North Carolina is poised to prohibit private insurance companies from covering customers who decide to have abortions if their policies are purchased through a health insurance marketplace.
Limiting private coverage of abortion is allowed under the federal health overhaul law requiring nearly everyone to buy insurance or pay a fine, and more than 20 other states have already decided to do so.
Legislation aiming to further restrict abortion in North Carolina includes a ban on covering the procedure when it's elective in private policies sold on the new online marketplace. The House and Senate passed a pair of competing measures, and negotiations are under way over final language.
The 2010 health care overhaul law requires states to have websites where households and small businesses can shop for private health insurance. Individuals can shop for their own coverage through the exchanges and could receive government subsidies based on their income. Consumers can start shopping in October for coverage that begins in January.
North Carolina, like many states where Republican opposition to the health care law continues, opted against setting up an exchange. The federal government will run the state's exchange instead.
But the federal law that created the insurance marketplaces also allows states to prohibit abortion coverage in health insurance policies offered through them. Anyone wanting coverage for most abortions would need to purchase that coverage separately, outside the marketplace. Abortions that follow rape or incest or if deemed necessary to preserve the mother's life would be covered by policies sold on the exchange.
The federal law also sets up a mechanism requiring insurance plans that offer abortion coverage to charge beneficiaries separately, and those funds would have to be kept in a separate account from taxpayer money like government subsidies that help people buy health insurance. That wasn't satisfactory for North Carolina Republicans who have written the state abortion legislation.
"Under the Affordable Care Act, direct funding for abortions is prohibited. However, through these segregated funds that can be used in the plans, you have taxpayer funds that are indirectly going to be funding abortions unless the state opts out of that," said Rep. Jacqueline Schaffer, R-Mecklenburg.
Blue Cross and Blue Shield of North Carolina controlled more than 80 percent of the individual insurance market, the U.S. Health and Human Services Department said last year. Blue Cross does not cover abortion, pregnancy or delivery in its standard plans, company spokesman Lew Borman said. Those procedures can be covered by purchasing an additional maternity rider, he said.
Based on company filings with the state, some of the seven Blue Cross individual and group policies submitted to the N.C. Insurance Department for potential listing on the exchange included abortion coverage. The state reviews policies to make sure they comply with laws and regulations that govern what's marketed in North Carolina, then they're reviewed by the federal marketplace operators to make sure they meet further standards.
Two smaller insurers also have submitted individual policies to the Insurance Department for potential inclusion in the exchange. Coventry Health Care of the Carolinas Inc. filed two policies for individuals that do not cover elective abortions, said Aetna spokesman Walt Cherniak. Aetna acquired Coventry in May.
FirstCarolinaCare Insurance Co. filed one policy for individuals that specifically excludes abortion and one that makes no mention of the term, according to company filings. Company representatives did not respond to requests for comment about the policies.
A final list of available policies is expected to be published by the time open enrollment starts Oct. 1.
In the abortion legislation pending in the General Assembly, other elements would direct state health regulators to change abortion clinic rules so they're similar to those for ambulatory surgery centers. Any medical professional could refuse to participate in an abortion based on conscience, a right that now applies to doctors and nurses.
County and local governments would be prohibited from covering abortions beyond the exceptions for rape, incest or preservation of a mother's life. Insurance policies for state employees and teachers already have those limits. The federal government also excludes insurance coverage for abortions except in the same circumstances.
By the end of June, 22 states had moved to restrict abortion coverage available through the marketplaces, according to the Guttmacher Institute, which tracks restrictions on abortion rights.
Supporters say the health exchange provision is consistent with North Carolina's longstanding ban on prohibiting taxpayer support for elective abortions. Critics say it is an example of anti-abortion advocates trying to limit others from making the right choice for their lives.
"They're picking and choosing what women are able to buy health insurance for. This is a woman buying a health plan with her own money," said Adam Searing, a health care advocate for the liberal-leaning North Carolina Justice Center. "This jus