Each year, the Centers for Medicare and Medicaid Services releases a Notice of Benefit and Payment Parameters, a proposal which establishes rules governing qualified health plans issued through the Affordable Care Act’s insurance marketplace. Buried within this massive, 331-page proposed rule is a new requirement that insurers offering plans covering abortion care through the exchanges must also offer a mirror plan that does not cover abortion care. This proposal was clearly designed to discourage and, ultimately, to eliminate private insurance coverage of abortion. Resulting increases in costs and administrative burdens will incentivize insurers to drop abortion coverage entirely rather than spend millions to comply with the new requirement, a fact the proposed rule itself openly acknowledges. What’s more, the proposal blatantly violates a section of the Affordable Care Act guaranteeing that insurers offering marketplace coverage can decide for themselves whether to cover abortion. Comments on the proposed rule are accepted through February 19, 2019.
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Re: Docket No. CMS-2019-0006-0016: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020
Dear Secretary Azar and Administrator Verma:
I am writing in response to the Centers for Medicare and Medicaid Services Notice of Benefit and Payment Parameters to express our strong opposition to the proposed rule relating to segregation of funds for abortion services as published in the Federal Register on January 17, 2019. The proposed rule incentivizes insurers to withhold abortion coverage in order to avoid millions of dollars in costs and administrative hurdles that would result from offering additional “mirror plans.” We urge that this proposal is withdrawn in its entirety, and that clear Congressional intent that insurers offering marketplace coverage can decide for themselves whether to cover abortion be upheld.
The National Council of Jewish Women (NCJW) is dedicated to improving the quality of life for women, children, and families and safeguarding individual rights and freedoms. Protecting reproductive health, rights, and justice is at the forefront of NCJW’s work across the country. We have 125 years of experience in being a leading voice for justice in the United States. Our core principle that “individual liberties and rights guaranteed by the Constitution are keystones of a free and pluralistic society and must be protected and preserved” guides our work to ensure access to safe, legal abortion and to eliminate obstacles that limit reproductive freedom. NCJW endorses and resolves to work for laws, policies, and programs that protect every woman’s right and ability to make reproductive and childbearing decisions.
Our Jewish values teach us to pursue justice for all. We must not stand idly by while barriers to health
care — including abortion at any and all stages of pregnancy — place any individual’s autonomy, health, economic security, or well-being at risk. We must heed this call, especially for the most marginalized who face structural barriers, such as racism, classism, and ableism, to exercising their human rights. Abortion coverage bans amplify these existing health disparities and disproportionately impact low and moderate income individuals and communities of color.
NCJW believes that every woman, regardless of her income, insurance, or other factors, should have comprehensive insurance coverage for the full range of her reproductive health care needs, including abortion, so she can make personal decisions about her body, health, and future per her own religious beliefs and circumstances. Yet the proposed rule will lead insurers to drop abortion coverage entirely rather than face the increased costs and administrative burdens necessary to comply with the mirror plan requirement, a fact the proposal itself openly acknowledges. What’s more, the proposed rule blatantly violates Section 1303(b)(1)(A)(ii) of the Affordable Care Act by mandating that plans do not offer abortion coverage as well as Section 1321, which guarantees state flexibility in the operation and enforcement of the exchanges.
The Centers for Medicare and Medicaid Services should immediately withdraw its current proposal and dedicate its efforts to advancing policies that ensure all women have access to basic health care — including abortion — regardless of how much they earn, where they live, or how they are insured.