From the beginning of the rollout of the federal and state websites displaying health insurance plans eligible for premium subsidies, the ability to identify key elements of the plans, compare and contrast them, and understand the scope of coverage and other issues has been limited at best.
In most cases, it was necessary at the outset of healthcare.gov (the federal exchange web site) on October 1, 2013 for an individual to register for a plan before finding out what it contained and what it excluded. That situation prevailed even for the most controversial of coverage topics – elective abortion – despite the prominence of the abortion issue in the final passage of the Affordable Care Act.
These and other issues with the operation of the health care exchange websites, especially healthcare.gov, prompted a series of hearings on Capitol Hill where members of Congress questioned the cost, structure, operation and transparency of the web sites.
On October 30, 2013, Rep. John Shimkus (R-IL) asked Health and Human Services Secretary Kathleen Sebelius whether the federal exchange website would “clearly” identify which insurers and plans in the exchange cover elective abortion.
Sebelius at first replied, “I don’t know” but then indicated she understood the question. Shimkus then asked Sebelius if her office would provide the House Energy and Commerce Committee with a list of companies and plans in the exchanges and their status with respect to elective abortion coverage. Sebelius replied, “I think we can do that, sir.”
Six weeks later, on December 11, 2013, Secretary Sebelius appeared before the committee again and was asked about the status of the promised list and the federal website. She replied, “Sir, every plan lists plan benefits, and the one plan benefit that they must list by law is abortions services. So, as a shopper goes on, I would highly recommend that they look in the plan benefits section, and go back to the coverage they’re interested in.”
This reply apparently impressed Rep. Shimkus as unresponsive regarding whether Sebelius intended to give the committee the promised list of providers and coverages. Shimkus pressed his question several more times, with Sebelius ultimately saying, “Sir, it is on the website. It is available. It is available for every customer.”
What, then, is the state of the federal exchange website and its transparency on abortion coverage as of December 11, 2013? Does the site allow customers to consult and compare individual plans before purchasing one? Does it clearly indicate which plans cover elective abortion and what that term or similar terms mean with respect to covered abortions, and does it inform customers regarding the cost of this coverage and how it will be collected from them?
To answer this question, the Charlotte Lozier Institute (CLI) reviewed individual health plans from a number of states, including states that have passed laws opting out of permitting elective abortion coverage in their exchange plans and states (a narrow majority) that have not excluded such coverage.
The result: obtaining plan information on elective abortion coverage or exclusion remains extremely difficult for many plans.
Here is a recap of states and plans visited online and what CLI found:
- New Jersey does not operate its own exchange website but instead participates via healthcare. gov. CLI used the federal exchange and viewed plan documents at AmeriHealth.com and Horizon Blue Cross Blue Shield of New Jersey. There was no abortion-coverage-specific information for either plan in their online documents (Summary of Benefits and Coverage and/or Plan Brochure).
- Texas does not operate its own exchange website but instead participates via healthcare. gov. CLI used the federal exchange and viewed plan documents from Blue Cross Blue Shield of Texas. There was no abortion-coverage-specific information for this plan in its online documents (Summary of Benefits and Coverage and/or Plan Brochure).
- Wyoming does not operate its own exchange website but instead participates via healthcare. gov. CLI used the federal exchange and viewed plan documents from Blue Cross Blue Shield of Wyoming and WINhealth Partners. There was no information on abortion coverage via Blue Cross Blue Shield of Wyoming’s Summary of Benefits. As for WINhealth Partners, healthcare.gov does not provide a link to any Summary of Benefits and Coverage document; however, CLI found separately that the insurance company itself does have Summaries of Benefits available online for its plans. For this WINhealth Partners Bronze plan, there was no abortion-specific-coverage information found.
- Alaska does not operate its own exchange website but instead participates via healthcare. gov. It has not adopted a law opting out of permitting plans that cover elective abortion from participating in its exchange. The plan names (e.g., “Be Savvy”) listed on the federal exchange website for a company named Moda do not match up with the plan names listed on the Moda website, confusing the tracing of the plan options. Though CLI was able to find the Summary of Benefits for the “Be Savvy” plan and the Plan Brochure elsewhere on Moda’s website, neither contained information about whether the plan covered abortion. Alaska’s multi-state plans from Premera do have a Summary of Benefits and Coverage indicating that “voluntary termination of pregnancy” is excluded from coverage.
- Alabama does not operate its own exchange website but instead participates via healthcare. gov. Its state legislature has barred plans with elective abortion coverage from its exchange, and federal operation of the exchange does not override this state statutory limitation. Nonetheless, it may be important to consumers to verify whether or not individual plans they are considering include coverage of elective abortion. CLI was unable to locate abortion-specific information via the Summary of Benefits for this plan offered by Blue Cross Blue Shield of Alabama; however, we were able to find in another plan document, the Benefit Booklet, that “services, expenses or supplies for abortion (except when the life of the woman would be endangered)” are clearly listed under Health Benefit Exclusions.
- Oklahoma does not operate its own exchange website but instead participates via healthcare.gov. It has opted out of abortion coverage in the exchange. CLI could not access any plan documents for Global Health plan, because the page healthcare.gov links to upon clicking on “Summary of Benefits” and “Plan Brochure” requires a group number.
- South Carolina does not operate its own exchange website but instead participates via healthcare.gov. It has opted out of abortion coverage in the exchange. While trying to access the Summary of Benefits for a Blue Cross Blue Shield of South Carolina plan, CLI was sent via healthcare.gov’s link to this list of all plans offered. After locating the plan’s Summary of Benefits, CLI could not discern whether it covered abortion.
- Florida does not operate its own exchange website but instead participates via healthcare.gov. It has opted out of having abortion coverage in the exchange. For this plan from Blue Cross Blue Shield Florida, CLI was unable to find information on abortion coverage in the Summary of Benefits; however, the Plan Brochure does explicitly list elective abortions under Limitations and Exclusions.
From this survey sample of online websites via the federal exchange CLI concludes that clear statements of coverage of elective abortion via the SBC’s and other plan documents are not the rule. If anything, they are the exception.
A simpler solution to the challenge of identifying which plans contain this controversial coverage would be to include, on the home page of government websites access to a list of plans that cover or that exclude abortion, with definition of terms.
This could be done via a separate drop-down screen or as a standard FAQ, as the District of Columbia has done, that is available to all site visitors at the time they are reviewing plan options and before they have applied for coverage or provided information to the government and/or a prospective carrier.
Editor’s note: Genevieve Plaster is a co-author of this column.