Payers Respond to SCOTUS Overturning Abortion Rights Case

June 24, 2022 - Updated 6/28/2022: This article has been updated to include statements from the Association for Community Affiliated Plans (ACAP), Robert Wood Johnson Foundation, and the American Benefits Council.

Payers and healthcare leaders are responding to the Supreme Court’s decision to overturn Roe v Wade, the case which protected abortion rights at the federal level, and while the repercussions remain uncertain many healthcare leaders are voicing their commitment to helping women navigate the impacts.

In deciding the case Dobbs v. Jackson Women’s Health, the Supreme Court ruled that the Constitution does not protect the right to abortion and overruled the original decision in the Roe v Wade case. With the case overturned, the authority to determine abortion rights returned to the states.

“The Supreme Court decision in Dobbs v. Jackson Women’s Health represents a fundamental change in the way abortion services are regulated in the United States,” David Allen, an AHIP spokesperson, told HealthPayerIntelligence in an emailed comment.

“Health insurance providers have long worked with partners across the country to support and promote women’s health. We remain committed to working with federal officials, state policymakers, employer customers, and local health care leaders to provide coverage options that best meet the local needs, rules, and regulations in states and communities across the country.”

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Healthcare leaders have started to assess what the downstream implications that this case could have for health insurance coverage of abortions.

Doniella Pliss, a director of the health insurance ratings team at AM Best, said in an emailed statement that abortions are already regulated at the state level. While some states have already banned private payers from covering abortions, most have not banned coverage for the procedure.

“From a cost standpoint, abortion is not very frequent and relatively inexpensive procedure,” Pliss explained. “The potential decline in number of covered abortions is not likely to impact the overall cost materially.”

Pliss did not anticipate that the decision would have a major impact on self-funded plans.

“Time will tell as to the impact of the Supreme Court decision on the coverage issue,” Pliss acknowledged. 

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“Maybe more states will ban the abortion coverage, but on the other hand, more states could mandate coverage. Additionally, multi-state employers already have to comply with different states regulations of the coverage. Some progressive employers have discussed offering abortion assistance to their employees who live in the states with abortion restrictions. It is not clear how that would be carried out—through health coverage or just through direct reimbursement.”

CMS Administrator Chiquita Brooks-LaSure issued an emailed statement in response to the decision, focusing on women’s health.

“A woman’s right to make decisions about her health is essential. As we review today’s Supreme Court decision, as the Administrator of the Centers for Medicare & Medicaid Services, I will do everything in my authority to ensure that people have the choice of when and how to start a family,” Administrator Brooks-LaSure said.

“Today, more than 150 million people are served by Medicare, Medicaid and CHIP, and the Affordable Care Act, including more than 80 million women and girls. To you I say: CMS will continue working to maintain and expand access to the full range of reproductive health care services across the lifespan—that includes IUDs, emergency contraception, oral contraception, other forms of contraception, and abortion care within our legal authority. It is our fundamental value that reproductive health care is critical to ensuring that everyone can build healthy lives with economic security.”

Margaret A. Murray, chief executive officer of the Association for Community Affiliated Plans (ACAP), voiced the safety net health plan organization's support for more measures to protect access to contraception and other reproductive health services.

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“Access to contraceptives and family planning services are imperative for people to have autonomy over their reproductive health," Murray said in a public statement.

“ACAP supports the Administration's efforts to ensure equitable access to contraception and family planning services. Safety Net Health Plans are--and remain--committed to providing contraception at no cost in accordance with the Affordable Care Act, other Federal law, and the Administration’s guidelines."

Some organizations have been more vocal in criticizing the Supreme Court's decision. Richard Besser, MD, president and chief executive officer of the Robert Wood Johnson Foundation, stated that the decision has implications for health equity in states that have banned abortion and expressed concerns about the potential ramifications for access to contraception.

"Dobbs joins the annals of major Supreme Court decisions for all the wrong reasons," Besser said in a public statement. "This decision is another injustice to the core health equity principles of respecting individual autonomy regarding healthcare decisions and preserving access to the full array of reproductive healthcare services. As a Foundation focused on building a Culture of Health where every person has a fair and just opportunity for health and wellbeing, we believe unequivocally that individuals seeking reproductive healthcare deserve to be seen, heard, represented, cared for, and supported—and that policies at all levels of government should reflect those principles in action.” 

The decision has implications for employers as well, as employers who would want to cover abortion and reproductive health services in states where abortion is now banned will have to find new ways to offer access. The American Benefits Council shared that employers have a number of factors to consider such as designing medical travel benefits for receiving abortions outside of the state, predicting the role of ERISA, and changing pharmacy benefits.