Insurance Exchanges Provide Opportunity for Abortion-Rights Opponents To Restrict Coverage

April 11, 2011 — As states develop health care exchanges under the federal health reform law (PL 111-148), those who oppose abortion rights are pushing lawmakers to restrict private health insurance coverage of abortion care, the New York Times reports (Tavernise, New York Times, 4/9).

To ensure that no federal funds pay for abortion care, the federal health reform law imposes new restrictions on private insurance plans. It allows private insurers selling health plans through the exchanges to provide abortion coverage, but requires enrollees who purchase plans that include abortion coverage to make two separate premium payments, one for the abortion coverage and one for the remainder of the coverage. Abortion-rights advocates have criticized the two-payment system, saying that it is cumbersome for insurers and could lead them to opt out of providing abortion coverage altogether (Women's Health Policy Report, 3/11). The law also allows states to enact legislation prohibiting private insurance coverage of abortion care.

On Wednesday, Virginia became the eighth state to pass a law to ban abortion coverage in private plans sold through the exchanges. Arizona, Idaho, Louisiana, Mississippi, Missouri, Tennessee and Utah also have passed laws banning abortion coverage by private health plans in the exchanges. Nancy Northup, president of the Center for Reproductive Rights, said 28 states were considering or had already passed similiar laws. That includes five states that already banned all private insurers from covering abortion services: Oklahoma, North Dakota, Idaho, Kentucky and Missouri. The organization is tracking more than 600 pieces of legislation that seek to limit abortion coverage.

Abortion-rights advocates are concerned that if enough states ban abortion coverage it could lead insurers to stop offering the coverage. "Every additional restriction is adding to the probability that insurance companies will throw up their hands and say, 'This isn't worth our time anymore,'" according to Adam Sonfield, a public policy expert at the Guttmacher Institute.

Sonfield said that abortion-rights advocates also are concerned that if enough states pass laws banning insurance coverage of abortion care, such policies will be seen as the norm, rather than the exception, leading more states to enact bans. He said a similar trend occurred with coverage of contraceptives, but the shift occurred in the opposite direction: coverage of birth control became the norm after many states began requiring coverage.

Antiabortion-rights groups say that the exchanges are established with the help of tax dollars and that President Obama specifically banned the use of any federal funds for abortion in signing the health reform law. Abortion-rights supporters have criticized that argument. "The idea is that because the government itself is helping set up the exchanges that's reason enough for the ban," Sonfield said, adding, "It's like saying that everything I purchased on Amazon is somehow government subsidized, if the government helped set up the Internet" (New York Times, 4/9).