Attorneys General Bonta and James Lead Coalition Supporting the Biden Administration’s Work to Undo Trump's Harmful Rule Requiring Separate Abortion Billing

Thursday, July 29, 2021
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Eleven attorneys general submitted a comment letter supporting the reversal of Trump’s 2019 Rule that violated Section 1303 of the ACA

OAKLAND – California Attorney General Rob Bonta and New York Attorney General Letitia James, leading a coalition of 11 state attorneys general, submitted a comment letter to the U.S. Department of Health and Human Services (HHS) in support of the Biden Administration’s Proposed Rule that will reverse the previous administration’s harmful changes to the compliance requirements of Section 1303 of the Affordable Care Act (ACA). The Trump Administration’s 2019 Separate Abortion Billing Rule (2019 Rule) required insurers participating in the State Exchanges to send consumers two separate premium bills – one bill of at least $1 for abortion coverage and another bill for the remaining covered health benefits. Under the 2019 Rule, if consumers failed to pay the $1, they could potentially lose their coverage altogether. In the letter, the attorneys general urged the administration to finalize a rule that is more consistent with Section 1303 by eliminating the option that allows insurers to separately bill for the portion of health insurance premiums attributable to abortion coverage.

“In California, we protect access to quality healthcare, including women’s reproductive care,” said Attorney General Bonta. “The 2019 Rule attempted to throw up barriers to abortion coverage and put individuals at risk of completely losing their health insurance. That was an unacceptable risk, especially as 2020 confronted us with a global pandemic that endangered the health of our nation. We applaud the Biden Administration for seeking to undo the harms of the 2019 Rule, and ensure the ACA operates as intended: to provide Americans more access to quality, affordable healthcare.”

Under California law, all health plans are required to provide abortion coverage as part of consumers’ basic healthcare benefits. The 2019 Rule would have disrupted California's market operations, because requiring insurers to send separate bills for abortion coverage and forcing consumers to make separate payments of at least $1 for these services would have resulted in onerous and costly administrative changes. The Trump Administration admitted that requiring separate bills and separate payments would lead to consumer confusion, putting more than 1.4 million enrollees in California alone at risk of losing coverage if they inadvertently failed to make full premium payments on time. 

In January 2020, the Offices of the California and New York Attorneys General co-led a multistate coalition that included Colorado, Maine, Maryland, Oregon, Vermont, and the District of Columbia, in filing a complaint challenging the legality of the 2019 Rule. The lawsuit argued that the 2019 Rule was unreasonable, incompatible with the ACA’s protections and compliance requirements of Section 1303, and disproportionately affected States like California and New York that are committed to ensuring access to comprehensive reproductive healthcare. The coalition’s efforts were successful and last July the District Court for the Northern District of California vacated the 2019 Rule.

In its support for HHS’s Proposed Rule, the coalition commented that the Proposed Rule will protect consumers' health insurance coverage. The COVID-19 pandemic caused many Americans to lose both their jobs and their health coverage. Now, as individuals and families enroll in health insurance through special enrollment periods, the Proposed Rule will ensure their coverage is not again put at risk.

Attorney General Bonta and Attorney General James were joined in submitting the comment letter by the attorneys general of Colorado, Illinois, Maine, Maryland, Massachusetts, Oregon, Vermont, Washington, and the District of Columbia. 

A copy of the letter is available here.

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