Insurers must cover ultrasounds included in late-term abortion law

State insurance officials ruled companies must cover ultrasounds included in a state ban on late-term abortions. These "handmaids" joined last June 24 in a protest of the state budget and its companion trailer measure that included the abortion ban. From left, Deborah Jakubowski, Lyn Lindpaintner, Liz-Anne Platt, Kathy Cahill and Maura Willing.

Health insurance carriers in New Hampshire must cover the ultrasounds mandated by the recently adopted ban on late-term abortions, a top state official has ruled.

Insurance Commissioner Christopher Nicolopoulos made the requirement known in a bulletin sent out July 1, six days after Gov. Chris Sununu signed the trailer bill to the state budget (HB 2), which includes the first abortion ban in state history.

The ban outlaws the procedure after 24 weeks of pregnancy unless it is to protect the health of the mother. The ban contains no exceptions for rape, incest or fetal abnormality, though abortion opponents said these women, if rape or incest victims, could choose to abort long before the ban would apply.

Republican legislative leaders said they required ultrasounds for all pregnancies so doctors can determine the “gestational age” of the fetus and not perform an abortion if the pregnancy is into the third trimester.

During debate over the trailer bill, state Rep. Jess Edwards, R-Auburn, said the provision means an expectant mother will come in contact with the fetus and perhaps reconsider a decision not to carry it to term.

“Determining the gestational age of a fetus is part of routine prenatal and maternity care, and therefore is a covered service,” Insurance Commissioner Nicolopoulos wrote.

“Insurers must cover all necessary medical examinations, imaging studies, and tests required to make a gestational age determination.”

The bulletin made official what the state’s departments of Insurance and Health and Human Services told Executive Councilor Cinde Warmington, D-Concord, when she asked about the process at the council’s June 30 meeting.

This applies to all health care plans in the commercial insurance market.

Different with Medicaid

It does not affect how the costs are covered for low-income residents and the disabled who get insurance from the federal/state Medicaid program.

Medicaid Director Henry Lipman told the council the exam and related costs could be covered, but that’s not a certainty.

“If the physician feels an ultrasound is indicated … that is typically not challenged,” Lipman said.

Medicaid rules base coverage on the medical necessity of any procedure, he said.

“So the position is if it were based on medical necessity, it would be covered,” Lipman said. “If there were an indication that it wasn’t medically necessary, then it might not be covered.”

Planned Parenthood officials have said many ultrasounds, especially in the early stages of pregnancy, are not deemed medically necessary.

“This is especially true for medication abortion, which is a safe and effective way to terminate a pregnancy at early gestations, accounting for about 39% of all abortion care nationally,” Planned Parenthood said in a white paper on the new abortion ban.

“Requiring an ultrasound to obtain a medication abortion creates unnecessary barriers to abortion access, including transportation and cost.”

Senate Democratic Leader Donna Soucy and state Sen. Kevin Cavanaugh, both D-Manchester, called upon the Senate Health and Human Services Committee on Thursday to do a “full review and analysis” on the impact of the commissioner’s bulletin.

“While there is certainly no desire to create additional financial barriers for women seeking an abortion, the bulletin leaves room for questions when a woman may be able to seek ultrasound coverage,” wrote the senators, who opposed the budget and the abortion ban.

“As this procedure is often unnecessary early on in a pregnancy, it is unclear whether this coverage now extends to anyone seeking this information, or only those seeking to terminate their pregnancy.”

Meanwhile, both abortion rights and anti-abortion organizations in New Hampshire have begun messaging campaigns, hoping to sway voters either for or against the abortion ban.

In Planned Parenthood’s recent memo, the abortion provider said the ultrasound mandate “could drive up insurance premiums.”

For those without insurance, the group cited the state Insurance Department estimate of $404. Planned Parenthood officials said this means the patient will need to pay $83 to $1,015, depending on the location.

Cornerstone Action, a socially conservative group opposed to abortions, said in its own FAQ document that unlike many states, New Hampshire does not require the expectant mother to have to view the ultrasound image.

According to the Guttmacher Institute’s analysis, 27 states regulate the provision of ultrasounds by abortion providers.

Five states require the provider show and describe the image of the ultrasound to the pregnant mother. Another eight states require these women be given the opportunity to see the image if that’s the woman’s wish.

New Hampshire’s law includes no such language either way. It appears New Hampshire will join North Carolina and Oklahoma as states with ultrasound mandates that do not require providers to give women the chance to view the ultrasound.

Cornerstone Action also rebutted the claim that ultrasounds will be costly.

The group noted the only penalties will be for for doctors who failed to do an ultrasound when they knew there was a “substantial risk” the fetus was at least 24 weeks old and could not legally be aborted.

“Early in pregnancy, abortion providers can skip the ultrasound and face no legal penalties of any kind,” Cornerstone Action said in its white paper.

The group further pointed out that a 2012 state law that outlaws a so-called “partial-birth abortion” has the same felony provisions against providers who perform a late-term abortion as this new ban — a prison term of up to seven years and fines up to $100,000.