State Reconsiders Letting Catholic Universities Limit Abortion Coverage

By Grace Rubenstein and Mina Kim

State officials are reviewing whether they made the right call when they approved health plans that limit abortion coverage.

California law has strongly protected abortion rights for decades. But in recent years, the state's Department of Managed Health Care -- which oversees health insurance -- has approved a handful of plans that exclude coverage for "elective" abortions. That is, abortions that aren't necessary to protect the health of the mother.

Those insurance-plan approvals occurred quietly, with little public attention. Until last year, when officials at two Catholic universities, Santa Clara University and Loyola Marymount in Los Angeles, told faculty and staff that the schools would now only cover abortions that are "medically necessary" for the mother's health. State officials had approved those insurance plans.

The decision surprised and angered hundreds of Santa Clara faculty members, who tried and failed earlier this year to get the school's Board of Trustees to reverse the decision. And it also appeared to reverse decades of legal precedent in California. Now, officials from the Department of Managed Health Care say they're going back and reviewing the policy.

"The question is, are abortions chosen by a woman with the approval of her doctor medically necessary?" said Bob Egelko, a San Francisco Chronicle reporter who's been following the story. "Until pretty recently it was assumed by insurers that they were."

Anti-abortion groups, such as the Life Legal Defense Foundation, maintain that abortions by choice are not necessary.

California is known for having strong reproductive rights protections. In 1972, the state Supreme Court struck down a law that allowed abortions only to prevent serious physical harm to a woman, not abortions chosen for any other reason.

"The court said that standard is vague and violates women's rights," Egelko said. "So ever since then California law has treated all abortions chosen by the woman as within her rights and ... as medically necessary. It's pretty much been taken for granted up until now."

And a 1975 state law, the Knox-Keene Health Care Services Plan Act, required health plans to cover all medically necessary procedures.

When Anthem Blue Cross applied in 2008 to offer a plan for religious institutions that excluded "elective" abortions, however, the state approved it. Officials approved a Kaiser Permanente plan with a similar exclusion in 2012; that plan is available to any employer with an objection to abortion, religious or not.

"They didn't really explain themselves," Egelko said of state regulators.

California Lawyer magazine, which first reported on the universities' changes in June, spells out the legal complexity of the matter:

Despite the public perception of clear state constitutional and statutory protections for abortion in California, private insurance law has a muddier history. ...

Members of group health plans elsewhere in California may soon find themselves as surprised as [Santa Clara University faculty] to learn how weak protections for access to abortion have become under the state's health insurance regulators.

Knox-Keene spells out the basic health services that insurers must provide to meet medical standards of care. Significantly, the statute contains no religious exception for eliminating abortion access.

Santa Clara University's new plan doesn't go into effect until next year. Loyola's is already in effect, but there's a provision for employees to pay extra for abortion coverage through a private plan.

Meanwhile, nationwide, more than 100 universities and other nonprofit institutions are suing the Obama administration over a birth control conflict that MSNBC called "the next Hobby Lobby." In short, the federal government created an opt-out form that religious institutions can sign to certify their opposition to contraception; then their insurers directly cover contraceptive costs, taking the employer out of the equation. The employers stay that still results in contraception and thus impinges on their religious liberty, so they're suing.

It's not clear when California officials will announce whether they'll allow the plans limiting abortion coverage to go on.