Emotions often run high when conversation turns to the subject of abortion, so it’s no surprise that the issue has entered the health care reform debate.
The issue of whether abortion is even legal under certain circumstances differs by state. For example, 41 states, including Alabama, Texas and Georgia, ban abortion except when necessary to save a woman’s life after a specified point in the pregnancy (for example, 20 weeks after conception).
Then there’s the issue of health insurance. In situations where abortion is legal, some wrongly believe that the Affordable Care Act, also known as Obamacare, will require health insurance plans to cover them. However, the truth is that women’s options surrounding abortion coverage vary greatly by state, and depending upon where you live, insurance plans may not cover abortions at all.
When it comes to abortion, there are a number of regulations that fall under the new health care law.
- Federal funds can’t be used for abortions except in the cases of rape, incest, or if the life of the woman giving birth is in danger.
- States have the right to ban insurance companies that participate in the state’s insurance exchange from covering abortion.
- If a health insurance plan includes coverage for abortion, the insurance policyholder must pay a separate premium for it, which ensures that no federal dollars are being used to pay for abortions.
- Every state must have at least one health insurance plan in their exchange that doesn’t cover abortion. States don’t have to offer any health insurance plans in their exchange that cover abortion.
How Obamacare affects abortion
In states that don’t ban insurance plans from covering abortions, some worry that the transition to Obamacare may slow the availability of abortion coverage. The Affordable Care Act requires plans that offer abortion coverage to put new procedures in place to separate the premium that is paid for abortion coverage from the premium that is paid for the rest of the health insurance coverage.
Since insurance providers are preparing for the transition to the Affordable Care Act, some may not have time to set up those new procedures, says Gretchen Borchelt, senior counsel at the National Women's Law Center, based in Washington D.C. As a result, some plans may not include abortion coverage this first year, though they may do so in future years.
Most insurance companies have plans that cover the costs of abortion just as they would the costs of any other medical procedure, Borchelt says. For example, Aetna and Blue Cross Blue Shield both have plans that cover abortion costs. In states without a ban on abortion coverage, “we think insurance companies recognize it’s part of comprehensive health care and they will keep it in their plan,” Borchelt says.
How much does abortion cost?
The issue of who will pay for abortion coverage is a crucial one for many women because of the cost of abortion. The average cost of a first trimester abortion (one that takes place in the first 12 weeks of pregnancy) was $470 in 2009, according to the Guttmacher Institute, an organization that advocates for sexual and reproductive health. For women on limited incomes, the money paid for an abortion may be money that’s needed for rent or monthly food bills.
Women give a variety of reasons for why they believe an abortion is necessary. According to the National Abortion Federation, many women who have abortions believe they are not financially prepared to have a baby; others do not want to bring a child into an unstable environment. Others turn to abortion after learning of medical problems affecting the fetus, such as Down’s syndrome.
A 2013 study conducted by researchers at the Guttmacher Institute and the organization Advancing New Standards in Reproductive Health found that most women don’t pay for abortions using insurance and half depend on someone else such as their partner or family members to help them with the costs.
The U.S. Department of Health & Human Services points out that the federal government’s stance on not funding the majority of abortions with taxpayer money has been largely unchanged since the 1976 Hyde Amendment – legislation that banned the use of federal funds to cover abortions. However, recent changes regarding insurance coverage of abortion have taken place in many states.
States limiting abortion coverage
The Affordable Care Act states explicitly that states can ban insurance plans in the exchanges from covering abortion. Since the law was passed, a number of states have done just that, says Gretchen Borchelt, senior counsel for the National Women’s Law Center.
Today, 22 states have laws banning insurance coverage for abortion. Fourteen states – Alabama, Arizona, Arkansas, Florida, Indiana, Louisiana, Mississippi, Ohio, Pennsylvania, South Carolina, South Dakota, Tennessee, Virginia and Wisconsin – ban insurance coverage of abortion by plans in the state exchanges. Six other states – Idaho, Kansas, Missouri, Nebraska, Oklahoma and Utah – ban insurance coverage by plans in the state exchanges, as well as plans outside of the state exchanges.
Finally two other states – Kentucky and North Dakota – don’t mention the state exchanges in their legislation, but they ban insurance coverage of abortion in all private health insurance plans in the state (which includes the state exchanges).
Other states may be following suit. As of the end of July 2013, North Carolina lawmakers were drafting legislation to also ban insurance coverage for abortion in plans that are part of the state exchange.
For women who are in a state where insurance coverage of abortion is banned, options for getting financial help to pay for the procedure are limited, Borchelt says. Some regions have abortion funds, organizations that provide financial help to low-income women who need to pay for abortions. The National Network of Abortion Funds helps women find funds in their state.