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Proposal would require private insurers to cover abortions

State lawmakers will be asked this session to require private insurance plans to cover abortion, a mandate that likely would be the first of its kind in the nation.

By Jonathan Martin and Carol M. Ostrom, The Seattle Times
State lawmakers will be asked this session to require private insurance plans to cover abortion, a mandate that likely would be the first of its kind in the nation.

Backed by abortion-rights advocates, the proposal would extend a 20-year-old mandate that insurance plans funded or administered by the state cover abortion if they cover maternity care.

The proposal, still in draft form, comes amid uncertainty about how the federal health-care overhaul, and restrictions on abortion funding, might affect abortion coverage in the state.

State and federal regulations are in play as the state prepares to set up a health-insurance exchange, a marketplace for buyers established by the 2010 federal health-care law.

Supporters of the proposal, including Rep. Eileen Cody, D-West Seattle, said legislation is needed to preserve abortion coverage.

“I don’t want us to go backward. We have a great pro-choice state right now, and I don’t want us to go backward,” said Cody, chairwoman of the House health-care committee.

Details are still being worked out, but federal law requires state-run health-care exchanges to include at least one insurance plan — the federal employees plan — that does not cover abortion. That requirement could give Washington employers or individual buyers opposed to abortion an option.

A coalition of abortion-rights groups plans a news conference Sunday in Seattle to unveil the bill.

Abortions are already widely covered by health plans in the state, not only by the state-funded plans but by most private plans.

Even so, anti-abortion groups said the new proposal would be vigorously fought. “To mandate that we violate our conscience is tyranny,” said Dan Kennedy, CEO of Human Life of Washington. “There’s no subtle or soft way to put the truth.”

Tough issues

The Legislature has not had a full debate on abortion since Democrats gained abortion-rights majorities in the House and Senate. But this new proposal, also sponsored by Sen. Steve Hobbs, D-Lake Stevens, occurs as the Legislature is poised to tackle gay marriage, marijuana legalization and a roughly $1.5 billion budget deficit.

Washington voters approved Initiative 120 in 1991, guaranteeing a woman’s right to abortion and requiring health-insurance programs funded or administered by the state — such as Medicaid — to cover the procedure. Sixteen other states also allow public funding for abortion.

Because federal law bans federal money for abortions, the state uses its own funds to pay for the procedure for Medicaid recipients.

At least 12 states have passed legislation restricting or banning insurance coverage of abortions since the 2010 federal health-care overhaul, according to the National Conference of State Legislatures. Spokeswoman Megan Dorsch said her staff was unaware of any state that had mandated coverage.

Of the 24,279 abortions performed in Washington in 2008 (the most recent year data is available), about half were publicly funded, according to state data.

It is unclear how many private insurance plans cover abortion. Stephanie Marquis, spokeswoman for the state Insurance Commissioner’s Office, said all individual and small-group plans in Washington already cover abortion. She did not have information about coverage by self-insured plans, usually offered by large employers.

Spokespeople for several large insurers — including Regence and Group Health Cooperative — said most of their plans cover abortion but declined to discuss the proposal.

In general, insurers don’t like coverage mandates, but the state already has imposed 14 coverage requirements, including contraception, mammograms, prostate-cancer and colorectal-cancer screenings.

A state “conscience clause” law allows health-insurance plans sponsored by religious organizations to refuse to pay for abortion.

Backers

The new proposal is supported by Planned Parenthood Votes Northwest, NARAL Pro-Choice Washington and Legal Voice. Hobbs said the measure wouldn’t cause “much controversy” because most private insurers already cover abortion, and the issue of state funding was settled with Initiative 120.

“We’re not talking about ending a health-care benefit, or adding one that is not already there,” said Hobbs. “It is ensuring what is already there.”

At this point, nobody knows quite how federal and state laws will affect private health insurers.

Federal funds will subsidize insurance coverage for low-income people who buy insurance on the exchange. But the federal ban on payments for abortion could conflict with Initiative 120’s requirement that state-administered plans cover abortion if insurance plans offered on the exchange are considered to be administered by the state, said Jonathan Seib, health-policy adviser for Gov. Chris Gregoire.

Potentially, the federal government could withhold a portion of the subsidy, said Seib. Given the uncertainty, as well as the state’s history of supporting abortion rights, advocates say a clear mandate — that abortion must be covered if insurance covers maternity — is the simplest solution.

And extending the mandate to all insurance plans, including private insurance, is necessary to maintain consistency of coverage, cost and access across economic classes, said Dana Laurent, political director for Planned Parenthood Votes Northwest.

“We want to ensure equity of all health care, whether it’s inside or outside the exchange,” said Laurent. “That certainly goes for a medical procedure as common as abortion.”

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