It started slowly, when the Republican National Committee acknowledged that it couldn’t attack abortion coverage in health insurance without removing that benefit for its own employees.  But what started slowly may eventually become an avalanche as a movement begins to remove abortion from health insurance plans across the country.

In Kansas, a bill in front of the House Insurance Committee will require people who want coverage for abortions to purchase an abortion rider and pay a separate payment. "This is needed so people who are opposed to abortion aren’t paying for coverage for services that they find objectionable," according to the representative sponsoring the bill. 

This bill, unlike many in the past, does not address simply state employees or those who’s insurance is subsidized, but in fact addresses all new insurance policies, including private insurance plans.

Be it enacted by the Legislature of the State of Kansas:
New Section 1. (a) Any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization, municipal group-funded pool and the state employee health care benefits plan which is delivered, issued for delivery, amended or renewed on and after July 1, 2010, shall exclude coverage for abortions unless the procedure is necessary to preserve the
life of the mother or in the case of rape reported to a law enforcement agency or in the case of incest involving a minor and reported to a law enforcement agency. Coverage may be obtained through an optional rider for which an additional premium is paid. 

In North Carolina, Wake County has made the move to cease paying for any elective abortions for employees, claiming that it has recently discovered that the coverage of abortions is "illegal." The board of commissioners has stated that the change is immediate and that there will be no vote or discussion.  Both the ACLU and the local Planned Parenthood organization have done a legal analysis that shows that the local government is free to provide "whatever benefits package they deem appropriate without specific restriction on abortion coverage," but that did not stop Wake County from following in the path of Apex, another city in North Carolina that stopped coverage for abortions recently as well.

The biggest fear that reproductive rights advocates had when the Stupak-Pitts amendment was introduced into the health care debate was that that women would lose existing insurance coverage for abortion care, now held by 87 percent of women with private insurance plans.   While Congressman Stupak repeatedly claimed that his amendment would not affect funding for abortion beyond current restrictions in the Hyde Amendment, it was quickly recognized that changes wrought by Stupak-Pitts wold indeed cause dramatic shifts in the private insurance market as restrictions caused insurance companies to offer separate policies. These moves in North Carolina and Kansas show that governments are already taking it upon themselves to pre-emptively eliminate coverage before health care even passes.

Imagine the irony if health care reform itself fails to pass, and the only lasting legacy from the endeavor is the growing removal of reproductive health care from insurance plans in both the public and private sector.