Senator Maria Cantwell's office issued the following earlier today:
01.09.19
Cantwell, Democrats Call On Trump Administration to Rescind Proposal That Would Undermine Women's Health Care
Proposal Would Burden Women Seeking Coverage for Reproductive Care With Cumbersome Billing Process
WASHINGTON, D.C. – This week, U.S.
Senator Maria Cantwell (D-WA) joined Democratic members of the House
and Senate, including U.S. Senator Patty Murray (D-WA) and Congresswomen
Barbara Lee (D-CA), Jan Schakowsky (D-IL), and Diana DeGette (D-CO), to
send letters to Secretary Alex Azar at the Department of Health and
Human Services (HHS) to express their grave concern about a proposed
rule from the Trump administration that would create new burdens for
women seeking insurance that covers comprehensive reproductive health
care.
The proposed rule would require insurers to send
two separate billing statements and instruct consumers to make two
separate payments. The duplicative billing process would increase
administrative complexity and could lead to people losing needed
coverage, including coverage for all health care services. The members
made clear the proposed rule goes against Congressional intent and would
jeopardize care for women across the country, and they urged the
administration to reverse course and rescind it.
“It is clear the proposed rule is intended to
eliminate insurance coverage of abortion. It is the latest
administrative action in a long line of attacks by the Trump-Pence
Administration to undermine access to comprehensive sexual and
reproductive health care, particularly abortion, and to sabotage the
health care system. The regulatory process is meant to implement the
laws that Congress passes, not to undermine them. This proposed rule
likely would result in a loss of coverage, furthering the
Administration’s goal of sabotaging access to health care, and in
particular, women’s access to health care. We strongly oppose finalizing
this rule and urge the Administration to reverse course and rescind the
proposed rule,” wrote the senators.
“Women have the right to make their own
decisions about their reproductive health. Barriers to abortion care
force women to delay care, resulting in unintended pregnancies and
unplanned births, which often times force families deeper into poverty.
For these aforementioned reasons, along with the fact that abortion care
is health care, we oppose this rule and urge you to withdraw it
immediately before it has the opportunity to cause harm to Americans
across the country,” wrote the House members.
The Senate letter was also signed by Senators
Richard Blumenthal (D-CT), Sherrod Brown (D-OH), Sheldon Whitehouse
(D-RI), Tammy Baldwin (D-WI), Maggie Hassan (D-NH), Jeanne Shaheen
(D-NH), Ed Markey (D-MA), Kirsten Gillibrand (D-NY), Ben Cardin (D-MD),
Dianne Feinstein (D-CA), Elizabeth Warren (D-MA), Chris Van Hollen
(D-MD), Bernie Sanders (I-VT), Patrick Leahy (D-VT), Catherine Cortez
Masto (D-NV), Tina Smith (D-MN), Brian Schatz (D-HI), Tammy Duckworth
(D-IL), Tom Carper (D-DE), Kamala Harris (D-CA), Bob Menendez (D-NJ),
Ron Wyden (D-OR), Amy Klobuchar (D-MN), Cory Booker (D-NJ), Jeff Merkley
(D-OR), Chris Coons (D-DE), Mazie Hirono (D-HI), Debbie Stabenow
(D-MI), Chris Murphy (D-CT), Gary Peters (D-MI), Chuck Schumer (D-NY),
and Michael Bennet (D-CO).
The text of the House letter is available HERE.
January 8, 2019
The Honorable Alex Azar II
Secretary
U.S. Department of Health and Human Services
Hubert H. Humphrey Building, Room 716G
200 Independence Avenue SW
Washington, DC 20201
RE: RIN 0938-AT53 Patient Protection and Affordable Care Act; Exchange Program Integrity
Dear Secretary Azar,
We write with grave concern about the potential
impacts of the regulation proposed on November 7, 2018, by the
Department of Health and Human Services (HHS) regarding the health
insurance marketplaces established under the Affordable Care Act (ACA)
and urge the Trump-Pence Administration to withdraw the proposed rule.
This proposed rule would substantially change the federal law around
health insurance coverage of abortion and would undermine access to
insurance coverage for abortion and other health care services, which
would run afoul of the clear Congressional intent of section 1303 of the
ACA. In addition, the proposed rule could confuse consumers, increase
their health care costs, and ultimately lead to consumers losing not
only abortion coverage, but health coverage in its entirety. HHS should
rescind the proposed rule and instead focus on expanding health care and
coverage options.
