OLYMPIA — Attorney General Bob Ferguson recently announced that he will file a lawsuit against the Trump Administration over its rule requiring health insurance companies to send consumers two separate bills for monthly insurance premiums. This unlawful rule would affect thousands of Washingtonians and cause many to inadvertently fail to pay their premiums in full, jeopardizing their health coverage.

The lawsuit Ferguson filed in U.S. District Court for the Eastern District of Washington, asserts that the “double-billing” rule violates state law requiring insurers to send only one bill for monthly premiums. It also violates the Affordable Care Act, which does not allow federal agency rules to preempt state laws.

“The Administration’s new rule requiring health insurance carriers to send two separate bills to consumers — one for abortion services and another for the rest of their coverage — will confuse consumers and jeopardize their coverage,” Ferguson said. “In the Affordable Care Act, Congress already said that states can establish their own rules on this issue, and Washington’s legislature has done that. We will not let this latest unlawful action by the Administration go unchallenged. My legal team has been working on this for months. I directed them to file a lawsuit tomorrow challenging this unlawful rule in Eastern District of Washington.”

“This scheduled federal rule will cause unnecessary confusion for consumers and is another attempt to chip away at reproductive health services,” Gov. Jay Inslee said. “I stand with Attorney General Ferguson and Insurance Commissioner Kreidler in their efforts to protect Washingtonians. “

Details of the new rule

Under the Affordable Care Act (ACA), federal funds cannot be used to cover abortions. The ACA requires insurers to collect a separate payment from individual health plan enrollees for the portion of their monthly premiums that cover abortion services. A 2016 regulation allows insurers to collect these separate payments via a single monthly, itemized bill.

The Trump Administration’s new rule, which applies specifically to individual qualified health plans, requires insurance companies to request the abortion payment in a “separate transaction.” In other words, enrollees must receive two separate bills for the same insurance plan each month — one for abortion coverage and one for all other coverage — and must be asked to make two separate payments.

Often, abortion coverage accounts for less than a dollar of a patient’s monthly premium. The double-billing rule requires insurers to charge enrollees at least one dollar for abortion coverage. All enrollees will receive the second bill, regardless of whether or not they received abortion services.

This will cause unnecessary confusion for Washington consumers, who may assume a separate bill for a small portion — often as little as one dollar — of their monthly premium is a scam, part of a bill they already paid, or a rider or fee that doesn’t apply to them.

Impacts in Washington

The double-billing rule is highly likely to increase the number of uninsured Washingtonians who must rely on the state for their healthcare — particularly in parts of the state where many residents depend on individual qualified health plans. In five Washington counties, 40 percent or more of the population are enrolled in a qualified health plan. Four of those counties are in Eastern Washington.

Washington insurance companies estimate that this rule will raise their costs by $100,000 to $500,000 each, a total of $3.5 million. If carriers double-bill their enrollees, it’s uncertain how many enrollees will fail to pay their premiums in full, driving up premium costs across the board. This could cause consumers to lose their coverage if they inadvertently miss a second bill or if they can’t afford a higher premium.

Assistant Attorney General Kristin Beneski is leading the case for Washington, working with Assistant Attorneys General Laura Clinton and Jeff Sprung.