Abortion is always a hot-button issue, but the result of the latest wrangling may at first sound trivial: Affordable Care Act health insurance plans that cover abortion — most don’t — will have to send a separate monthly bill for the part of the premium calculated to cover abortion care. Even men with such plans will get a separate bill.

Abortion is the only medical service that must be broken out separately by ACA plans. “It’s hard to think of another industry where the government mandates, as the Trump administration would here, that consumers cut two checks a month for the same service,” said Margaret A. Murray, CEO of the Association for Community Affiliated Plans.

The new requirement is moot in 26 states, including Pennsylvania, because they banned abortion coverage by state ACA exchange plans. An additional eight states allow ACA plans to cover abortion but none of the insurance plans offered there do so, according to the Kaiser Family Foundation. New Jersey is among 16 states with exchange plans that do cover abortion.

Clearly, abortion coverage is not the norm under the ACA. And federal funding of abortion has been illegal under the Hyde Amendment since 1976. Nonetheless, abortion foes wanted to make sure that the ACA would not cover abortion through tax breaks and subsidies, so from the start, the law included a requirement that insurers itemize abortion coverage separately and segregate consumers’ payments for that coverage from premiums for other health services. (Plans have to charge consumers at least $1 a month for abortion coverage.)

The problem is, health plans’ early compliance with this requirement was not great, according to a 2014 report by the General Accounting Office.

The new billing rules were proposed in 2018 by the U.S. Department of Health and Human Services and finalized last month. The requirement “fulfills Congress’ intent and reflects President Trump’s strong commitment to preventing taxpayer funding of abortion,” HHS Secretary Alex Azar said last month in a statement.

The new rule also generated a tsunami of 75,000 comments to the HHS from the insurance industry, state regulators, consumer advocacy organizations, and activists on both sides of the abortion divide.

“Nearly all commenters objected to the proposal, raising concerns about high implementation costs, consumer confusion and frustration, reduced access to care, and coverage losses,” said a Dec. 23 article in the journal Health Affairs.

America’s Health Insurance Plans said in its comments: “We have serious concerns with any proposals that create a more complex and confusing consumer experience, and could increase premiums by imposing new costs on health insurance providers.”

Fears of coverage loss, at least, may be overblown. As Health Affairs noted, insurers cannot terminate coverage if consumers continue to pay their entire premium, including abortion coverage, with a single payment. Instead, insurers have to separate the abortion part of the payment and put it into a separate account.