Fee on health insurers to fund abortion services debated in WA Legislature

Insurers in Washington could soon need to foot the bill for additional abortion funding.

A proposal under consideration in the state Legislature would require health carriers with insurance plans offered on the Washington Health Benefit Exchange to pay a tax.

Senate Bill 6182 would impose an assessment of $0.82 per month of coverage for each plan enrollee in the first year, dropping to $0.165 in the following years. The first payment would be due March 2027.

In the first year, the tax would raise about $10 million and around $2 million each year after that, according to a fiscal analysis. Insurers could face fines if they don't provide related information to the state insurance commissioner. And unpaid assessments accrue interest.

Under the legislation, carriers would have to bear the costs of the assessment and not pass the burden onto enrollees through premium hikes or other charges. Insurers don't think this is feasible. The only exception in the proposal is if it would "create a significant risk of carrier insolvency or consumer harm."

People generally get insurance policies through the state's online marketplace, available under the Affordable Care Act, when they don't have access to health insurance through their jobs or from government programs, like Medicaid.

The money from the fee would go toward grants administered by the state Department of Health to organizations that provide abortion services. At least 85% of the proceeds have to fund these grants.

Religious leaders oppose the proposal, given their objections to abortion. Pastor Eric Lundberg of Living Word Lutheran Church in Graham believes the idea amounts to "forced manipulation" of his congregants who get their insurance through the Exchange, with funding going to "procedures that we completely and morally disagree with."

The Affordable Care Act requires insurers to charge each enrollee $1 per month to pay for abortions. These premiums have accumulated over time, as the $1 per month exceeds the cost of providing the coverage, according to the National Health Law Program.

Lawmakers in Maryland last year decided to tap this fund for grants to organizations providing abortion assistance in the state.

Given this, the Trump administration in December told carriers they could keep the excess premiums.

"It's simply about where the funds go after they're collected," said Courtney Normand, the Washington director of Planned Parenthood Alliance Advocates. "Are they going to go into whatever insurance companies feel like doing with them? Or are they going to go to caring for patients? That's literally the only two options here. So we feel really strongly that this is the right thing to do."

Democrats in the Washington state Senate approved the legislation late last month with no Republican support.

The measure is scheduled for a Monday vote out of the Appropriations Committee, leaving it with just a few days for a vote from the full House before the legislative session ends Thursday.

Funding threatsFunding for abortion providers has been threatened at the state and federal levels in the past year.

State lawmakers last year cut $8.5 million in funding for the Abortion Access Project, which was created in response to the 2022 U.S. Supreme Court decision overturning the right to abortion. Washington had allocated $15 million in the previous two-year budget for the effort.

Advocates decried the cut, saying it would lead to reduced services at Planned Parenthood and Cedar River Clinics.

Last September, dozens of Democratic lawmakers urged legislative leadership, budget writers and Gov. Bob Ferguson to restore the state funding.

"Safety net family planning providers cannot continue to serve patients at present levels without state investment, and if Washington does not take action to restore funding, health outcomes in our state will plummet and the state will ultimately pay the price tag," they wrote in a letter.

Both the state House and Senate proposed supplemental budgets include the desired money for the Abortion Access Project.

Meanwhile, congressional Republicans last year included a one-year prohibition on Medicaid funding for Planned Parenthood clinics across the country in the "big, beautiful bill." Federal Medicaid dollars already can't pay for abortions except in cases where the pregnancy endangers the mother or is the result of rape or incest. So the moratorium targeted Planned Parenthood's other services, including primary care and cancer screenings.

A federal judge blocked enforcement of the provision in response to a lawsuit from Washington Attorney General Nick Brown and others. But an appeals court paused the lower court ruling pending an appeal from the Trump administration.

Before the legal fight, Ferguson, a Democrat, committed to backfilling more than $11 million Planned Parenthood stood to lose in Washington without a year's worth of federal Medicaid reimbursements.

It's unclear how much the state has reimbursed the organization during the prohibition on Medicaid funding. Spokespeople for the governor's office and Planned Parenthood both said last week they were uncertain about the total.

The abortion tax is one of several ways Democratic state lawmakers are considering leaning on insurers for funding this year. They also have multiple proposals that would involve nonprofit health carriers or an insurance premium tax to pay for state subsidies for people getting insurance through the Exchange after the loss of federal tax credits.