Colorado lawmakers on Wednesday spent their afternoon working on a trio of bills tied to abortion, the Democrats’ response to the U.S. Supreme Court’s decision last year that overturned a nearly 50-year old decision legalizing abortion.

The Senate Health and Human Services Committee tackled Senate Bill 189, which would require health insurance carriers that serve large employers – those with more than 100 employees – to pay for abortion coverage without deductibles, copays or coinsurance.

Witnesses claimed the bill will help provide reproductive healthcare at a time when it is threatened nationwide, while opponents argued it would result in taxpayer funding for abortions or interfere with parental rights.

Also under the measure, health insurance for the small group and individual market would provide that coverage depending on how the federal Centers for Medicare and Medicaid Services, which regulates the Affordable Care Act, views those services.  

Under the Affordable Care Act – and this pertains more to individual health insurance than to the small group market – any state insurance mandate would be reviewed under the lens of how it affects premiums. If the mandate has the potential to increase premiums, the state would technically be required to defray those extra costs, although that scenario is rare and has never happened in Colorado.

SB 189 was one of the first bills to get an actuarial review under a 2022 law that looks at the effect of health insurance mandates on premium costs.

That review, done by a third party contracted by the Division of Insurance, reported the bill’s effect on health insurance premiums would be a minimal decrease in costs, around 15 cents per member, instead of an increase. It would also improve health “equity,” the review said.

“Fewer unintended pregnancies will reduce medical costs that would otherwise result from pre/post-natal care, deliveries, and potential pregnancy complications. Reduced medical costs result in lower out-of-pocket costs for the member and lower costs to the carrier, which could be passed on to the members by way of lower premiums,” the review said.

SB 189 gives employers the option of refusing to offer abortion services if it conflicts with their religious beliefs, so long as the decision is in line with federal court decisions. 

The measure’s insurance mandate also applies to treatment for HIV and other sexually-transmitted diseases. The bill prohibits health insurance carriers to require HIV patients use step therapy, a requirement that a patient use a lower-cost drug before moving on to a more expensive one, even if the patient has been on the more expensive one before or it’s the drug preferred by the doctor. For other care, the bill prohibits a carrier from requiring deductibles, copays, coinsurance, or impose a lifetime maximum benefit for treating a sexually transmitted disease or for sterilization services.

Finally, the bill expands the kinds of health care providers than can give contraception, including procedures, supplies or information to a minor without first needing to obtain parental consent or provide notification. Currently, the law allows only for physicians to provide those services; the bill would add, for example, nurse practitioners.

That section of the bill strikes language the sponsors consider to be outdated: Current law requires notification to parents or legal guardians or to someone who makes a referral for those services, such as a member of the clergy, family planning clinics, or schools or colleges. 

The bill was amended to set up a grant program for those under the age of 19 who want to pay for their own contraception and don’t want to go through their parents’ insurance to keep the matter confidential. Those grants would to go health care providers, not the patients.

What the bill doesn’t do – according to sponsor Sen. Lisa Cutter, D-LIttleton – is apply to gender-affirming care. It also doesn’t lift the state law requiring parental notification for abortions, she said.

Colorado voters passed a ballot measure, later affirmed in state law in 2003, known as the Parental Notification Act, that requires parents or legal guardians be notified 48 hours in advance of a minor child obtaining an abortion. That law, however, does not require parental consent.

SB 189 also does not allow for public funding for abortions, which is banned in the state Constitution.

Despite that insistence from the sponsors, those opposed to the bill claimed it would do the exact opposite.

That included Brittany Vessely, executive director of the Colorado Catholic Conference, who said the bill would violate the constitutional prohibition against using public funds for abortion. 

It’s ridiculous to assume that premiums are all covered by private funding, she said. The bill’s religious exemption is not guaranteed, either, she told the committee, given that it relies on a federal court ruling, which she called “illusionary.”

She also insisted the bill would expand state-run reproductive healthcare programs that allow minors to apply for and enroll themselves in state-funded family planning and related services, which include access to contraception and abortion referrals and without parental consent. That, she said, erodes parental authority. 

State law already allows minors to obtain abortions without parental consent.

Dr. Catherine Wheeler, an ob-gyn who used to practice in Utah but never in Colorado, told the committee that Colorado is a state with high suicide rates and a lot of human trafficking, which she blamed on the ability to get abortions and “early sex.” Wheeler also said the bill would apply to gender-affirming care.

“When young people have gender affirming care, they’re committed to a lifelong change of needing medical care” and medication, Wheeler said. “When you hear the people who have de-transitioned, they tell you of an incredibly difficult and sick life of constantly being ill and not well.”

De-transitioning is the process of stopping or reversing a gender transition.

“Abortion is not health care,” no matter how many times it’s repeated, said Christine Neely, who also claimed studies show 20% of women that use the abortion pill end up in the ER with excessive bleeding. “That doesn’t sound like healthcare to me.”

A 2015 report that looked at 20 studies, including those from the National Institutes of Health, involving 33,846 women who used medication abortions said severe adverse events, such as “blood transfusions (0.03-0.6%) and hospitalization (0.04-0.9%) are uncommon.”

Tom Perille of Democrats for Life said SB 189 is fatally flawed because it characterizes abortion as essential reproductive healthcare, “which is patently false.” The bill tips the scale toward abortion and away from prenatal care, he said. 

Brandon Arnold with the Colorado Association of Health Plans also insisted that when the state increases insurance mandates and coverage requirements, that “inherently will increase the cost for premiums.”

Those who support the bill cited a pending federal ruling expected any day from Texas that could affect access to contraceptive services, notably the abortion pill.

Erin Miller from the Colorado Children’s Campaign said the bill will secure access to critical preventive services that are already included in the Affordable Care Act but that are threatened in pending federal legislation. The campaign, Miller said, supports expanded access to abortion care because of its belief in personal bodily autonomy, including whether to have children or not.

Ali Altman, a resident of Capitol Hill, said she knows firsthand “the crippling anxiety of taking a pregnancy test in a grocery store bathroom and seeing my entire life flash before my eyes.” She had a financial safety net to lean on but said many young people do not. She added the Supreme Court’s ruling last year pushed access to sexual and reproductive healthcare out of the reach for many and the bill will expand critical coverage for people and communities that have been falling through the cracks for generations, even for those with insurance, because most coverage doesn’t pay for essential sexual and reproductive healthcare. 

Angie Harold, a survivor of child sexual abuse, recounted how she attempted suicide after being raped and found out she was pregnant in Wyoming, where abortions weren’t available. She over-exercised and stopped eating, and eventually had a miscarriage, which she called “wonderful, because I got to live.” She said she would have preferred an abortion because it would have been less stressful, safer, and made her feel like she was cared for,  and would be able to decide what happened to her body.

“Increasing access to abortion care is vital to creating equity,” she said. “Access to reproductive healthcare is a human right and not only saves life, but enhances life quality.” 

SB 189 won a 6-3 party-line vote and now heads to Senate Appropriations.

Editor’s note: This story has been clarified to include other health practitioners who, under the proposal, can provide family planning services to minors. Also, at the request of the Children’s Campaign, the testimony by Erin Miller has been clarified to accurately reflect its position.