Trump-Pence Administration Issues Proposed Rule Designed to Eliminate Insurance Coverage of Abortion in the ACA Marketplace

Say NO to the Trump Administration's Latest Attempt to Ban Abortion Coverage

Each of us should have coverage for a full range of pregnancy-related care, including abortion. #CoverMyAbortion

The Trump administration is at it again. In trying to force burdensome, confusing regulations on consumers and private insurance companies, Trump and his ideologues are attempting once again to end health insurance coverage for abortion. 

  • The Proposed Rule would drastically expand the burdensome and arbitrary accounting requirements imposed on qualified health plans that cover medically necessary abortion. This would impose significant barriers on insurance companies and on consumers who need a comprehensive health plan that covers abortion.

  • These proposed barriers are likely to cause insurance companies to stop providing insurance coverage of abortion. Indeed, insurance issuers have said that barriers like the ones being proposed would be onerous and act as a strong disincentive to covering abortion.

  • The impact of the Proposed Rule could reach well beyond the marketplace, causing insurance companies to drop abortion coverage in other markets as well.

Let's be clear: these proposed regulations shame, stigmatize and financially burden people who have abortions. And it's time we tell the Trump administration once and for all to stop playing politics with our reproductive care. 

We have until January 8 to tell them NO on these unnecessary, burdensome regulations, so submit your comments today. 

We know that abortion coverage bans force people to delay care and can push people deeper into poverty. And we know the impact falls hardest on low-income people and people of color.  As we fight for gender equity, we have to fight back against attempts to control *certain* people's bodies and reproductive choices.

It's time the federal administration listens to us. Follow the instructions below to submit your comment:

  1. Go to regulations.gov

  2. Search “9922-P (or click here)

  3. Select “Comment Now!” and submit your comments

Your comments should tell the Trump administration why you are opposed to the proposed regulations. The comments should ideally include a personal story or testimonial about how these changes would hurt you or people you know. If you have any expertise or experience working with these regulations or people who would be negatively affected by the proposed regulations, you should say so. You can view the sample comments below to help you get started, but please make sure your comments are personalized so that they will each be read. Use your unique voice to express why this proposed change would be harmful.

Tips for for submitting your comments:

  • Identify yourself and your experience. Let the Trump administration know you are saying NO to its latest attempt to ban abortion coverage.

  • The administration is REQUIRED to read EVERY comment submitted. Comments that are cookie-cutter will be bypassed and overlooked so you want to make them as personal as possible.

  • If you are able, take a photo of your comments and submit them as an attachment. This also affects how they are accounted for by the administration.

  • DO upload your comments as a PDF and print out your receipt.

  • DON’T suggest corrective language or ways to improve the proposed rule.

Comments are due on January 8th by 5:00 PM EST


Gender Justice’s Statement to the Trump Administration

Dear Health and Human Services Secretary Alex M. Azar II and Centers for Medicare & Medicaid Services Administrator Seema Verma,

Gender Justice is a nonprofit legal and policy advocacy organization based in Minnesota committed to the eradication of gender barriers through impact litigation, policy advocacy, and education. We have worked extensively to promote and protect reproductive rights in Minnesota and vehemently oppose the Trump administration’s proposed changes to the Affordable Care Act, which effectively acts to limit abortion coverage. 

The proposed changes to the Affordable Care Act have one clear goal in mind: making insurance companies less likely to coverage abortion care, limiting access to abortion. By forcing qualified health plans to send separate bills and receive separate payments, it essentially doubles the work of the insurance companies, but only with regards to abortion coverage. Once again, abortion care is siloed into a separate sphere for no reason. Abortion care is treated as an “other” procedure, rather than what it really is: healthcare. We have had a constitutional right to abortion care since 1973, and this administration’s thinly veiled attempts to limit that right will not go unchallenged.  

The proposed changes will affect some of the most vulnerable individuals in our society, making it less likely that they will get the healthcare that they need. If insurance companies drop coverage for abortion care, individuals will be forced to pay out of pocket for this care. This will negatively affect low-income individuals, who cannot afford such care without insurance coverage. It will compound the challenges faced by those living in poverty, and extend the intergenerational cycle of poverty. It will disproportionately affect women and members of the LGBTQ+ community, who depend on their bodily autonomy and right to abortion care to fully participate in society and have control of their lives and futures.  

The proposed changes to the Affordable Care Act are a clear attempt to limit our right to abortion access – a right we have had for over 45 years. Gender Justice strongly opposes these attempts to limit our reproductive rights. The organization supports bodily autonomy, and the rights all of individuals to fully participate in society. The proposed changes to the Affordable Care Act undermine those rights and seek to impose a single vision on the world in which women, low-income individuals, and members of the LGBTQ+ community are continually marginalized and treated as second-class citizens. 

Gender Justice opposes the proposed changes to the Affordable Care Act and urges you to see them as they are: an attempt to restrict our fundamental rights. Gender Justice urges you to reject this proposal and respect reproductive rights in healthcare. 


