Finding a health insurance plan that includes coverage of abortion services can be near impossible in the United States. Not only do many states have outright bans on private insurance coverage of abortions, but in states that allow coverage, the vast majority of plans don’t provide transparent and consistent information on whether and to what extent the medical procedure is covered.

And what’s more, while President Obama recently acknowledged the need for increased information on the details of abortion coverage in health plans, the steps taken by his administration are only the first toward achieving real transparency, according to a new review of insurance plans published by the Guttmacher Institute this week.

Under the Affordable Care Act (ACA), states can decide whether or not to permit insurance coverage of abortion, and many have chosen not to. So far, 25 states explicitly prohibit private insurance plans in the marketplace from covering the procedure, except in the cases of rape, incest, or life endangerment.

People in some of those states have the limited option of buying a separate insurance rider for abortion coverage, though “there is little evidence about their availability and no documentation of their cost or impact on access,” according to the Kaiser Family Foundation.

Even in states that allow for private insurance coverage of abortion, figuring out the details of that coverage can include many hurdles. Researchers at Guttmacher found that details about abortion care covered can be difficult to find or completely absent when they reviewed 2015 health plans in the 25 states that that legally permit coverage of abortion.

The biggest indicator of transparent information for Guttmacher came from a close look at those states’ “summary of benefits and coverage” forms (SBCs), standardized documents that are meant to describe the details of a plan’s coverage. The point of the SBC is to make it easy for insurance consumers to compare coverage options side by side and make informed decisions about which plans meet their needs.

The ACA requires that insurers provide consumers with SBCs, and states that plans covering abortion must include coverage details in the SBCs.

However, one-fifth of states reviewed by Guttmacher have no SBCs that describe abortion coverage, and in nine other states, only one insurer does. Plans are more likely to say in a SBC that they do not cover abortion than they are to include coverage details when they do, according to the report.

Guttmacher found that even when SBCs mention abortion coverage, the information often appears in several different places or uses confusing, inconsistent language.

“One issuer states, ‘Includes voluntary abortion services rendered by a licensed and certified professional provider, including those for which federal funding is prohibited.’ Another says, ‘Coverage includes termination of pregnancy. Laws prohibit funding of certain covered terminations of pregnancy. Premium payments are segregated to ensure compliance.’ And yet another issuer’s SBCs only says, ‘Pregnancy termination services are subject to restrictions and state law.’”

This lack of consistency may be due in part to the fact that, though the ACA requires plans notifying consumers about abortion coverage options, the SBC template provided by the federal government does not include a clear place for discussion of abortion services.

The Obama administration in December acknowledged as much, pledging to update the SBC with clear language indicated where insurers should discuss abortion.

“In the interest of increasing transparency for consumers shopping for coverage, and to assist issuers with meeting applicable disclosure requirements … we are updating the SBC template,” the administration wrote. The new template, which the administration is seeking comment on, will indicate in which sections of the form abortion coverage should be detailed.

The Guttmacher analysis concluded that the steps taken by the Obama administration are not enough. The report recommends a number of adjustments to SBCs:

• Issuers should be required to post an electronic summary of benefits and coverage (SBC) for each plan offered through each insurance marketplace website. SBCs should also be posted to insurers’ websites.
• All plans—not just marketplace plans—should be required to provide information on abortion coverage and exclusions, including in states where abortion coverage is banned in the ACA marketplace.
• Issuers should be given specific guidance to include information on abortion coverage in the same place on each SBC, using consistent, accessible and neutral language.
• All SBCs should include a link to detailed plan documents and thorough explanations of the coverage or exclusion of abortion, among other health services.

“The bottom line is that abortion is basic health care and should be covered by insurance accordingly,” Kinsey Hasstedt, the report’s author, said in a statement. “However, few people buying insurance base their entire decision on whether the plan covers an individual service—particularly a service like abortion, which no woman plans to need. Given these realities, what women really need is the option to use their health coverage for abortion if and when they find themselves in need of such care. Unfortunately, policymakers have taken that decision out of far too many women’s hands.”