Rhode Island health insurers must offer plans that do not cover abortion under new requirements in the state’s recently passed fiscal 2016 budget. The changes, signed into law late last month by Gov. Gina Raimondo, have raised concern among women's healthcare proponents who fear the new language will restrict women's access to abortion.

While the new provisions that apply to companies selling insurance through the state healthcare exchange are more strict than federal stipulations laid out in the Affordable Care Act, they do not violate federal policy.

Still, the requirements are a departure from the state's previous approach to abortion coverage, activists said.

“We absolutely see this as new abortion restrictions,” Jamie Rhodes, director of public policy in Rhode Island for Planned Parenthood, said. “Rhode Island insurers never before had a mandate not to cover abortion. Now they’re being forced not to.” He said the new language undermined the very concept of access to abortion, which he called “a core value” of Rhode Islanders.

How the law will play out remains to be seen, but it's possible that some Rhode Island insurers, in an attempt to avoid the trouble of offering so many insurance plans, might simply withdraw abortion-inclusive plans altogether. “There is nothing stopping them from doing that, in the law,” Rhodes said. “That is a particular fear we have,” he added.

Rhode Island's new rules are more rigid than what federal law demands. Under the Affordable Care Act, state marketplaces must offer by 2017 at least one multi-state plan that does not cover abortions, except for those that are medically necessary or in the cases of rape and incest. 

“At least one plan variation for individual market plan designs offered on the exchange at each level of coverage … at which the carrier is offering a plan or plans, shall exclude coverage for abortion services," the Rhode Island budget reads.

The state’s insurance exchange, under which 31,513 Rhode Islanders bought coverage in 2015, offers four tiers of coverage — gold, silver, bronze and catastrophic — through three companies. Just under 50 percent each enrolled through Blue Cross & Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island, while 3 percent bought plans with UnitedHealthcare, according to official data as of Feb. 23.

Under the new regulations, for every tier at which each company offers health insurance coverage, it must also offer at least one plan that will not cover abortion, under what the budget describes as a religious exemption variation. That means if Blue Cross previously sold gold and silver plans that covered abortion, now it must sell at least one gold and one silver plan that do not, for instance.

“It leads to more questions. How will this be implemented on the exchange? For every plan on the exchange, will there be an asterisk?” said Rhodes of Planned Parenthood.

532535116_a76ca418aa_b Access to abortion could be restricted in Rhode Island. Photo: Creative Commons/Taber Andrew Bain

The new mandates are contained in an article of the budget, signed into law June 30, that also legally set up Health Source RI, the state’s health insurance exchange previously established by executive order. Prior to the budget’s passage, HealthSource RI did offer one plan excluding abortion coverage, which began earlier this year. In January, an anonymous man who was opposed to abortion sued the exchange for failing to provide such an option. Two weeks later, the exchange began offering a plan that did not cover abortion, which it had planned to do even before the lawsuit was filed, Maria Tocco, a HealthSource spokesperson, told the Providence Journal. But that plan was only offered at a bronze level, one of the three major tiers available to purchasers of health insurance, the Journal reported.

Abortion rights activists said they were blindsided by the new rules. Rhodes said that Planned Parenthood, whose political arm supported Democratic Gov. Gina Raimondo's 2014 election campaign, was not aware of the language until June 1, a week before voting began. Raimondo identifies as "clearly pro-choice."

The Rhode Island House of Representatives unanimously passed the $8.7 billion budget on June 16. A Senate Committee endorsed it the next day, and less than a week later, the full Senate voted 35-3 in favor of the budget. Raimondo signed the budget into law just in time for the fiscal year starting July 1.

"The governor remains committed to providing quality, affordable healthcare, including access to reproductive services. Federal law requires that state-based exchanges offer individuals a choice of health insurance plans that exclude coverage for elective abortion by 2017," Tocco told International Business Times Wednesday. "Rhode Islanders purchasing coverage through HealthSource RI will have access to both comprehensive coverage and coverage that excludes elective abortion services," she added.