The Affordable Care Act (ACA) legislation regarding abortion does not take effect until 2014. Under the ACA, insurers who participate in health insurance exchanges will be free to offer plans with abortion services or not. Individual plans can also choose their degree of abortion coverage (life of mother/rape/incest, have broader coverage for genetic anomalies, or include elective abortion), however, no federal money can be used to pay for abortions beyond Hyde (rape/incest/life of mother). To get extra abortion coverage women will be required to pay for a separate abortion rider.

Under the ACA, each states exchange must provide one health plan that covers abortion and one plan that does not cover abortion or restricts abortion coverage to the Hyde basics. Except where they aren’t allowed to provide abortion coverage. You see, there’s a loophole. A big loophole. Under the ACA the states are allowed to pass laws that completely prohibit abortion in the insurance exchanges. This is not just some hypothetical they might pass a law, it’s happening right now.

In preparation for the great abortion onslaught that the ACA is sure to bring (remember, abortion coverage does not increase the rate of abortion) 20 states have already spent money passing laws affecting abortion coverage for their health insurance exchanges. As a result:

  • 6 states limit coverage to life endangerment.
  • 2 states limit coverage to life endangerment and “substantial and irreversible impairment of a major bodily function.”
  • 1 state limits coverage to life endangerment, “substantial and irreversible impairment of a major bodily function,” rape or incest.
  • 7 states limit coverage to life endangerment, rape and incest.
  • 1 state limits coverage to life endangerment, rape and incest, fetal impairment and “substantial and irreversible impairment of a major bodily function.”
  • 1 state limits coverage to life endangerment, rape, incest and cases of “grave long-lasting physical health damage.”
  • 2 states prohibit all abortion coverage in the exchange (Tennessee and Louisiana) 

The ACA does many great things for health care, for example doing away with lifetime limites and pre-existing condition clauses. I also appreciate that legislation as sweeping as the ACA will need amending over time. However, allowing states another avenue to deny women the full spectrum of reproductive health services (especially considering the ACA requires plans to offer “essential health benefits”) is wrong.

From a business standpoint, excluding abortion services does not lower the cost of insurance and we know from the Canadian model that free abortion does not increase the rate. Therefore, the ACA legislation on abortion is simply another assault on Roe via the side door offered by the States. The abortion riders are likely to be $80 or more and will require a waiting period. In Kansas they don’t expect to sell any. However selling off reproductive rights state by state, well, that’s another matter.

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  1. I find all of this lunacy that each state in the USA is finding “unique” ways to attack those aspects of healthcare that the preferred deity of the majority of voters allegedly does not like to be about as stupid as it gets. The majority of healthcare providers seem to believe (as do I) that no matter what your personal religious beliefs are, people should be provided the very best and all medically/psychologically-necessary treatments. It is not exactly brain surgery to figure out that healthcare providers (and by extension insurers and government healthcare agencies) should be doing everything possible to provide high quality services and make people “healthy” and to leave the moral judgments for higher powers at such time as the patient might meet their maker(s). Abortion is a medically and/or psychologically-necessary treatment for some women (and each woman is the one who has the last say in concluding if this is necessary for her), and resources should be provided so that she may consult with any medical, psychological, or spiritual professional that she wishes to during her decision making process. Healthcare insurance needs to cover ALL medically/psychologically-necessary care for everyone of either gender, any race or SES bracket, sexual orientation, etc. If the elected officials and clergy of the USA could learn to stop trying to legislate morality and religion by imposing restrictions on abortion and devote 50% of that energy to eliminating conditions that “cause” rape and incest and underage sexual activity and improper use of contraception techniques, the USA would have a healthcare system we could all be proud of. I choose to believe that everyone’s preferred deities would be appreciative.

  2. Excellent post. I would like to know, however, what states are imposing which restrictions.

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