Congress clearly intended to allow insurers to offer a plan that includes abortion coverage
Section
1303 of the ACA establishes “special rules” that allow insurers to
decide whether to sell plans on the marketplaces that cover
abortion, while imposing accounting requirements plans must follow in
order to cover abortion beyond the limited exceptions included in the
harmful Hyde Amendment.
This
proposed rule contradicts Congressional intent, as its goal is to
eliminate insurance coverage of abortion. While section 1303 imposes
accounting requirements on plans that offer abortion coverage, the
proposed rule goes far beyond Congressional intent by requiring insurers
to send two separate billing statements or invoices for abortion
services and other health services, and instructing consumers to make
two separate payments.[1]
These requirements would increase the cost and burden of selling plans
in the marketplace that cover abortion outside of the limited instances
of rape, incest, and life-endangerment. The onerous nature of these
requirements could force many insurers to drop abortion coverage.
By
effectively forcing insurers to drop abortion coverage from marketplace
plans, the proposed rule runs counter to Congressional intent. During
the drafting of the ACA, and section 1303 specifically, Congress clearly
chose to allow insurers to continue to decide whether to cover
abortion, thereby preserving the ability of women across the country to
obtain insurance coverage of abortion. In fact, Congress explicitly
rejected proposals that would have eliminated insurance coverage of
abortion in the ACA marketplaces. For example, during the drafting of
and debate over the ACA, the House of Representatives initially passed a
bill that included a provision known as the “Stupak Amendment.” The
“Stupak Amendment” would have denied the use of federal subsidies for
any plan that included abortion coverage, effectively eliminating
insurance coverage of abortion in the marketplace.[2]
Ultimately, Congress rejected the Stupak Amendment and instead passed
section 1303’s “special rules” on abortion coverage to ensure plans
could be offered that include coverage of abortion. Further, following
the passage of the ACA, Congress has similarly rejected several
proposals that aimed to restrict abortion coverage in the marketplaces.
This proposed rule undermines Congress’s explicit intent and could
instead result in many insurers not covering abortion services due to
the burdensome requirements imposed on them.
The
separate payments requirement would increase costs and confusion for
consumers and would potentially lead to many consumers losing their
insurance coverage entirely.
The
Trump-Pence Administration has frequently justified their sabotage of
the health care system by citing a need to decrease health care costs
for consumers and reduce regulatory burden. Yet, this proposed rule
would clearly fail to achieve both those goals: it would increase costs
to consumers and impose additional burdensome requirements on patients
and insurers. In fact, the Trump-Pence Administration acknowledges the
proposed rule will burden consumers, estimating it will cost consumers
alone more than $30 million. This $30 million estimate does not include
the cost of consumers learning about the new billing and payment
requirements, or the cost consumers will incur if they lose abortion
coverage or coverage entirely. Additionally, the separate emails,
mailings, and the necessary consumer education would likely cost
insurers significantly more than the $1.6 million contemplated in the
proposed rule– costs that would certainly be passed on to consumers.[3]
Further, the proposed rule does not acknowledge that the federal and
state governments will need to devote additional personnel time and
resources to ensure compliance with the proposed rule’s complex
requirements.
The
proposed rule’s requirements would also result in consumer confusion.
Requiring one premium to be broken up into two separate bills goes
against industry practice. Consumers may not understand why they are
receiving a separate bill every month in addition to the rest of their
insurance bill, particularly when the second bill may be as little
as one dollar. As a result, some consumers may inadvertently fail to pay
the second, smaller bill, while others may fail to properly pay either
bill. A consumer who does not pay both bills in full could face loss of
coverage entirely. The proposed rule does nothing to prevent this
unnecessary loss of coverage from happening.
The
proposed rule is clearly intended to make it harder for women to access
abortion care and to prevent insurers from offering abortion coverage.
There is no reason to overhaul implementation of
Section 1303. It is clear the proposed rule is intended to eliminate
insurance coverage of abortion. It is the latest administrative action
in a long line of attacks by the Trump-Pence Administration to undermine
access to comprehensive sexual and reproductive health care,
particularly abortion, and to sabotage the health care system. The
regulatory process is meant to implement the laws that Congress passes,
not to undermine them. This proposed rule likely would result in a loss
of coverage, furthering the Administration’s goal of sabotaging access
to health care, and in particular, women’s access to health care. We
strongly oppose finalizing this rule and urge the Administration to
reverse course and rescind the proposed rule.
Sincerely,
cc: The Honorable Seema Verma
Administrator
U.S. Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244
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