as well as the construction of the Affordable Care Act and how it regards essential health benefits in the individual marketplace,” he says.
Elective abortions are not considered an essential health benefit. Neither is adult vision care, which Community Health Options also dropped.
Lewis says eliminating elective abortion coverage is part of a series of decisions to offset high premiums, which are already increasing an average of 25 percent next year.
“Overall, we’re able to carve 8 percent off of what would otherwise have been premium increases,” he says.
“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,” says Nicole Clegg, a spokeswoman for Planned Parenthood of Northern New England.
Community Health Options covered 33 elective abortions in 2015. The cost for an abortion during the first trimester is about $500. Shifting that cost to consumers, Clegg says, will place a financial burden on those who need support the most.
“For a number of people who are purchasing their plans through the marketplace, they qualify for subsidies because their incomes are so low,” she says.
The news is especially surprising, Clegg says, because just last year, Planned Parenthood awarded Community Health Options for being a leader in abortion coverage.
Andrea Irwin of the Mabel Wadsworth Health Center in Bangor says eliminating elective abortion coverage erects a health care barrier for women both literally and symbolically.
“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,” she says.
But Laurie Sobel, a senior policy analyst with the Kaiser Family Foundation, says abortion care is often singled out.
“It’s the only service under the ACA that is explicitly allowed to be banned,” she says.
And coverage for elective abortions in the Affordable Care Act online marketplace is limited, Sobel says. Twenty-five states have passed laws that ban abortion coverage.
“And six of the remaining states that have no ban on abortion coverage did not have any plans that offered coverage in 2016,” she says.
Sobel says for insurers that do offer coverage, the federal health care law requires that funds are segregated, which adds administrative complexity. While Maine does not have a law banning marketplace coverage, she says Community Health Options’ decision reflects a wider trend.
“It’s a reflection of abortion coverage being extremely restricted in the country as a whole,” she says.
And even though Community Health Options covers birth control, which is required by the Affordable Care Act, Irwin says sometimes birth control doesn’t work and women need another option.
She and other abortion providers are hoping that Community Health Options will reconsider its decision.
