“It would depend on legal language,” said Doniella Pliss, director of AM Best’s health insurance rating team, a credit rating agency. “For an insurance company, this is not an ideological issue … They will go strictly by what the law is.”
Another important element is whether employers offer self-insured coverage, which is governed by federal regulation, or fully insured policies, which must comply with state regulations. In the former, companies pay the health expenses of their workers, while in the latter, they contract with state-licensed insurers to cover claims. Many large employers are self-insured.
Abortion health insurance coverage has long faced many limitations.
Some 34 states and the District of Columbia allow Medicaid to cover abortions only in cases of rape, incest, or danger to a woman’s life due to the Hyde Amendment, which restricts federal funding for the procedure, according to the Kaiser Family Foundation . The remaining 16 states use their own money to provide broader coverage of Medicaid abortion.
Some 26 states prohibit policies that are sold on their Affordable Care Act exchanges from covering abortion, with certain exceptions.
When it comes to work-based plans, 11 states have laws that prohibit the benefits of abortion, with certain exceptions, in the policies of small businesses and large employers that regulate states. According to Kaiser, some states may allow abortion coverage to be purchased as a rider.
Seven states have laws that require all of their fully insured employer plans, as well as Obamacare and other individual market policies, to provide benefits for abortion.
The federal law that regulates self-insured plans, the Employee Retirement Income Security Act of 1974, known as ERISA, does not contain any limitations or requirements for abortion coverage.
But the Federal Pregnancy Discrimination Act requires all employers who offer health insurance and have 15 or more workers to cover abortion if a woman’s life is at risk.
Consequences of the decision of the Supreme Court
About 10 states have effectively banned abortion since the Supreme Court ruling on Friday. And 26 states are sure or likely to ban the procedure, according to the Guttmacher Institute, a research and policy organization that supports abortion rights. No state currently prohibits its residents from obtaining abortions in other states where it is legal. But Missouri Republican lawmakers have tried to include it in the legislation, unsuccessfully, so far. Other states can follow suit, experts say. Liberal Supreme Court judges warned of this potential in their dissent, although Judge Brett Kavanaugh tried to allay those concerns in his concurring opinion, saying states cannot ban their residents from traveling elsewhere. to have an abortion. . Insurers and employers may also be concerned about state laws that could hold accountable those who help and encourage abortion, which is a provision of the Texas abortion law that was passed last year. This could affect abortion coverage across state lines.
“Is coverage considered a help?” said Alina Salganicoff, director of women’s health policy at Kaiser. “Insurers will really have to look at it.”
Many insurers and employers will be “prudent,” he said. “There’s a lot of activity right now, trying to figure it out.”
Citigroup and Lyft have already angered some Texas Republican lawmakers for offering travel benefits for abortion procedures. A Republican state representative in Texas said earlier this year that it will introduce legislation that prohibits local governments from doing business with any company that offers abortion coverage or pays abortion-related expenses.
It is also possible that ERISA may not extend certain state laws, such as criminal laws.
Another question will be whether states can ban drug-induced abortions coverage for their residents in self-insured business plans, said Katy Johnson, senior health policy adviser to the American Benefits Council, a business association for large business owners primarily.
“This is really a new situation here,” he said, noting that many of the board members offer abortion benefits. “Looks like there’s nothing on the table.”
So far, Johnson has not heard any employers withdraw their abortion coverage, even across state lines. And a lot of companies have already stated that they will pay for abortions and out-of-state travel services.
But that doesn’t mean they won’t face a setback in states that ban the procedure.
“I hope some states make some pretty broad interpretations of the kind of behavior that their own laws cover,” Johnson said.