Supreme Court's Roe v. Wade decision could affect health insurance coverage
Twenty-five states have restrictions on coverage of abortion, while in the others insurance carriers determine what their plans will include.
Photo: Mike Kline/Getty Images
Today's Supreme Court ruling striking down Roe v. Wade has implications for health insurance coverage, according to healthinsurance.org.
The 6-3 ruling that unwinds close to 50 years of a woman's right to an abortion now leaves that decision to individual states. An estimated half of them already have abortion restrictions in place or are expected to implement restrictions.
"With Roe v. Wade overturned, abortion access will vary more sharply from one state to another," said Louise Norris, an analyst with healthinsurance.org said in a statement. "State-level variations were already the norm for health insurance coverage of abortion, particularly for health plans purchased by individuals and small groups. States that will now ban abortions were generally the same states that already prohibited abortion coverage on health plans purchased in the exchange or even on all private state-regulated health plans."
For the time being, she said, most health plans in all states will continue to provide coverage for FDA-approved female contraception, including sterilization, long-acting contraception (IUDs and implants) and emergency contraception.
WHY THIS MATTERS
There is a wide variation in how states regulate health insurance coverage, healthinsurance.org said.
Twenty-five states have restrictions on health coverage of abortion. In the other states insurance carriers determine whether their plans will include coverage.
Six states – Oregon, New York, California, Washington, Illinois and Maine – require all state-regulated health insurance plans to cover abortions. In three of these – 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, co-pays and coinsurance.
There isn't likely to be a major change in how abortion is covered under health plans sold in Affordable Care Act marketplaces, Norris said.
THE LARGER TREND
The Supreme Court on Friday overturned 49 years of a women's right to an abortion in siding with Mississippi Department of Health Officer Thomas E. Dobbs in Dobbs v. Jackson Women's Health Organization.
In the 6-3 decision, Justice Samuel Alito wrote the opinion for the majority: Chief Justice John Roberts and Justices Neil Gorsuch, Brett Kavanaugh, Amy Coney Barrett and Clarence Thomas. Justices Stephen Breyer, Sonia Sotomayor and Elena Kagan, dissented.
Alito said the Constitution does not confer a right to an abortion. Regulating abortion is now a decision that goes back to the states, he said.
The Supreme Court case pivoted on Mississippi's Gestational Age Act, which generally prohibits abortion after the 15th week of pregnancy – several weeks before a fetus is regarded as viable outside the womb.
Chief Justice John Roberts said the question in Dobbs v. Jackson Women's Health Organization is whether all pre-viability prohibitions on elective abortions are unconstitutional.
"In urging our review, Mississippi stated that its case was 'an ideal vehicle' to 'reconsider the bright-line viability rule,' and that a judgment in its favor would 'not require the Court to overturn' Roe v. Wade, and Planned Parenthood of Southeastern Pa. v. Casey. Today, the Court nonetheless rules for Mississippi by doing just that."
In dissenting, Justices Breyer, Sotomayor and Kagan said of the ruling, "It says that from the very moment of fertilization, a woman has no rights to speak of. A state can force her to bring a pregnancy to term, even at the steepest personal and familial costs. An abortion restriction, the majority holds, is permissible whenever rational, the lowest level of scrutiny known to the law. And because, as the Court has often stated, protecting fetal life is rational, States will feel free to enact all manner of restrictions. The Mississippi law at issue here bars abortions after the 15th week of pregnancy. Under the majority's ruling, though, another state's law could do so after ten weeks, or five or three or one – or, again, from the moment of fertilization."
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
