The Patient Protection and Affordable Care Act (ACA) did not change state law on abortions and expressly allowed states to elect out of abortion coverage in qualified health plans offered through the Exchange if such state enacts laws to provide for such prohibition. It is on the Exchange where the ACA’s PTCs are triggered. 2016 saw 25 states banning abortion coverage on the Exchange, 6 states with no ban but no plans that offer coverage, 17 states plus DC with no ban at least 1 plan with coverage, and 2 states with no ban with all plans offering abortion coverage, according to the Kaiser Family Foundation.
While the ACA’s allowance of the prohibition of abortion coverage with respect to PTCs is state centric, the American Health Care Act (AHCA) would ban abortion coverage nationwide for RTCs. Under the AHCA, RTCs are assessed for each “eligible coverage month,” which requires the individual to be covered by “eligible health insurance” for that month. However, “eligible health insurance” excludes abortion coverage unless the cause of rape/incest or would endanger the life of the mother. In other words, if an individual has healthcare coverage that includes abortion coverage, that coverage would not be qualified as “eligible health insurance,” and thus disqualifying eligibility for RTCs.
The AHCA expressly precludes abortion coverage from such “eligible health insurance.”While the AHCA does not preclude an individual from purchasing separate abortion coverage or a healthcare plan with abortion coverage, that individual will not be entitled to any RTCs for such coverage or plan. Likewise, the AHCA does not preclude an insurer from offering a healthcare plan that includes abortion coverage. However, the premiums for such coverage or plan may not be paid for by RTC.
In other words, the AHCA would deny RTCs to any healthcare plan that has abortion coverage. Also, with the RTCs not slated to begin until 2020, the AHCA will have a more immediate impact on PTCs available for coverage under the current healthcare insurance marketplace as the same restriction against abortion coverage applies to PTCs.
