APEX — Town officials decided to eliminate coverage of elective abortions from employees' health plans, saying that the town should not foot the bill for abortions unless they are deemed medically necessary to preserve the life of a mother.
"I was surprised and dismayed to find out recently that, even after having served here for quite a while, that our insurance policy covers abortions," Mayor Keith Weatherly said. "I don't believe that taxpayers intend to fund elective abortions."
Town leaders say the unanimous decision, made at a Jan. 19 council meeting, is not intended to tell town employees whether they should or should not have an abortion, only whether the town should pay for it.
"Apex can't actually prohibit abortions, whether it's for an employee or not," Weatherly said. "But our plan can."
While it was couched initially as a decision of fiscal responsibility, moral and political undertones loomed large. The decision set new precedent among western Wake County towns, surprising leaders of neighboring towns and fueling similar debates elsewhere in the county.
Apex's health insurance policy has for years afforded employees the benefit of having the procedure covered at a minimal out-of-pocket expense. During the past six years, three employees have claimed the benefit, town manager Bruce Radford said.
The restricted policy took effect on Monday.
Apex, like other towns across North Carolina, has a self-funded health insurance plan. The town switched to a self-funded policy with Blue Cross Blue Shield of North Carolina in 2007.
As a self-insured policy holder, Apex relies on Blue Cross only as a third-party administrator and not as the town's healthcare agent. Although Blue Cross provided the town with a standard policy, town leaders have greater authority to decide what is included in it, said Eleanor Green, the town's human resources director.
"Because we own the plan, we pay the claims," she said. "[Blue Cross] pays the doctors, but then they bill us for the payments."
Other towns have elective-abortion provisions with Blue Cross that remain in effect.
Cary and Morrisville cover therapeutic - those deemed medically necessary by a doctor - and elective abortions for employees.
In Fuquay-Varina, elective abortions are covered for a town employee or their spouse but not for dependents. And in Holly Springs, an employee or their spouse may have an elective abortion.
"It's pretty much the standard language included in [Blue Cross] contracts," said Holly Springs human resources director Erika Phillips.
Apex's decision to break from the standard policy raises new questions about local government's role in abortion rights. "There's very rarely a case when you have a locality tackling this issue," said Williamjames Hoffer, a history professor at Seton Hall University and co-editor of "The Abortion Rights Controversy in America: A Legal Reader." "These kinds of issues are usually taken up at the state and federal levels."
Hoffer said Apex could risk legal challenges based on the due process and equal protection clauses of the 14th amendment of the U.S. Constitution.
"They are technically a state entity, which means they get their authority to do things from state governments. Since state governments are included under the 14th amendment, anything a locality does in an official capacity can be challenged under civil rights law."
But Apex's policy mimics the federal government's health plan, which is prohibited by law to use funds to pay for its employees' abortions except in the case of rape or incest, or if the mother's life is endangered.
And because the town is self-insured, the state Department of Insurance doesn't regulate Apex's healthcare coverage, said department spokeswoman Kristin Milam.
"I just don't think our taxpayers should be subsidizing that," Councilman Mike Jones said. "There are options for abortions other than using town-sponsored insurance. ... There's cost, sure, but the underlying issue for me is the moral issue of abortion."
The town's decision to follow the federal example has caused others to examine the rights of cities and towns in North Carolina to pick and choose when it comes to their individual policies.
Tony Gurley of the Wake County Board of Commissioners said he plans to raise the issue of abortion coverage at the county level at an upcoming board meeting.
And the North Carolina League of Municipalities is looking into the issue, according to Kim Hibbard, general counsel for the nonpartisan association of state municipalities.
Apex's move, meanwhile, surprised leaders in surrounding communities.
"Is this a moral issue or a cost issue?" said Cary Mayor Harold Weinbrecht. "If it's moral, then it's a national issue and, in that case, you're just politicizing it. If it's a cost issue, then you have to start looking at other things too."
Weinbrecht wondered if Apex would also cancel coverage birth control for women, erectile-dysfunction drugs or procedures such as vasectomies for men - two things for which Apex employees are still covered.
"It raises all kinds of broader questions," Weinbrecht said. "Which is why, in my opinion, this is not the business of a local council. "We're supposed to be setting local policy, not deciding these bigger life issues."
Genesis of policy
Weatherly said he learned of the policy from a friend, Kent Misegades of Cary.
Misegades is director of Thales Academy in Apex, president of aerospace components maker AeroSouth and a founder of The Cary Watchmen, a group that advocates fiscal responsibility and, according to its Web site, provides "unbiased assessments of spending and policies to better the town of Cary for all citizens and businesses."
Misegades had been reviewing Cary's employee benefits package in September.
He said he asked Weatherly out of personal concern, and not in an attempt to change local policy. "I'm opposed to abortion and especially to taxpayer-funded abortion," Misegades said. "I'm all for letting voters decide."
Misegades added: "If more people knew about this, I do think they would oppose it."
Staff writer Sadia Latifi contributed to this report.
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