AFFORDABLE CARE ACT (ACA) Facts

What the ACA Currently Does

  • It does not require insurance plans to cover abortions, but it also does not prevent plans from covering abortions

  • It is up to the states and then the qualified health plans as to whether abortion is covered by insurance plans

  • The Hyde Amendment prohibits federal money from being used to fund abortion care outside of rape, incest, and life endangerment

Current State of Insurance Plans

  • 26 states allow for abortion coverage

  • Four states require abortion coverage: California, New York, Oregon and Washington

  • Due to the Hyde Amendment, plans must segregate funds into two accounts:

    • One account for payments for all services for which federal funding is available

    • A second account for payments for abortion services beyond rape, incest, and life endangerment

Proposed Changes

  • The qualified health plans must…

    • Send an entirely separate monthly bill for only the portion of the premium related to the non-exception abortion services

      • This requires separate billing, mailing, and postage (or separate electronic communications, if done online)

    • The enrollee must also pay this premium in separate transactions

Impact

  • This will make it much more difficult for insurance companies to cover abortion care — and that’s the goal: to end coverage for abortion

  • The proposed changes create additional hurdles that insurance providers must jump through in order to provide coverage for abortion care

  • For insurance companies that choose to maintain abortion coverage, it will likely make payment more confusing for the consumer


Sample Language to Use When Submitting Your Comments (provided by All* Above All)

SAMPLE 1

Dear Health and Human Services Secretary Alex M. Azar II and Centers for Medicare & Medicaid Services Administrator Seema Verma,  

The proposed rule is the latest attempt by the Trump-Pence administration to take away abortion coverage, this time targeting people who purchase their health insurance through the Affordable Care Act Marketplaces. I urge you to reject the rule, as this will do nothing but force more people to delay care, stop women from getting abortions, and can push people deeper into poverty. In fact, studies show that when a woman is denied abortion care, she is more likely to fall into poverty than someone who is able to get the care she needs. The proposed rule will shame, stigmatize and financially burden women who have abortions. And that burden will fall hardest on low-income families. Already, too many women do not have insurance coverage for abortion because of how much money they make or how they’re insured.  However someone gets their health insurance, each of us should have coverage for a full range of pregnancy-related care, including abortion.  

Reject this proposed rule now and stop playing politics with women’s reproductive health care. 

Sincerely, 

[NAME] 

SAMPLE 2

Dear Health and Human Services Secretary Alex M. Azar II and Centers for Medicare & Medicaid Services Administrator Seema Verma,  

 The proposed rule creates overly burdensome regulations for health insurance companies that may dissuade them from offering abortion coverage, not to mention cause confusion among consumers.  I urge you to reject this rule. Pregnancy-related care—including prenatal, maternity care, and abortion—is basic women’s health care and should be included in all insurance plans. When this rule sidelines abortion coverage, it is a threat to women’s health. By interfering with abortion coverage, this rule could force people to delay care, stop women from getting abortions, and can push people deeper into poverty. This is unpopular with the majority of Americans who agree that women should be able to make decisions about their health care with dignity and respect, and without interference. Too many women are already denied coverage for abortion because of how much money they make, and this new rule would only push abortion care out of reach for more women and their families. 

 Once again I urge you to reject this rule.  

 Thank you, 

[NAME] 

SAMPLE 3 

Dear Health and Human Services Secretary Alex M. Azar II and Centers for Medicare & Medicaid Services  Administrator Seema Verma,  

 The proposed rule places unnecessary, burdensome requirements on private insurers and will dissuade them from offering abortion coverage at all.  Reject the proposed rule now— it is yet another attempt by the Trump-Pence administration to ban insurance coverage for abortion. The Hyde Amendment already denies women who are insured through Medicaid coverage for their abortion, putting their economic security and well-being at risk.  This rule directly attacks those who get their health insurance through the Affordable Care Act’s Marketplace and could push care out of reach for even more people. Each of us should have coverage for a full range of pregnancy-related care, including abortion, whether we have private or government-funded health insurance. 

Again, I urge you to reject this proposed rule now and stop playing politics with women’s reproductive health care. 

 Sincerely, 

[NAME] 

Additional state-specific sample comments:  

The proposed rule could have different impacts on insurance companies and consumers in different states,  

depending on the current laws, regulations, and practices surrounding abortion coverage in the state. If you would like to share a grassroots comment with your list on the specific impact these rules might have on the state you live in you can choose from the following language:  

States without a ban, but the state marketplace does not offer a plan that covers abortion (Minnesota, Nevada, Wyoming, Iowa, West Virginia, and Delaware):  

The residents of my state already have a hard time accessing the coverage we need for our reproductive health care. We currently lack the ability to choose an insurance plan that covers abortion care even when we want to, and this regulation only further jeopardizes our ability to access that coverage in the future. The proposed rule could halt any progress our state is trying to make to encourage providers to cover abortion care. 

For states that mandate coverage or have strong guidance from regulatory agencies that coverage should  include abortion (California, Maryland, Massachusetts, New York, Oregon, Washington):  

The lawmakers, voters, and residents of my state have already decided what is best for us – making sure that everyone in  our state has coverage for all our reproductive health needs including abortion. These regulations go against what our state has already decided for itself, would place a huge burden on our consumers and insurers, and could jeopardize our ability to access coverage for the care we need. 

 States with widespread coverage of abortion in their insurance plans (Alaska, Colorado, Connecticut, District of Columbia, Hawaii, Illinois, Maine, Montana, New Hampshire, New Jersey, New Mexico, Rhode Island, Vermont):  

 The consumers and insurers of my state already know what’s important to us – making sure that we have access to insurance plans that cover all our reproductive health needs including abortion. These regulations would place a substantial burden on the huge number of people in my state that currently choose to purchase insurance that covers abortion and could jeopardize our ability to make that choice for ourselves.   

States with no coverage or a ban on abortion coverage in their state (all others):  

The residents of my state already have a hard time accessing the coverage we need for our reproductive health care. We currently lack the ability to choose an insurance plan that covers abortion care even when we want to, and this regulation only further jeopardizes our ability to access that coverage in the future.