As states ban abortion, Minnesota's employers weigh medical travel benefits

The U.S. Supreme Court decision allowing states to ban abortion has left Minnesota's largest companies grappling with whether they will help their employees in other states travel to access the procedure.

Minnesota's multistate employers are weighing legal risks from various state laws, along with their workers' health care priorities, as they consider next steps for health benefits.

Medtronic, with operational headquarters in Fridley, was the first to publicly engage the debate on Monday, announcing it was expanding employee benefits "to enable access to critical health care for our people."

"The new benefit will allow for reimbursement of travel, relocation and legal expenses and is in addition to coverage already included in U.S. Medtronic medical plans," Erika Winkels, a company spokeswoman, said in a statement.

The medical device manufacturer's announcement did not specifically mention abortion services.

Across the country, more than two dozen companies have gone further by clearly stating that they cover abortion in addition to describing how they will help employees travel for care, said Shelley Alpern of Rhia Ventures, a venture capital fund that invests in companies addressing gaps in reproductive health.

The fund's tracking list includes companies ranging from Amazon and Apple to Dick's Sporting Goods, where company officials announced to employees Friday that "if the state you live in restricts access to abortion, [we] will provide up to $4,000 in travel expense reimbursement to travel to the nearest location where that care is legally available."

Alpern said that "before we would add [Medtronic] to our tracker, we'd want to confirm that abortion is covered." Medtronic did not respond to a request seeking more specifics about their announcement.

Many of the federal protections under the Roe v. Wade ruling overturned by the Supreme Court last week are maintained under Minnesota law. That means the high court's decision is not expected to affect coverage within Minnesota if an employee health plan already covers abortion, according to the Minnesota Council of Health Plans, a trade group for nonprofit insurers.

But many of Minnesota's largest employers operate in states that are now moving quickly to restrict access to abortion. Those companies face decisions about structuring health plans for employees — with some workers in states that permit the service and others in states that severely curtail it.

St. Paul-based Ecolab, which makes cleaning chemicals and water treatments, is reviewing its employee benefits and human resource policies to see if or how it might be able to continue offering reproductive health care services to its employees in various states.

"Currently, our health care benefits do include a range of reproductive health options including fertility treatments and abortion in states where it is legal. So, one of the things that we are reviewing is: How do we maintain the same level for care for associates, which ultimately comes down to travel?" Ecolab spokesman Roman Blahoski said. "We are evaluating it."

The employee health plan at Maplewood-based 3M covers a variety of reproductive health needs, the company said, including abortions due to medical necessity or elective reasons and related short-term disability. The manufacturer also provides supports for fertility, adoption, surrogacy and parental leave.

"We are reviewing the Supreme Court decision and evaluating what it means and how it impacts employees and our benefit plans," 3M said in a statement.

On Monday, Wells Fargo told employees it plans to expand existing travel benefits for medical coverage to include abortion travel reimbursement "in accordance with applicable law," the New York Times reported.

There's precedent for employers to pay for travel so that workers can obtain far-away health care services, said Laurie Sobel, associate director for women's health policy at the California-based Kaiser Family Foundation.

For years, health plans have used "centers of excellence" programs that cover travel costs and provide other support so that workers can go out of state to obtain certain specialty services such as solid organ transplants that most patients don't usually need.

"Abortion, of course, is not that unusual," Sobel said, "but it's now illegal in some states."

Before addressing the travel question, some employers likely need to verify whether their employee health plan even covers abortion, Sobel said. The service doesn't typically generate big bills that might command attention from health plan administrators.

While it's generally believed that many, if not most, employer health plans cover abortion, "nobody has a reliable statistic," Sobel said.

Where the service is covered in health plans, multistate employers are now carefully looking at the language in state abortion bans that were made effective by the court's ruling. Some of those bans address the "procuring" of instruments, medicines, drugs or devices with the purpose of terminating a pregnancy.

"How is that going to be interpreted?" Sobel said. "I think when they wrote this, they weren't thinking insurance companies. I think they were thinking clinicians, and they were probably thinking clinicians in the state. It's an open question about how those laws will be interpreted and whether the states have the resources to try and prosecute insurance companies and employers — and whether they politically want to do that."

Before a draft opinion of the court's ruling was leaked this spring, a survey from Mercer found that 14% of employers with 20,000 or more employees said they already provided or were planning to provide a travel and lodging benefit for employees who must travel to receive an abortion. Another 25% of similarly sized employers were considering it, according to the benefits consulting firm.

Research from the Society for Human Resource Management shows that nearly one-quarter of organizations agree they can better compete for talent by offering a health savings account to cover travel for reproductive care in another state.

"How these policies interact with state laws is unclear, and employers should be aware of the legal risks involved," said Emily M. Dickens, the group's chief of staff and head of government affairs.

Large employers with workers in multiple states routinely operate "self-funded" health plans that generally are not subject to state insurance laws, said Bob Radecki, a principal at Benefit Comply LLC, a St. Paul-based employee benefits compliance consulting firm. But, he said, it's less clear how state laws imposing civil or criminal penalties related to abortion might impact employers and their health plans if abortion is a covered medical benefit.

In Minnesota, about 9,100 abortions were performed in 2020, with public health insurance programs paying in about 45% of all cases, according to state data. Payment for the remainder was split roughly in half between private insurance and self-pay.