Health Reform Puts Abortion Coverage on the Run

Credit: Steve Rhodes on Flickr, under Creative Commons (CC BY-ND 2.0).

(WOMENSENEWS)–The Affordable Care Act was supposed to increase access and affordability of critical reproductive health services, such as abortion.

But for many women it is not working out that way as state lawmakers exploit provisions that the Obama administration accepted in a series of compromises to get anti-choice Democrats on board for passage of health reform.

Health Reform Puts Abortion Coverage on the Run

Here’s a breakdown of the women whose abortion coverage will and could be affected by the provisions of the health reform law, based on information provided by the National Women’s Law Center:

Uninsured women in these 19 states: Alabama, Arizona, Arkansas, Florida, Idaho, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia and Wisconsin.

Privately insured women in eight states: Indiana, Kansas, Missouri, Nebraska, Oklahoma, Utah, Kentucky and North Dakota.

Victims of rape and incest in eight states: Idaho, Kansas, Missouri, Nebraska, Kentucky, North Dakota, Utah and Oklahoma.

Women whose lives are endangered by pregnancy and those who were impregnated by either rape or incest in two states: Louisiana and Tennessee.

Seven more states, meanwhile, will consider passing bans or extending the reach of their coverage bans in 2013: Iowa, Texas, Virginia, Indiana, Mississippi, Michigan and Kentucky.

Iowa, Texas and Virginia have legislation banning coverage in the exchanges.

Indiana and Mississippi have bills that would extend their states’ bans in the exchange to reach all private plans.

Michigan is considering banning insurance coverage of abortion in private plans, even though GOP Gov. Rick Snyder vetoed such a ban in 2012.

Kentucky also has a bill pending that would apply its existing ban on any insurance coverage of abortion to only plans in the state.

One provision says state laws on abortion coverage may take precedence.

Some states have longstanding coverage bans, but now some are passing them in a flurry and extending them to private plans as health reform is coming down the pike, which means women who used to have abortion coverage are losing it.

Another provision allows lawmakers to ban private coverage of abortion in the new state exchanges, which will serve the uninsured in 2014. Uninsured women means all those who have no coverage through their employers, are not buying it for themselves individually and are not on Medicaid, the public health program for low-income Americans and those with disabilities.

More than 1-in-5 women of reproductive age (15 to 44) was uninsured in 2010, including 41 percent of those who had incomes below the federal poverty level ($18,530 for a family of three), according to a 2011 Guttmacher Institute study.

Planned Parenthood estimates that the typical abortion cost $490 in 2012. While that is not an expensive procedure from an insurer-policy vantage point, it is expensive for many women.

“These costs take a serious toll on women, especially the poor who have difficulty paying for abortions with their own funds,” says Adam Sonfield, senior public policy director of the New York-based Guttmacher Institute, a nonprofit research organization on reproductive health.

Growing Coverage Bans

Gretchen Borchelt, senior counsel and director of state reproductive health policy at the Washington-based National Women’s Law Center, is keeping track of the growing array of coverage bans in the states.

She says 21 states have passed bans on private insurance coverage of abortion in the new state exchanges. Other states have passed stricter coverage bans or could be enacting or intensifying bans in the year ahead. See a breakdown of state activity.

As coverage banning speeds up, it’s important to emphasize that the bans are not new. Because states have long regulated insurance, anti-choice governors and state legislatures have been able to pass bans for their employees. Now they are extending them to private employers.

The activity is focused on the states because public support is strong for Roe v. Wade, the Supreme Court decision that legalized abortion nationwide. An NBC/Wall Street Journal poll in January found that 70 percent of Americans support the 1972 Supreme Court ruling.

Fifteen states prohibit abortion coverage for their public employees and since the 1980s the federal government has denied coverage to its employees in such agencies as the Indian Health Service and the Peace Corps. In December 2012, Congress lifted a longstanding ban on abortion coverage in instances of rape and incest for women in the military, but a coverage ban remains for all circumstances beyond when a pregnancy threatens a woman’s life or results from rape or incest.”

Private abortion coverage was a nonissue for many years. Many private employer plans covered it because it was relatively inexpensive and considered part of comprehensive reproductive care. If an insurer was going to cover amniocentesis (a procedure to determine genetic abnormalities), complicated C-sections caused by preeclampsia and other life-threatening conditions, then the carrier would also cover abortions.

The Affordable Care Act, however, has had the effect of further stigmatizing and isolating abortion.

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