RD107 - Evaluation of House Bill 1174: Mandated Offer of Insurance Plans Not Covering Induced Abortions Outside of Certain Exceptions


Executive Summary:
House Bill (HB) 1174 of the 2012 General Assembly Session would mandate health insurers to offer policies that do not provide coverage for abortion services outside of certain required exceptions. In particular, the bill would require that insurers that provide coverage for abortion services must also offer substantively identical policies that do not provide coverage for abortion services. The bill stipulates that any policy not covering abortion services must provide coverage for medical costs incurred in preserving the life of a pregnant woman as long as every possible measure is taken to save the life of the unborn child. It further requires that a policy that does not cover abortion services must reimburse the medical costs of treating previous fetal demise or intrauterine fetal death. In addition, an existing mandate may still require coverage of abortion services in cases of rape or incest.

MEDICAL EFFICACY AND EFFECTIVENESS

Medical and surgical abortions are the standard medical practices for terminating pregnancies, and the medical efficacy and effectiveness of these methods are well established. Clinical trials show that medical and surgical abortions achieve their intended outcome of terminating pregnancy with a high rate of success overall (approaching 100 percent). However, the efficacy and effectiveness of medical and surgical abortions vary by gestational age and, to some extent, the medication regimen and surgical method.

SOCIAL IMPACT

Approximately 25,000 women in Virginia received induced abortions in 2010. Of those, it is estimated that one to two percent of the abortions were performed in cases of rape, incest, fetal anomaly, or to preserve the life of the pregnant woman. Up to three-fourths of women nationwide who receive induced abortions in outpatient settings are estimated to pay for their abortions out of pocket (some may be reimbursed later by insurance). Because so many women pay out of pocket, not providing coverage outside of the exceptions listed above would not appear to cause a financial hardship for many. However, lack of coverage would cause more of a hardship for women receiving more costly second term abortions.

Based on a Bureau of Insurance survey, approximately 37 percent of insurers’ standard plans do not cover induced abortions outside of rape, incest, or to preserve the life of the pregnant woman. This option may become more widely available depending on Virginia’s implementation of the health insurance exchanges required by the federal Affordable Care Act (ACA). Legislation passed during 2011 indicated the General Assembly’s intent that plans sold through the exchanges not provide abortion coverage, and in February 2013, the Governor’s Office also indicated its interest in excluding abortion coverage from the exchanges.

FINANCIAL IMPACT

HB 1174 is not expected to significantly impact the cost or utilization of abortions, or the availability of abortion providers. As a result, HB 1174 is unlikely to have a direct measurable impact on premiums. The take-up rate for HB 1174 is not expected to be high and most women pay out of pocket for abortions. However, the mandate could result in more women carrying their pregnancies to term if their insurance does not cover induced abortions, which could lead to higher overall health care costs and higher insurance premiums.

BALANCING MEDICAL, SOCIAL, AND FINANCIAL CONSIDERATIONS

HB 1174 is not expected to be a costly health insurance mandate, but it does not appear needed. Although there is some documented unmet demand for health insurance policies in Virginia that do not include coverage for induced abortions (outside of the required exceptions), health insurers indicate that there are few requests for such policies. Further, plans exist in the current individual, small group, and large group markets that indicate they will provide these policies. An option may be for BOI to make available a list of plans that are willing to offer policies not covering abortion.