Birth Control Pills in a pink circular dispenser on a white background

Millions of Americans including men with health insurance through an Affordable Care Act state exchange, are in for a surprise next year in the form of 2 separate bills from their insurers. The Department of Health and Human Services finalized a new rule in December that requires insurers to provide a separate invoice detailing how much of their premium goes toward abortions. Beginning in June, customers will receive one bill for their typical coverage and another for abortion services.

The Hyde Amendment

As of 1976 federal funding for abortions has been illegal when Congress passed the Hyde Amendment sponsored by Rep. Henry Hyde (R. Ill). Later updates to the amendment made exceptions or life threatening pregnancies. Antiabortion law makers were told by Barack Obama that the Affordable Care Act would not illegally fund abortions. Under the rules of the ACA, insurance providers are required to separately detail abortion coverage. In 2014 the Government Accountability Office found that not all insurers were following the requirement. In a statement by HHS Secretary Alex Azar, “The separate billing requirement fulfills Congress’ intent and reflects President Trump’s strong commitment to preventing taxpayer funding of abortion coverage.

Opponents and Proponents

As with any political change there are proponents and opponents of this change. The U.S. Conference of Catholic Bishops oppose abortion and are in favor of the new rule. An official for the USCCB, Archbishop Joseph F. Naumann of Kansas City says consumers  “have a right to know if they are paying for elective abortion,” . On December 23 the Archbishop went on to say “While the Affordable Care Act still allows government-subsidized plans to cover abortion, at least with this rule, Americans can now see and try to avoid complicity by choosing plans consistent with their consciences,”  As for those who oppose the new rule many objections are being made public. Abortion advocates say the new rule will create adversity when trying to find an insurer with abortion coverage. In the opinion of Planned Parenthood Federation of America, Vice President for Government Relations, Jacqueline Ayers, “This rule won’t just require separate payments, it further splits off abortion from other reproductive health care and puts up massive barriers to access.

Some insurance providers are also opposed to the new rule citing the burden of administrative requirements. The fear of medical groups is that customers may loose coverage if they don’t pay both bills. Many who commented when the rule was made available for comment before its final state expressed concerns that “enrollees might not realize or understand that there is a separate bill covering different services under their plan; enrollees may not realize that such a payment is mandatory in order to fulfill satisfying their premium liability each month and avoid termination of coverage…”. In response to their concerns about confusion leading to loss of coverage, HHS made the following suggestion to insurance providers, “We also suggest that insurers state clearly for policy holders on both bills that the policy holder s receiving two bills to cover the total amount of premium due for the coverage period, the policy holder’s total premium due is inclusive of the amount attributable to coverage of non-Hyde abortion services, and that the policy holder should make separate payments for each bill.” In December 2018 the Kaiser Family Foundation released its opinion after the initial draft was made public. In their analysis, some insurers would cease to cover abortions.

How Much Will the Insured Pay

For those questioning how much the second bill to cover non-Hyde abortion charges will be, the new rule states “issuers that offer QHPs that provide coverage of non-Hyde abortions services must collect a separate payment of no less than $1 per enrollee in the plan per month, regardless of the actuarial value of coverage of non-Hyde abortion services and regardless of whether premiums are paid directly by enrollees or through payroll deductions.” Naturally the cost of such services is determined by the insurer. Under the new rule abortion services coverage should not increase the price of premiums because it is not an added cost to existing coverage which is deducted from the original single bill enrollees were provided before the new rule.

Insurers are concerned about the additional costs from changing billing software, handling twice as many payments, and resources for servicing confused customers. HHS estimates costs to insurers, exchanges, and enrollees will be $546.1 million in 2020, stabilizing in 2021 at $232.1 million, $230.7 million in 2022, and reaching a final level of $229.3 million in 2023 and years following. As this is the cost of a socialist health care system provider to Americans where everyone pays for services they may not now or ever need. You can find the complete HHS “Patient Protection and Affordable Care Act: Exchanges Program Integrity in its final form at the following link. HHS New Rule

James Cheef