*This post was written by Darian Diepholz & Madeline T. Morcelle. Darian Diepholz, MPH, CHES, was a Spitzer intern at the National Health Law Program over the Summer of 2021. She is a JD Candidate at Saint Louis University School of Law.
Comprehensive health care access cannot be achieved without equitable coverage of abortion services. This blog post reviews state legislative trends related to health insurance abortion coverage as of July 30th. Notwithstanding some positive abortion coverage changes that should be celebrated, state legislatures were consumed by abortion coverage restrictions this year.
Increasing abortion coverage
State legislators introduced 17 bills designed to improve abortion coverage. Three bills attempted to remove cost-sharing for abortion in private plans (California, Hawaii, and Massachusetts). In addition, New Jersey lawmakers introduced comprehensive legislation late in 2020 that, among other reproductive health coverage protections, seeks to eliminate cost-sharing for abortion services. Legislators in other states introduced bills to repeal current laws that restrict private insurance coverage, such as in Texas and North Carolina. Meanwhile, legislators in Rhode Island sought to mandate abortion coverage for Medicaid enrollees and state employees. Of the states trying to improve coverage, only Virginia’s legislation removing the prohibition of abortion coverage for qualified health plans in the Marketplace and Washington’s bill to require student health plans to cover abortions were enacted.
Restricting Abortion Coverage
This year, states enacted more abortion restrictions than any other year since the Supreme Court decided Roe v. Wade in 1973. Lawmakers in five states proposed legislation to limit insurance coverage of abortion services. In Illinois and Maine, anti-abortion legislators unsuccessfully tried to repeal current abortion coverage requirements for state plans. Other states introduced similar bills to prohibit coverage of abortions services in qualified health plans (such as West Virginia) as well as Medicaid (like Maryland). Only Montana succeeded in prohibiting coverage of abortion services in qualified health care plans.
Failing to Cover Abortions Perpetuates Inequities
Denying coverage for, and in effect, access to, abortions perpetuates inequities in health, reproductive, racial, and economic injustice. Because of the Hyde Amendment, millions of people cannot use their health insurance to pay for abortion care. In addition to significant out-of-pocket costs for the abortion itself (for instance, a first trimester abortion can cost $500–$1,000), there are also high costs associated with travel, childcare, and lost income from missed work. The Turnaway Study demonstrates that abortion coverage restrictions such as the Hyde Amendment coerce many underserved people and people with low incomes who receive health insurance or care through the federal government to continue pregnancies that they wish to end. These restrictions particularly harm those who bear the brunt of racism and other systems of oppression—particularly Black, Indigenous, and other people of color.
In conclusion, while some states are moving to protect abortion access, other states are securing new restrictions in insurance coverage of abortions. Those restrictions endanger the health, economic stability, and well-being of pregnant people and their families. Ending these restrictions and securing increased coverage of abortion care is vital to advancing health equity, economic security, and reproductive justice for all.