In five states, all QHPs cover abortions.

Many public exchange plan issuers may be failing to charge enrollees a separate fee for abortion benefits.

The Patient Protection and Affordable Care Act (PPACA) requires exchange qualified health plan (QHP) issuers that provide routine access to abortion benefits to charge separately for the benefits, to keep the plans from using PPACA subsidy money to pay for abortions.

Investigators from the U.S. Government Accountability Office (GAO) talked to 18 carriers that provide “non-excepted abortion benefits” through a total of 246 exchange QHPs. Only one was charging separately for abortion benefits, according to John Dicken, a GAO director.

The issuers said actual abortion claim costs ranged from about 10 cents per enrollee per month to $1.10 per enrollee per month.

Dicken summarized the investigators’ work in a QHP abortion benefits report sent to House Republican leaders.

PPACA includes an exception that lets QHP issuers use PPACA subsidy money to pay for abortions when a pregnancy is the result of rape or incest, or the life of the pregnant woman would be endangered if the abortion were not performed.

Twenty-three states limit QHPs’ ability to cover “non-excepted” abortions — elective abortions; 28 do not. In the 23 states with restrictions, 17 prohibit QHPs from covering any elective abortions, and six let QHPs cover elective abortions only in specified circumstances, such as circumstances in which continuing a pregnancy could cause irreversible harm to a pregnant woman’s body, Dicken says.

In the 28 states with no state restrictions on QHP coverage of elective abortions, eight states — Delaware, Illinois, Iowa, Minnesota, Nevada, New Hampshire, West Virginia and Wyoming — have no QHPs that cover elective abortions.

In 15 of the 28 states, some QHPs cover elective abortions, and in five of the states — Connecticut, Hawaii, New Jersey, Rhode Island and Vermont — all QHPs based in those states cover elective abortions. To get a QHP that does cover elective abortions in those states, a consumer must sign up for a multi-state plan based in another state.

The investigators found 1,036 QHPs in the 28 states that cover elective abortions and 1,062 QHPs in those states that do not cover elective abortions.

Although most of the issuers in the 18-issuer sample have been violating the PPACA abortion benefits premium rules, the issuer sample is a non-random sample, and the GAO cannot make any estimates for all QHP issuers based on the results from the sample, Dicken says.

Officials at the U.S. Department of Health and Human Services (HHS) said in a response that states and state insurance commissioners are responsible for enforcing the PPACA abortion benefits payment rules. 

HHS may have to do a better job of explaining the rules to states and issuers, HHS officials said.