The Trump administration on Wednesday re-opened an abortion question from the days of Obamacare's passage, proposing that individual market insurers isolate the add-on premium for plans that cover abortion and bill enrollees separately for the surcharge.
The proposed rule would impact individual market insurers in 24 states and the District of Columbia that can cover abortions as long as they include the surcharge.
The Affordable Care Act provision was initially included in the landmark bill to sway anti-abortion Democrats while blocking federal funding — through the subsidies known as premium tax credits — from funding abortion coverage. In the compromise, people who enrolled in a plan that covers elective abortion would pay an additional premium.
The Obama administration in 2016 provided guidance that allowed insurers to include the surcharge with premiums rather than charge beneficiaries separate amounts. It was a contentious point for anti-abortion groups, and they have lobbied for a change.
Now, the CMS proposed changing the policy, even if the surcharge turns out to be minimal. The only dollar requirement the rule proposes is that it can't be less than $1 per enrollee per month.
The "individual market exchange issuers must determine the amount of, and collect, from each enrollee, a 'separate payment' for an amount equal to the actuarial value of the coverage for abortions for which public funding is prohibited, which must be no less than $1 per enrollee per month," the proposed rule says.
The anti-abortion group Susan B. Anthony List welcomed the proposed rule as a "step in the right direction," although they still want Congress to ban any federally subsidized plan from covering elective abortions.
In a statement, SBA List President Marjorie Dannenfelser called the Obama-era regulations a violation of the statute, which she said mandates that the surcharge be collected separately, and argued that people have "unwittingly purchased plans without knowing about the hidden abortion surcharge."
"Consumers deserve to know how Obamacare pays for abortion so they can avoid having their hard-earned dollars used to fund the destruction of innocent lives," Dannenfelser said.
Planned Parenthood blasted the proposal. Dawn Laguens, the organization's executive vice president, deemed the proposal, along with another rule finalized Wednesday that lets employers exclude contraception coverage from their health plans for religious reasons, as "dangerous, and not what the vast majority of the American people want."
"Women resoundingly rejected the Trump-Pence agenda, so Trump and Pence took direct aim at women's health coverage for birth control and abortion," Laguens said.
The lack of transparency over abortion coverage within the individual market has troubled people on both sides of the abortion debate since the early days of the law. How does someone know if a qualified health plan covers abortion?
"Given the special treatment of abortion care under the ACA and the confusion it has created, individuals covered by or shopping for a plan should be at least able to easily discern whether and to what extent a plan covers such care," Kinsey Hasstedt of the Guttmacher Institute wrote in a 2015 analysis of the issue.
In the same paper, Hasstedt addressed the abortion coverage surcharge, writing that the "ACA allows, but does not require, issuers to itemize or separate on a monthly premium bill the part of the premium that goes toward abortion coverage."
Although the single-payment allowance "raises suspicion in the minds of antiabortion members of Congress, a U.S. Government Accountability Office (GAO) review they requested on abortion coverage under the ACA found no evidence of noncompliance with these provisions," Hasstedt wrote.
As of press time, Hasstedt and other experts from the Guttmacher Institute did not respond to a request for comment.
America's Health Insurance Plans said it was still reviewing the proposed rule and had no comment.
The proposed rule includes two other provisions. One follows a Government Accountability Office (GAO) mandate to clarify federal oversight and audit authority over state-based exchanges in the individual market.
The other would establish an optional system to block people from enrolling in the individual market if they are eligible for Medicare.