The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization dealt a devastating blow to the sexual and reproductive health care landscape, as thirteen states (and counting) have severely restricted or banned abortion. While some states responded to the Dobbs decision by convening special sessions to enact increasingly extreme abortion restrictions, other states have chosen to pursue policies that protect and expand abortion access for their residents and for people seeking care who are forced to travel from restrictive states.
During the 2022 state legislative sessions, one important trend that has emerged is a focus on expanding access through robust insurance coverage of abortion in private and public health care plans. While protecting the legality of abortion is vital in this post-Roe world, having the legal right means little if people have no access to abortion. Comprehensive insurance coverage is a crucial component of creating an equitable abortion access landscape.
Four states (California, Maryland, Massachusetts, and New York) all enacted proactive bills to eliminate cost-sharing requirements for abortion services in all or some health plans offered in the state. For example, as a part of a series of bills this session designed to cement the state’s status as a “reproductive freedom state,” California enacted the Abortion Accessibility Act (SB 245), a bill the National Health Law Program sponsored. This bill eliminates barriers to abortion by requiring all state-licensed health care service plans to cover abortion services without any cost-sharing requirements. Massachusetts instituted a similar prohibition on cost-sharing provisions, while Maryland and New York eliminated cost-sharing for abortion services in commercial plans. Finally, New York passed a budget bill codifying the regulations that require private plans to cover abortion services without cost-sharing.
Eliminating cost-sharing requirements for abortion coverage means an individual seeking an abortion cannot be required to pay a co-payment or meet their deductible in order to have their services covered. The average deductible for an individual with employer-sponsored insurance is around $2000, while the average cost for abortion can range anywhere from $500 to well over $1000. That means the average person would essentially have to pay out of pocket for their abortion if they were not close to hitting their deductible. This kind of out-of-pocket cost can be catastrophic for people with low incomes or may force people to spend time collecting the money they need to pay for their care, pushing them further into their pregnancy and escalating the costs. Eliminating out-of-pocket costs for people seeking an abortion is crucial step toward ensuring all people can access abortion, regardless of their income.
Beyond the states that enacted reforms to abortion coverage in 2022, six states and the District of Columbia introduced bills that would mandate or improve insurance coverage for abortion services. The District of Columbia, Hawaii, New Jersey, and Rhode Island all introduced bills that would mandate coverage of abortion services in some or all health plans offered in their state and most of those states also included provisions to prohibit cost-sharing requirements for abortion. Additionally, Rhode Island’s Governor Dan McKee recently requested funding in the budget to provide abortion coverage for Medicaid enrollees and state employees. Also, Nebraska, North Carolina, and Wisconsin introduced bills to repeal bans on insurance coverage of abortion. While these bills have not been enacted, the geographic and political diversity in these states shows that advocates across the country are fighting to expand access to abortion through insurance coverage.
Given the heinous model legislation we’ve seen from the National Right to Life Council, it is safe to assume that the 2023 state legislative session will be another brutal onslaught of abortion restrictions. However, we hope that this proactive trend of expanding and improving insurance coverage of abortion will continue in the states that recognize abortion for the health care service that it is.