State provides parity for abortion coverage

Opinion editor’s note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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The Equal Rights Amendment ballot measure, which would have constitutionally protected abortion and other reproductive health care in Minnesota, regrettably fell short at the Legislature. But fortunately, lawmakers did pass important legislation to bolster access to this essential medical procedure in the state.

This sensible measure requires state-regulated private health insurance plans to provide coverage for “abortions and abortion-related services,” according to the language included in the health and human services omnibus bill.

Currently, state-regulated insurers cover medically necessary abortions but can choose whether to cover elective abortions. It appears that few if any do.

None of the plans sold on the MNsure marketplace cover elective abortions, bill author Rep. Zack Stephenson, DFL-Coon Rapids, told an editorial writer this week.

“I believe abortion is essential health care ... this was a place where there was a gap in insurance. And cost is a barrier to people,” Stephenson said. “Health insurance isn’t really worth much if it doesn’t cover the care that people need.”

In addition, insurers are required to have the same cost-sharing policies for abortion as they do for other procedures or services. This means there can’t be higher out-of-pocket expenses for abortions. A different deductible or copay would make it not equitable. Insurers have to treat it like every type of care, which is a logical update.

The new requirement will go into effect Jan. 1 of next year. The coverage requirement includes plans sold on MNsure. It also applies to the state’s publicly funded medical assistance programs. State-level workarounds will be necessary to comply with the Affordable Care Act and to avoid abortion restrictions on federal dollars’ use. The latter is necessary because medical assistance programs are funded jointly by state and federal governments.

In addition to Stephenson, the measure’s legislative advocates included two physicians serving in the Minnesota Senate: Alice Mann, DFL-Edina, and Kelly Morrison, DFL-Deephaven.

The coverage expansion will admirably put Minnesota in the vanguard of states protecting abortion access this way.

Eleven other states require private insurance coverage for abortion services, according to a Minnesota Commerce Department analysis from March. The other states are: California, Colorado, Illinois, Maine, Maryland, Massachusetts, New Jersey, New York, Oregon, Vermont and Washington. It’s no surprise that these states are public health innovators and regularly fare well in “healthiest state measurements.”

Minnesota’s coverage expansion also contrasts favorably to states that are moving to restrict abortion access.

In Louisiana, lawmakers recently passed a bill that reclassifies two drugs used in medication abortions as controlled and dangerous substances. “The bill would make it harder to obtain the pills by placing them on the list of Schedule IV drugs ... [and] would require doctors to have a specific license to prescribe the drugs, and the drugs would have to be stored in certain facilities that in some cases could end up being located far from rural clinics,” the Associated Press reported last week.

Additional context is important in considering the Minnesota change’s impact. Many large employers’ health plans are regulated federally, not by the state. Therefore, the new state abortion coverage requirement would not apply to many who get coverage through their jobs.

Still, a sizable percentage of Minnesotans will benefit. About 39% of Minnesotans have coverage the new requirement applies to, according to an analysis of state data provided by the Minnesota Council of Health Plans.

Objections to the change during the legislative session included costs to the state and potential insurance premium price increases for consumers. But the Commerce Department analysis released in March helps allay cost concerns. It concluded that the workarounds necessary to comply with the ACA would cost between $90,000 and $300,000 in the first year.

The analysis also looked at the fiscal impact on a large health plan the requirement would apply to — the State Employee Group Insurance Program. It estimated the cost of the legislation for the state plan to be $27,300 for the partial 2025 fiscal year and $57,300 for all of 2026. These additional costs would be spread out among enrollees and would be measured in cents.

The Minnesota Council of Health Plans sounded a cautionary note about the analysis, saying that it was done before the state’s public programs were included in the legislation, so it doesn’t have numbers for that.

There were also religious objections. But Stephenson told an editorial writer that the measure includes exemptions for employers with “sincerely held religious beliefs,” allowing them to buy coverage that doesn’t cover abortions.

The state’s DFL trifecta, which controls both legislative chambers and the governor’s office, has clearly put a priority on protecting abortion access in Minnesota after the U.S. Supreme Court overturned Roe v. Wade. It has repeatedly and commendably delivered, though there’s still more work to do.