Abortion coverage restricted in high-risk insurance pools

A new regulation issued by the Department of Health and Human Services on Thursday clearly prohibits state high-risk pools from covering elective abortions.

“The (high-risk pool) program,” the regulation states, “is Federally-created, funded, and administered (whether directly or through contract); it is a temporary Federal insurance program in which the risk is borne by the Federal government up to a fixed appropriation. As such, the services covered by the PCIP [Pre-existing Condition Insurance Plan] program shall not include abortion services except in the case of rape or incest, or where the life of the woman would be endangered.”


An HHS spokeswoman on July 14 said the department would be issuing guidance to states setting up the pools regarding the restrictions. But Senate Republicans, armed with a report from the Congressional Research Service, said Wednesday that statement was insufficient. The senators had given HHS until Friday to issue more restrictive regulations.

“Much has been made of this policy by both sides of the debate,” White House Office of Health Reform Director Nancy-Ann DeParle said on the White House blog Thursday morning. “But, in reality, no new ground has been broken. The program’s restriction on abortion coverage is not a precedent for other programs or policies given the unique, temporary nature of the program and the population it serves. It does not restrict private insurance choices and the implementation of the Affordable Care Act will continue to be guided by the law and the President’s Executive Order.”

The pools are created by the healthcare reform law and are funded by the federal government. Their goal is to cover people with pre-existing conditions who can’t find affordable health insurance until an overhaul of the insurance industry in 2014 prohibits health plans from discriminating against sick people.

The new regulation also describes the options for determining who has a pre-existing condition, how to verify citizenship, and how an individual can appeal a high-risk pool decision, according to DeParle. It also details how federal funding will be allocated, how to prevent ‘dumping’ of already-insured people into the program and strategies for preventing fraud.

The regulation also lists the benefits that can and can’t be covered under this temporary federal program, DeParle said. Covered benefits include hospitalization, outpatient care, maternity care, and hospice and home health care.

The regulation is an interim final rule that opens a 60-day comment period.