Insurance Coverage

Insurance coverage bans restrict insurance coverage of abortion in order to eliminate access to safe abortion care. The Affordable Care Act (ACA), which President Obama signed into law in 2010, calls for each state to set up a health insurance exchange or “marketplace” so that people who do not have health insurance coverage through their employers can shop for health insurance at competitive rates. The ACA expressly permits states to opt out of providing abortion coverage by enacting “opt-out” laws. By passing such “opt-out” legislation, states can prohibit insurance plans available through the state’s health insurance marketplace from covering elective abortions. Some states offered varying exceptions within these coverage bans for rape, incest, or life endangerment, and some states permit women to purchase abortion coverage outside the health insurance exchange if they pay a separate premium for that coverage.

Anti-choice activists view these insurance coverage bans as a way to push back on what they claim are federal subsidies of abortion through the health-care law. As the White House has noted, however, such claims have no merit: The Hyde Amendment prohibits federal dollars from being used to pay for abortions except in cases of rape, incest, or when the life of the woman is endangered.

The push to excise abortion from health insurance coverage is part of a significant strategy of the anti-choice movement, which has realized in recent years that activists do not have to topple Roe v. Wade to eliminate access to safe abortion. Rather, anti-choice proponents understand that making abortion unobtainable, even though it is legal, can in some cases have the same effect. One effective strategy to reduce access to abortion is to make it unaffordable by ensuring that women have no option but to pay for procedures without coverage.

Examples of Insurance Coverage Bans (last updated September 12, 2018)

According to the Guttmacher Institute, eleven states restrict insurance coverage of abortion in all private insurance plans written in the state, including plans that will be offered through the health insurance exchanges. Twenty-six states restrict abortion coverage in plans to be offered through the health insurance exchanges, with some of these states offering exceptions in cases of rape, incest, or life-endangerment. Twenty-two states and the federal government restrict abortion coverage in insurance plans for public employees.

“Rape Insurance”

Some states permit women to obtain insurance coverage for abortion by alternative means. Pennsylvania, for example, permits the purchase of abortion coverage outside the health insurance exchange if a separate premium is paid for that coverage. While Pennsylvania’s law permits insurance coverage for abortion in cases of rape and incest, other states are much more stringent. In Michigan, for example, women are required to purchase a separate rider for abortion coverage even in cases of rape and incest.

Colloquially known as “Rape Insurance,” such laws ban private and public health insurance plans from offering coverage for abortion except through the purchase of an optional rider, which insurance companies, HMOs, and employers are not required to provide and which must be purchased prior to pregnancy

Texas became the most recent state to sign a “rape insurance” bill into law. HB 214, slated to take effect at the end of the year, would prohibit all insurance companies from covering abortion care in their standard plans, requiring women to purchase optional riders if they anticipate needing an abortion in the future. The law only allows a plan to provide coverage for abortion in the case of a life-threatening medical emergency.

Many state opt-out insurance coverage bans are based upon model legislation called “The Federal Abortion Mandate Opt-Out Act” drafted by Americans United for Life (AUL). Eight states have passed opt-out bills based on AUL model legislation, and four additional states passed similar bills with assistance from AUL, according to AUL’s spokesperson Kristi Hamrick. In some cases, the legislation was sponsored by state legislators with significant ties to the American Legislative Exchange Council (ALEC). For example, insurance coverage bans in Indiana, Louisiana, Mississippi, Missouri, South Carolina, Utah, Virginia, and Wisconsin were sponsored by state legislators who served on various ALEC task forces and committees.

Laws