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« Whew! Birth control coverage safe for now | Main | ACA still in effect, so start using your new health coverage! »

Tues deadline for comments on Trump abortion coverage rule!

Proposed Trump rule would undermine abortion coverage


The deadline is almost here for submitting comments on a Trump administration proposal that would impose burdensome requirements on coverage of abortion services in health plans being offered through Affordable Care Act (ACA) marketplaces. We fear the proposed rule would confuse health plan enrollees and could even prompt insurers to drop abortion coverage. Comments are due by midnight on Tuesday, Jan. 8, on this proposal, which the administration rolled out right after the mid-term elections.

How would this proposed rule undermine abortion coverage? Under the current system, insurance companies can include abortion coverage in the comprehensive health plans they offer in ACA marketplaces, so long as: 1) abortion coverage is not prohibited by state law and 2) insurers do not use any federal funds to pay for the portion of the premium that covers abortion. Under the Nelson amendment to the ACA, insurers must charge at least $1 a month in premiums to cover the cost of abortion coverage.
In the states that permit or require abortion coverage, insurers have been able to send  enrollees one monthly itemized premium bill charging, for example, $1 for abortion coverage and $99 for the rest of the health plan. Federal subsidies can be applied to lower premium costs for the rest of the plan, but individuals must cover the $1 abortion premium themselves.
Under the Trump proposal, ACA insurance plans that cover abortion would be required to issue two separate bills and ask enrollees for two separate payments. What happens to people who are confused by the new requirements and don't write a separate $1 check each month? We don't know for sure, but there are reasons to worry they might lose their entire health coverage. Moreover, we fear that insurance companies would find the new requirements too burdensome and decide to drop abortion coverage. 
The current system isn't perfect. Coverage for abortion care shouldn't be treated differently from coverage for any other kind of routine health care. But until we have successfully repealed the Hyde Amendment, it’s a system that satisfies Congressional intent without unduly burdening individuals. By contrast, it’s clear that the administration’s goal is to create so much onerous red tape that insurance companies stop offering comprehensive plans with abortion altogether.
Public comments are due by midnight Eastern time on Tuesday, Jan. 8. We strongly encourage you to join us in submitting comments explaining why you oppose these new barriers to abortion coverage. You can submit comments electronically HERE.Note that the title of the proposed rule that includes the abortion coverage restrictions is this: Patient Protection and Affordable Care Act, Exchange Program Integrity NPRM, CMS-9922-P.


New House leadership sets vote to defend ACA against TX lawsuit


Last Thursday, Nancy Pelosi (D-CA)—arguably the most successful Speaker in recent history and the first woman to ever hold the post—reclaimed the gavel, swearing in the new Democratic House majority.

The new House’s first order of business was passing a bill to re-open those federal agencies that have been shut down since late last month. Most of the programs and agencies we cover, including Health and Human Services, were funded in last September’s year-long appropriations bill and have been relatively insulated. But the ongoing federal government shutdown has had significant implications for Native women and families who receive their health care through the Indian Health Service. As NPRreported, services that meet "immediate needs of the patients, medical staff, and medical facilities" are still open, but staffed by employees currently working without pay. And many preventive services funded through IHS remain shuttered. So far, Senate Republicans are refusing to pass a clean funding bill and it’s not clear how long the shutdown will continue.
The new House majority’s second order of business was to set the stage for a vote on January 9 to formally join in defense of the ACA against the threat posed by a federal judge’s ruling last month. Given the shocking scope of Judge Reed O’Connor’sdecision overturning the law – including all of its consumer protections, subsidies, Medicaid expansion and other provisions --we’ll be watching to see if any House Republicans feel pressured to support the ACA’s defense on appeal to the Fifth Circuit.
Meanwhile, the 17 Democratic attorneys general who have been defending the ACA in place of the Trump administration were joined last week by an 18th   Attorney General. Colorado’s newly-elected AG Phil Weiser, who made it his his first official act. In two more states, Wisconsin and Maine, newly-elected Democratic AGs are looking for ways to withdraw from the GOP side of the lawsuit. In Maine, former Governor Paul LePage, a Republican, did not have the legal authority to join the lawsuit in the first place. In Wisconsin, former Republican Governor Scott Walker’s last act was to lock his state into the lawsuit and by signing legislation that would gut the powers of incoming Democrats.
Finally, the new House Democratic majority is likely to be more “ideologically and geographically cohesive” than the Democratic majority that controlled the House from 2007 to 2010, which could give progressives a bigger say in its priorities. House leadership has committed to holding hearings in the next few weeks on Medicare for All as part of a longer-term process on educating the public, working through complicated details, and setting the stage for the 2020 presidential election. Democrats were successful in passing the ACA, and Republicans unsuccessful in repealing it, in part because the former spent years using hearings to work through the legislative details that would ultimately become the ACA while the latter skipped the refinement process and sprung poorly drafted legislation on their members at the last minute.
In other positive health care news last week, Maine’s incoming Democratic Governor Janet Mills used her first executive order to finally move forward with Medicaid expansion, more than a year after voters passed expansion on referendum by an overwhelming margin.

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