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Originally published August 28, 2013 at 7:50 PM | Page modified August 28, 2013 at 8:39 PM

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Questions arise over coverage for abortion in Group Health plans

Because abortion coverage is not in individual health-insurance plans to be sold inside the state’s new exchange marketplace, the company would have to refile its plans for review by the insurance commissioner, and there isn’t time to meet a Sept. 5 federal deadline.

Seattle Times health reporter

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After Group Health Cooperative confirmed Tuesday that it has dropped abortion coverage in the individual health-insurance plans to be sold inside the state’s new exchange marketplace — but will provide access to elective abortion in its medical centers without extra cost — a number of questions arose.

The most obvious: If Group Health, as both insurer and medical provider, is going to pay for the abortions anyway, why doesn’t it just cover them in its plans?

The answer is, in short, that because abortion coverage is not in those plans now, the company would have to refile its plans and rates, which would then need to be reviewed by the state’s Office of the Insurance Commissioner (OIC).

That means any new filing would miss a key deadline. “Unfortunately, even if Group Health wants to fix their plans and add abortion coverage, there isn’t enough time to meet the federal deadline of Sept. 5,” said Stephanie Marquis, spokeswoman for the state insurance office, which reviewed and selected plans to be included in the exchange.

Under rules set for the Affordable Care Act, states are required to submit insurance plans certified for sale in the exchange to the Health and Human Services Department. For Washington, that deadline was extended this week to Sept. 5.

That still would not be enough time for Group Health to “refile all of their plans and rates with us and undergo a complete second review,” Marquis said. “The time constraints are simply too tight.”

Group Health says it plans to put into writing its plan to provide abortion access at no additional cost as soon as some “key operational decisions” are made.

So how did Group Health, long a supporter of reproductive freedom and access, get into this mess?

Rep. Eileen Cody, D-West Seattle, who happens to be a nurse at Group Health, provided a bit of insight into the behind-the-scenes reason, which has cost Group Health some support from some longtime advocates.

As Cody and others recalled, there was a bit of confusion when insurance carriers first turned in their exchange plans for review by the state insurance office. In light of what appeared to be unclear federal regulations governing federal money and spending on abortion, two insurers — not Group Health — initially didn’t include abortion coverage.

Federal money is involved, because under the Affordable Care Act, people who buy insurance through the online exchanges could be eligible for federal subsidies to help pay for premiums.

Women’s groups complained, some stories ran, and the companies changed their minds. But because the Group Health plans at that point covered abortion, the company wasn’t on anyone’s radar.

Cody recalls it this way: “Group Health plan people knew that others weren’t [covering] so they decided they shouldn’t. Then when we harassed them all to cover, OIC didn’t have GHC on the list. ...”

Although the other insurance companies reinstated abortion coverage, somewhere in the back and forth Group Health dropped the coverage.

“It was definitely a case of the right hand not knowing what the left is doing,” Cody said. “What I can’t believe is that some idiot thought [Group Health] could even do such a thing since the membership voted years ago that abortion should be covered.”

Group Health said it will provide access to abortion at its medical centers at no additional costs. That made some women’s group leaders wonder what might happen if a patient with complex health issues sought an abortion. If she needed inpatient care beyond the limited services provided at Group Health Center, would the health maintenance organization foot the bills?

In a statement, Group Health sent this answer: “We are currently working to finalize the process our members will have available to them through our Group Health medical centers. Our members who enroll through the exchange can be assured they will receive the care they need when they join Group Health, with no greater financial burden than as if this was a covered benefit.”

Carol M. Ostrom: costrom@seattletimes.com or 206-464-2249. On Twitter @costrom

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