LEWISTON — The state’s only health insurance co-op will no longer cover elective abortions as part of individual- and small-group plans starting next year.
The head of Community Health Options says the change is meant to save its members money, but women’s health advocates say that savings will come at the expense of women.
“Decisions like these simply make it harder for women to access the care that they need,” said Eliza Townsend, executive director of the Maine Women’s Lobby, in a statement released Wednesday.
CHO is based in Lewiston and has 72,000 members throughout the state. It is the largest provider of individual health insurance in Maine and also sells small-group and large-group insurance.
Although once the only profitable co-op in the country, CHO has struggled financially over the past year as insurance claims amounted to more than expected. According to a CHO lawsuit, the federal government has failed to pay the co-op nearly $23 million it’s owed.
Last winter, CHO suspended sales of individual plans as it worked to get its finances under control. This year it slashed spending and received approval from the Maine Bureau of Insurance to increase rates an average of 25.5 percent for 2017 individual health insurance plans.
In an effort to save money, CHO also made changes to its insurance plans for 2017, including raising out-of-network deductibles “considerably” and dropping adult vision coverage and elective abortion coverage. Such changes meant CHO didn’t have to go up on premiums another 8 percent, CEO Kevin Lewis said.
“To be clear, I don’t want to imply that elective abortion was driving that 8 percent. We only had 33 elective abortions among Maine membership in 2015,” he said. “This is part of a broad effort to maximize benefits for the premium dollar.”
CHO will cover abortions in cases of rape or incest or when the woman’s life is in danger, but in no other situations.
Lewis said the decision was not made lightly and was not the result of a philosophical or religious objection to abortions.
“This was purely driven by economics and the regulatory framework of the (Affordable Care Act) and the Hyde Amendment,” he said.
The ACA allows — but does not require — insurers to provide abortion coverage in plans sold through the federal marketplace, HealthCare.gov. At the same time, the 40-year-old Hyde Amendment prohibits federal money from being used to pay for abortions except in certain cases, such as rape, incest or when the woman’s life is in danger.
That means federal ACA subsidies cannot be used to pay for insurance coverage of elective abortions. CHO, like other insurers, has had to charge and collect that abortion coverage portion of the premium directly from the person buying insurance.
“It imposes a cost to the plan, but most importantly to the members,” Lewis said.
All insurance plans are expected to cover abortions in the case of rape or incest or when a woman’s life in danger. In Maine, Harvard Pilgrim Health Care also covers elective abortions in individual plans, while Aetna and Anthem Blue Cross and Blue Shield do not. Harvard Pilgrim and Anthem both cover elective abortions in their small-group plans; Aetna does not.
The Maine Bureau of Insurance approved the abortion change for CHO. But women’s health advocates aren’t happy.
“We believe that a safe, legal procedure like abortion should not be segregated from comprehensive reproductive and sexual health care,” said Nicole Clegg, vice president of public policy for Planned Parenthood of Northern New England. “Decisions like these, where insurance companies drop coverage, it just shifts the cost and expense on to their customers. It doesn’t change the need for those procedures.”
Clegg said abortions in Maine can range from $550 to, in rare cases, $10,000.
CHO has largely become the insurer of choice for low-income Mainers buying through the federal marketplace. Its decision to stop elective abortion coverage means, Clegg said, “There’s a disproportionate impact for people who are least able to pay for it on their own.”
Planned Parenthood of Northern New England last year honored CHO with an award for its commitment to ensuring reproductive and sexual health care were treated like any other health care need.
While women’s health advocates weren’t happy with CHO, they also blamed lawmakers for the co-op’s decision.
“Politicians imposed burdensome requirements for those plans that opted to include abortion coverage,” said Kate Brogan, public affairs vice president for Maine Family Planning, in a statement released Wednesday. “It is no surprise that, in times of fiscal difficulty, abortion coverage is the first to go.”
Clegg said Thursday that she hoped CHO would reverse its decision.
“This decision does not need to be permanent,” she said. “This is something that can be corrected. It’s clear from the get-go that they had a strong level of commitment to making sure this service was covered. That coverage can be restored.”
Lewis said it’s too late to change CHO’s coverage for individual plans for 2017, which have already been approved by regulators. However, CHO is “looking at what needs to be done for 2018.”
For small-group plans, he said, “it’s something we have to take a hard look at. That’s as much as I can commit to at this time.”
Lewis said he respects the perspectives of women’s health advocates.
“We’re certainly taking notice,” he said.
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