What are bans on insurance coverage for abortion, and how do they restrict women's privacy and choices?
Anti-choice state and federal legislators have enacted laws that prohibit insurance companies from covering abortion services or require women to purchase a separate policy and pay an extra premium to receive abortion coverage. These insurance prohibitions can impede access to abortion coverage not only for state employees, but for all women in the state, regardless of their source of health insurance. Further, offering women the “option” to pay extra for supplemental abortion coverage, often known as a rider policy, is a false promise. Unintended pregnancies are by definition unplanned; women rarely purchase abortion coverage in anticipation of these circumstances. In fact, there is little evidence that insurers even offer these products. Women should not be denied coverage for basic reproductive-health services by politicians imposing their personal agendas on private medical decisions.
Current State Laws
27 states prohibit insurance plans for public employees and/or private-sector individuals from covering abortion services: AL, AZ, AR, CO, FL, ID, IL, IN, KS, KY, LA, MA, MS, MO, NE, NC, ND, OH, OK, PA, RI, SC, SD, TN, UT, VA, WI. Of these:
- 9 states prohibit abortion coverage in the entire private insurance market: ID, KS, KY, MO, NE, ND, OK, RI, UT.
- Rhode Island has two separate insurance-prohibition laws. Courts have declared one unconstitutional and unenforceable and the other partially unconstitional and unenforceable.
- 18 states expressly prohibit abortion coverage in state insurance exchanges: AL, AZ, FL, ID, IN, KS, LA, MS, MO, NE, OH, OK, SC, SD, TN, UT, VA, WI.
- 15 states prohibit abortion coverage for public employees: AZ, AR, CO, IL, KS, KY, MA, MS, NE, NC, OH, PA, RI, SC, VA.
- Massachusetts’ insurance prohibition for state employees applies only to coverage for certain procedures after viability.
Current Federal Laws
Federal law bars access to abortion coverage for most women who rely on the federal government for their health insurance. Federal employees are prohibited from selecting a health plan that provides abortion coverage. Federal law also denies abortion coverage to Indian Health Service enrollees, Peace Corps volunteers, and women incarcerated in federal prisons.
The Affordable Care Act affects abortion coverage in private insurance plans in an unprecedented manner. Abortion-coverage restrictions in the law, known as the Nelson provisions (after the law’s sponsor), require plans participating in health-insurance exchanges to segregate monies used for abortion services from all other funds and also require those purchasing a plan with abortion coverage to make separate premium payments. These restrictions compel both individuals and insurance companies to incur increased administrative burdens and could jeopardize insurers’ willingness to offer full reproductive-health coverage.
2012 Enacted State Legislation
4 states enacted 4 measures prohibiting abortion coverage in the private insurance market: AL, SC, SD, WI.
2012 Notable Cases
In ACLU of Kansas and Western Missouri v. Praeger, a federal district court heard a challenge to a Kansas law that bans abortion coverage in the state’s private insurance market and health-insurance exchange. The issue is pending before the court with a trial expected in early 2013.
2012 Notable Developments
Continuing an alarming trend from 2010 and 2011, this year four states enacted bans on private insurance coverage of abortion in the health-insurance exchanges created under the Affordable Care Act.
In Kansas, anti-choice lawmakers introduced two bills that would prohibit state employees from using their own funds set aside in tax-exempt health-savings accounts to pay for abortion services, with an exception only to save the life of the woman. One of the two measures also blocked the availability of tax credits or deductions for the purchase of an insurance rider to cover abortion. Although one bill succeeded in passing the lower chamber, both ultimately died in committee.
In South Carolina, anti-choice lawmakers attempted to ban abortion coverage for state employees in cases of rape and incest. While the budget ultimately was approved without eliminating these exceptions, lawmakers agreed to a compromise in which only funds from private insurance premiums – not state dollars – could pay for coverage of abortion in cases of rape or incest. State employees who object to such a use of their premiums would be able to opt out. Under the terms of the announced compromise, the new policy will be included in a separate measure after the state health plan produces a report detailing the policy’s effect on insurance costs.
