know about How employers and insurers are dealing with abortion after Dobbs
Some are offering travel benefits.
An already complicated patchwork of abortion coverage laws has become even more complex with the US Supreme Court ruling to overturn Roe v. Wade.
“It’s really everywhere,” says Fabiola Carrión, JD, director of sexual and reproductive health for the Los Angeles office of the National Health Law Program. There used to be a lot of restrictions, but “it’s getting very complicated,” she says.
Some states had abortion bans that went into effect immediately after the court’s 5-4 ruling in June 2022. Others have seen their abortion bans temporarily blocked by the courts. And another group of states has moved in the opposite direction, strengthening their abortion rights statutes. “The legal landscape is changing rapidly,” says Meera Shah, MD, MPH,MS, the national medical spokesperson for the Planned Parenthood Federation of America.
Even before the Supreme Court ruling, the laws governing abortion insurance coverage varied widely from state to state. As of July 1, 2022, seven states required private health plans to cover abortions, 11 states restricted insurance coverage from private insurance plans, and 25 restricted coverage from plans offered on state health exchanges, according to the Guttmacher Institute. , a research and policy organization committed to supporting sexual and reproductive rights.
Coverage also varies greatly for women who are insured through health insurance. The 1977 Hyde Amendment prohibits the use of federal funds for abortions unless a woman’s life is in danger or she is a victim of rape or incest, and many state Medicaid programs abide by that rule, which has been expanded to include the military Tricare program, Medicare and the Indian Health Service. But 16 states get around the Hyde Amendment by using state funds to pay for abortions for women covered by their Medicaid programs.
Fully insured health plans are subject to state insurance regulation, but self-funded plans are governed by the Employee Retirement Income Security Act and are not governed by state insurance law. Instead, they fall under the jurisdiction of the United States Department of Labor.
With all the differences between states, “for insurers, it could mean one version of a plan in one state and another in another,” notes Sarah Raaii, JD, an associate at the Chicago law firm McDermott Will & Emery, who focuses on in employee benefits.
Several health insurers, including CVS Health (Aetna’s parent), Cigna and Blue Shield of California have already spoken out in support of abortion rights and in support of their employees and customers. CVS Health said in an email: “We have made out-of-state care accessible to covered CVS Health employees who reside in states that have instituted laws limiting access in their state. With the new decision (of the Supreme Court), we are evaluating how we can better support the coverage needs of colleagues, clients and users”. That includes, the email said, giving them “the flexibility to choose the medical and pharmacy benefits that best fit their needs. This includes, subject to plan terms and client direction for self-funded plans, making out-of-state abortion care services more accessible and affordable.”
Other payers, such as Blue Cross Blue Shield of Michigan and Blue Cross Blue Shield of Massachusetts, are developing or have developed a travel benefit for those who need to leave the state for an abortion. The Michigan Blues plan said in an email that group clients had requested expanded travel benefits for a number of services, including behavioral health and substance use disorder treatment, and that the payer was including an option for coverage of the abortion in the new benefit. The benefit will be available in the next month or two and will reimburse travel between the patient’s home and the place where they receive care.
But there is concern that states in places where abortions are banned will try to restrict residents from traveling out of state for abortions. “It’s potentially murky legal territory,” says Raaii. In a concurring opinion in Dobbs v. Jackson Women’s Health Organization, Judge Brett Kavanaugh said he did not believe a state could prevent a woman from traveling to another state for abortion services. Raaii says that when he discussed Kavanaugh’s opinion with employers, “it helped build his confidence in an abortion travel benefit.” Several major companies, including Tesla, Starbucks, JPMorgan Chase and Amazon, have said they will cover employee travel expenses.
However, much remains to be clarified about travel benefits and insurance coverage of abortion services in general. Carrión says that even when companies and health plans say they will offer a travel benefit, it is not clear what type of transportation will be covered: the cost of gasoline if someone drives to another state, a bus ticket or a ticket of airplaine. Will food and accommodation be included? If so, for how many days? Carrión points out that some states have a 24- to 72-hour waiting period before a woman can have an abortion. Other variables include whether there will be coverage or consideration for lost income and additional child care expenses.
In 2020, the most recent year for which figures are available, more than 930,000 abortions were performed in the United States, according to the Guttmacher Institute. That was slightly more than in 2019, when more than 916,000 abortions were performed. But it was far below the more than 1.5 million abortions that occurred in 1991. The abortion rate in 2020 was 14.4 per 1,000 women between the ages of 15 and 44. The rate has been cut in half since 1981, when there were 29.3 abortions per 1,000 women. Access to contraception is believed to have helped reduce the abortion rate, and the Affordable Care Act requires most private health insurance plans to cover contraception. Centers for Disease Control and Prevention data from 2019 for 47 states and the District of Columbia shows that 57% of those who had abortions were in their 20s and that adolescents had only 9% of abortions.
President Joe Biden signed an executive order on July 8, 2022 directing the US Department of Health and Human Services to protect and expand access to abortion, including medical abortions; ensure all women’s access to emergency medical care; and protect access to contraception. The order does not address issues such as costs and insurance.
A first-trimester abortion costs about $600, says Carrión. Even those with health insurance may need to cover that cost because many policies have high deductibles. “It’s a huge amount for people with low and middle incomes,” she says.
“Hundreds of thousands of people are no longer able to access the abortion care they need, and even more are confused about the options available to them,” says Planned Parenthood’s Shah.
Carrie Baker, Ph.D., JD, MA, a professor of women’s and gender studies at Smith College in Northampton, Massachusetts, says her concern is, “Will women do dangerous things to have an illegal abortion?”
With the bans in place, Carrión says that “the people who will be most affected are marginalized people who do not yet have access to health care and services.
“It will result in two Americas,” he adds. “One with abortion and one without.”
Susan Ladika is a freelance journalist in Tampa, Florida who writes about health care and business.