Lewiston-based health insurance co-op Community Health Options is dropping coverage for elective abortions from all of its insurance plans in 2017.

Women’s health advocates in Maine said the decision presents a serious problem for Maine women who get their health insurance under the Affordable Care Act. CHO is Maine’s top provider of individual and small-group health insurance plans, with about 65,000 policyholders.

“We are disappointed. Abortion is a safe and legal procedure that women should be able to access as part of a comprehensive approach to health care,” said Eliza Townsend, executive director of the Maine Women’s Lobby and Maine Women’s Policy Center. “There is no reason to single this procedure out, and we encourage (CHO) to rethink their decision.”

Community Health Options CEO Kevin Lewis said it was not an easy decision to drop abortion coverage, along with adult vision care, for 2017. But he said both coverage areas are considered “non-essential health benefits” under the Affordable Care Act, and that the co-op needed to do everything possible to cut costs in order to remain viable.

“As you know, we came off a rough financial year, and both of those services are outside the essential health benefits, and so they are outside what the federal government will reimburse with subsidies,” Lewis said.

CHO’s decision to drop elective abortion coverage is part of a broader attempt to get its costs under control after a $31 million loss in 2015. The co-op also is raising individual premiums by an average of 25.5 percent, eliminating adult vision care coverage and increasing deductibles by as much as 470 percent for out-of-network care. Increases in federal tax breaks will offset the premium increases for most policyholders.

Lewis said he could not estimate the specific amount that CHO would save by eliminating elective abortion and adult vision coverage.

POLITICS AND POLICY

Abortion has been a hot-button issue in Congress and elsewhere for decades. In 25 states, elective abortion coverage has been banned outright for all Affordable Care Act insurance plans.

The ACA does include compromise language that allows insurers on health care exchanges to provide elective abortion coverage, but prohibits the federal government from subsidizing reimbursements for abortions other than those resulting from rape, incest or maternal health threats. The complex regulations require insurers on the exchange that do provide elective abortion benefits to set aside a portion of their policyholder premiums for abortion care, and keep them separate from the insurer’s other funds. The cost of abortion coverage is not allowed to be factored into the provider’s overall costs, Lewis said.

“The federal government simply wouldn’t count that as far as the applicable subsidy for the care,” he said.

Neither Maine’s Bureau of Insurance, nor the regional contact for the federal Centers for Medicare & Medicaid Services, which oversees the ACA marketplace, could say whether ACA plans nationally are dropping abortion coverage. But a report from the Kaiser Family Foundation earlier this year said restrictions on access to abortion coverage are a growing concern.

“Although the number of women gaining access to health insurance coverage is rising, an increasing share of women are facing limitations in the scope of that coverage when it comes to abortion services,” the report concluded. “The impact of the abortion coverage restrictions disproportionately affects poor and low-income women who have limited ability to pay for abortion services with out-of-pocket funds.”

According to data from the Maine’s public health database, there were 1,836 abortions performed in Maine in 2015, of which 1,093 were performed at the nine-week stage of pregnancy or earlier. The data did not indicate how the procedures were paid for.

OTHER OPTIONS REMAIN

Those purchasing health insurance for 2017 on the ACA exchange in Maine still will have the ability to obtain elective abortion coverage. Harvard Pilgrim Health Care will be the only insurance provider in Maine to offer individual and small-group coverage for elective abortions, according to the state Bureau of Insurance. Anthem will continue to provide abortion coverage for small-group plans, it said.

Still, Andrea Irwin, executive director of the Mabel Wadsworth Women’s Health Center in Bangor, said the loss of abortion coverage for CHO policyholders will negatively affect women in Maine. CHO has 86 percent of policyholders in the exchange.

“I think it’s absolutely troublesome,” Irwin said. “I’m disappointed that we weren’t given a heads-up that this was even being considered.”

The nonprofit center provides a variety of health services for women, including abortions. Irwin said a first-trimester abortion typically costs about $500, and that the cost is higher for later-term abortions requiring hospitalization and anesthesia.

In many cases, women end up paying those costs out of pocket even if they have elective abortion coverage, she said, because such costs are not excluded from their annual deductibles.

Still, Irwin said that at a time when some elected officials continue to push for the total elimination of abortion assistance, CHO’s decision to drop abortion coverage sends the wrong message.

In November 2015, the American Civil Liberties Union of Maine filed a lawsuit seeking to force the state’s Medicaid program to pay for abortions. The lawsuit contends that depriving women of abortion coverage violates state statute and the Maine Constitution. The Mable Wadsworth Women’s Health Center is a co-plaintiff in the case, which is still being adjudicated.

Irwin said CHO’s decision is “absolutely a step in the wrong direction.”

She noted that her organization has been a loyal customer of CHO, in part because of its comprehensive coverage for women’s health care.

“I’ve been a big fan of Community Health Options,” she said. “Now, we’re probably going to have to think that over.”

 


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