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Graham-Cassidy would start banning abortion coverage in Obamacare plans in 3 months

That could plunge patients, insurers, and state governments into chaos.

A protester at a rally against the Republican health care plan in Washington, DC, on July 26, 2017
A protester at a rally against the Republican health care plan in Washington, DC, on July 26, 2017.
Photo by Drew Angerer/Getty Images
Anna North is a senior correspondent for Vox, where she covers American family life, work, and education. Previously, she was an editor and writer at the New York Times. She is also the author of three novels, including the New York Times bestseller Outlawed.

The eleventh-hour Obamacare repeal bill sponsored by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) would reduce Americans’ access to reproductive health care in a number of ways. But one particular provision would take effect fast, and could plunge patients, insurers, and state governments into chaos.

Starting in 2018, the bill would bar the use of Obamacare’s premium tax credits to pay for plans that include coverage for abortion except in the cases of rape, incest, or a threat to the mother’s life, as health care analyst Charles Gaba notes at This would mean no plan offered on the exchanges could cover abortion. This is a problem in itself, as a lack of insurance coverage for abortion can cause a number of problems for patients, such as forcing them to choose between paying for the procedure and paying rent.

But the timing could cause another problem. As Gaba points out, the deadline for insurers to sign up for participation in the 2018 exchanges is in less than a week. If Graham-Cassidy passes, it will most likely happen after that. So plans that were legal days before will suddenly become illegal, just over a month before the 2018 enrollment period starts.

Twenty-five states already bar exchange plans from covering abortion, said Laurie Sobel, the associate director for women’s health policy at the Kaiser Family Foundation. So this particular provision of Graham-Cassidy won’t change anything there. (In six other states, no plans available on the exchanges in 2016 included abortion coverage.) But in 25 states, plans that cover abortion are allowed, and it’s not at all clear how insurers will respond if their plans suddenly violate federal law.

What’s more, California and New York require that all plans on the exchanges offer abortion coverage. So under Graham-Cassidy, all the plans in those state exchanges would become illegal. It’s unclear what the states would do to make sure their residents could get coverage, but as Gaba points out, they might decide to sue the federal government. (This issue brief from the Kaiser Family Foundation explains a similar conflict that would have been created by the American Health Care Act, the Obamacare repeal bill passed by the House in May.)

It’s possible that Congress could tweak the bill, or the Department of Health and Human Services could change the deadline for insurers, so as to sidestep some of the timing issues. But absent such changes, the bill threatens to throw the exchanges in nearly half the country into a state of flux.

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