Roe v. Wade decision unlikely to change ACA plan coverage

Today's U.S. Supreme Court decision overturning Roe v. Wade is unlikely to lead to a major change in how abortion is covered under health plans sold in Affordable Care Act marketplaces.

That was the word from healthinsurance.org, which issued a news release following today's high court decision that eliminated a constitutional right to abortion.

Louise Norris, a licensed broker and analyst at healthinsurance.org, provided insights on those regulations and how the ruling may impact coverage. Norris noted that regardless of the Supreme Court, there isn’t likely to be a major change in how abortion is covered under health plans sold in ACA marketplaces.

Insurance coverage of abortion was not mandated or banned under the Affordable Care Act. However, states have passed their own rules and regulations regarding abortion coverage – and those rules vary widely

“States were taking their own steps to regulate health insurance coverage of abortion long before the current lawsuit that could overturn Roe v. Wade,” Norris said. “States most likely to ban abortions already ban coverage of abortion by ACA-compliant health plans.”

Here’s the breakdown of state approaches:

• 25 states ban or restrict coverage of abortion by health plans offered through ACA health insurance exchanges. Of those states, all but two (Louisiana and Tennessee) have an exception allowing coverage in cases of life endangerment. Many states also have exceptions permitting coverage of abortion services in cases of rape and incest or other specific circumstances.
• Until last year, there were 26 states with restrictions on health coverage of abortion, but Virginia enacted legislation in 2021 reversing its ban.
• In most of the other 25 states, insurance carriers determine whether their plans will include coverage of abortion.
• Six states – Oregon, New York, California, Washington, Illinois, and Maine – require all state-regulated health insurance plans to cover abortions. In three of those states – Oregon, New York, and Illinois – the health plan must fully cover the cost, while health plans in the other three states can require the member to pay their normal deductible, copays and coinsurance.

Under the ACA, women (and their partners) have access to contraception at no additional cost. This includes birth control methods such as IUDs (intrauterine devices), implants, and tubal ligations that would have prohibitively high up-front costs if they weren’t covered by insurance.

Unlike abortion coverage, the ACA mandates health insurance coverage for birth control; as a result, that coverage is more consistent from state to state. Under the ACA and subsequent regulations, non-grandfathered health plans are required to cover a wide range of women’s preventive services, including FDA-approved contraceptive methods and sterilization procedures.

“That doesn’t mean that every birth control option for women is provided at no cost,” Norris said. “Rather, it means that at least one version of every type of contraceptive is covered at no additional cost to the patient.”

There are some exceptions. A 2014 U.S. Supreme Court ruling, Burwell v. Hobby Lobby, ruled that Hobby Lobby and other closely held corporations do not have to provide coverage for FDA-approved contraceptives that Hobby Lobby deemed abortifacients, or able to terminate a pregnancy. That includes emergency contraceptives, including Ella and Plan B, and IUDs. This ruling was expanded by regulation in 2017, granting employers access to religious and moral exemptions to the contraceptive mandate. This expansion of the contraceptive mandate exception was upheld by the Supreme Court in 2020.

“The landscape for insurance coverage of women’s health services has changed drastically since implementation of the ACA, and it keeps changing,” Norris said. “Understanding what coverage benefits you might utilize is something to think about each year when shopping for health coverage. People often don’t realize what is covered by their insurance until they are considering a specific health care service or medication.”