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Qualified Health Plans Providing Non-excepted Abortion Services as a Covered Benefit for 2014

GAO-14-742R September 15, 2014

The Patient Protection and Affordable Care Act (PPACA) requires insurance plans offered in health insurance exchanges—known as qualified health plans (QHP)—to cover a package of essential health benefits. While this package does not include abortion services, PPACA does not prohibit private health plan issuers from covering those services in QHPs as long as that coverage complies with federal and state law. Federal law applicable to QHPs for the 2014 benefit year prohibits the use of federal funds made available to offset the cost of QHP coverage to pay for abortion services except where the pregnancy is the result of an act of rape or incest, or the life of the pregnant woman would be endangered unless an abortion is performed. QHPs may cover abortion services that do not meet that exception (referred to as non-excepted abortion services), but state law may restrict the circumstances under which coverage can be provided.

The map shows whether state laws restrict coverage of non-excepted abortion services in 2014. In states where coverage of such services is not restricted, you can hover over each state in the map to see whether all, some, or no QHPs in that state cover non-excepted abortion services. You can also click on the map to access a table you can sort showing these data by state and issuer within the 28 states where coverage of non-excepted abortions services is not restricted (Show Data Table). Additionally, you can download the full data set (.CSV), which identifies non-excepted abortion services coverage for each QHP within those 28 states.

Show Map
State law does not permit the coverage of non-excepted abortion services.
State law permits the coverage of non-excepted abortion services only in limited circumstances.
No QHPs in state cover non-excepted abortion services.
Some QHPs in state cover non-excepted abortion services.
All QHPs in state cover non-excepted abortion services.

Download the full dataset: .CSV

Source: GAO analysis of state law and of information obtained from the Centers for Medicare & Medicaid Services, states, private issuers, and from the Office of Personnel Management. | GAO-14-742R

Note: See Enclosure I of GAO-14-742R for a complete listing of states with laws restricting the circumstances under which abortion services can be covered.

About this Report: This figure is a part of Health Insurance Exchanges: Coverage of Non-Excepted Abortion Services by Qualified Health Plans, GAO-14-742R.

About this Methodology: To obtain the information we present here, we contacted every state to determine whether states had laws restricting the circumstances under which abortion services may be provided as a covered benefit by QHPs in 2014. Based on our review of those laws and relevant federal requirements, we determined that 23 states have laws restricting the circumstances under which non-excepted abortion services may be provided as a covered benefit by QHPs for the 2014 benefit year. In order to report on whether non-excepted abortion services are covered by QHPs within the 28 states with no laws restricting such coverage in 2014, we collected data from the Centers for Medicare & Medicaid Services, within the Department of Health and Human Services, the agency responsible for overseeing the establishment of health insurance exchanges; private issuers of QHPs; state departments of insurance and state exchange organizations; and from officials at the Office of Personnel Management. While these sources have different characteristics and limitations, we have determined that, when taken together, they are reliable for the purpose of indentifying which QHPs do and which do not provide non-excepted abortion services coverage in 2014 within the 28 states with no laws restricting such coverage. See Enclosure II of GAO-14-742R for a detailed description of GAO’s scope and methodology.