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The Question of Abortion Coverage in Health Exchanges

But not all are. Aetna Inc., one of the nation’s largest insurers, does not plan to cover abortion in the District of Columbia exchange, according to district officials, and reportedly in other states. Aetna officials did not respond to requests for comment. Other insurers in the D.C. marketplace — CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealth Group — will offer plans that cover abortion.

During the 2010 debate over the law, questions about abortion coverage in the marketplaces were among the last to be settled. More than a dozen House Democrats who wanted more abortion limits almost derailed the law’s final passage when they threatened to oppose the bill.

Democrats on both sides of the issue aimed to continue the Hyde amendment, a provision added every year since the 1970s to the Labor-HHS-Education spending bill covering Medicaid and insurance for federal workers that bans federal dollars from paying for abortions except in cases of rape, incest or danger to the woman’s life.

A group of House Democrats led by then-Rep. Bart Stupak of Michigan sought to require women who got federal subsidies for insurance to buy a separate abortion policy rider with their own money if they wanted. But the Senate changed the language. The final version requires payments for abortion coverage to be separate from money for the rest of insurance so it is clear that no federal money supports abortion. The law said workers using direct deposit for their insurance must make separate deposits.

The House Democratic critics backed the bill when President Barack Obama signed an executive order confirming that tax credits and subsidies for copays or deductibles cannot fund abortion services through the exchanges, except in cases of rape, incest or risks to the life of the woman.

Groups that back abortion rights such as the National Women’s Law Center say that the provision requiring separate “payments” does not actually mean that customers — including men — must write two separate checks, one for insurance and another for abortion coverage. They are telling insurers they can collect one check and segregate the money internally later.

They base their interpretation on an April 24 memo from the Centers for Medicare and Medicaid Services, which oversees the health law, that says “there are no regulatory requirements governing the content of an issuer’s premium billing invoice for enrollees of the individual exchange.”

The question of whether consumers must make two separate payments is important because if customers must write two checks, it would be harder for insurers to administer abortion coverage and might irritate consumers who don’t want to pay for it.

Another twist is that the health law allows for multistate plans in each exchange. At least one multistate plan is supposed to cover abortion and another is not. But the multistate plans — which were intended to boost competition and serve as an alternative to the “public option” that many liberals wanted — are being phased in. Officials at the CMS and the Office of Personnel Management are not requiring two plans in each state right away.

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