Thanks in large part to the Affordable Care Act (ACA), nearly 90% of Americans are now covered by health insurance. However, there are often significant limitations to that coverage, especially for women. Because of the Hobby Lobby ruling, religious employers can neglect to cover contraceptive costs for their employees, and at the state level there has been a wave of restrictions on insurance coverage of abortion.
Prior to the ACA, the majority of private insurance plans covered abortion care, but the new health care law reignited a national debate over the use of government funds for abortion coverage. In 2011, 92 state-level abortion restrictions were enacted, followed by 43 more in 2012, and 70 in 2013. Changes in state legislatures after the 2010 election only made it easier for these bills to pass.
In the months leading up to the passage of the ACA, women’s health groups anticipated the restrictions, hoping lawmakers wouldn’t use the debate over health care reform as an opportunity to clamp down on abortion. Planned Parenthood put it simply: “Singling out abortion for exclusion from plans in a health insurance exchange is both discriminatory and harmful to women’s health.”
Which states restrict insurance coverage of abortion?
A recent report from the Guttmacher Institute provides a comprehensive list of state restrictions on abortion coverage. As of April 2015, 10 states severely restrict all insurance coverage of abortion, and 25 states severely restrict plans available from the health insurance exchanges. Some states allow insurance companies to offer supplemental coverage, but this has been criticized as an impractical option that just leads to more restrictions.
In every U.S. state, there are at least some limitations placed on abortion coverage, such as for federal employees and people on Medicaid. In fact, all federal employees have been prohibited from choosing a health plan that covers abortion since 1983, apart from a brief reversal from 1993 to 1994. Since its reinstatement in 1995, the ban has persisted.
The 10 states with active abortion coverage bans are Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, Oklahoma, and Utah. Indiana allows exceptions for life endangerment, rape, incest, and severe health impairment, as does Utah, with the addition of fetal impairment. The other eight states only allow coverage in the case of life endangerment.
The ACLU and ThinkProgress each published an interactive map detailing the specifics of each state’s restrictions on insurance coverage of abortion. ThinkProgress also includes other legal barriers to abortion services, as well as cost range, number of abortion clinics, and number of women of reproductive age.
How much does an abortion cost?
American women already face lower wages and higher health care costs than men. On top of that, low-income women in several states are now being priced out of their right to choose abortion. Depending on the circumstances, the out-of-pocket cost of terminating a pregnancy can be extremely high and even prohibitive.
Planned Parenthood estimates the cost of abortion to be up to $800 for the abortion pill and up to $1500 for an in-clinic abortion. Prices vary across the U.S., but according to national data collected by ThinkProgress, out-of-pocket costs for an abortion can range anywhere from $375 in the first trimester to $6,531 at 22 weeks.
Researchers at the University of California, San Francisco, found that more than 4,000 women were denied abortions in 2008 for being past the gestational limit, largely because it took them too long to save up the money to pay for it. Nearly six in 10 said they couldn’t get an abortion earlier because of travel and procedure costs. In some states, transportation costs can be the biggest obstacle due to a shortage of abortion clinics.
Jane Collins, a professor and researcher at the University of Wisconsin, told ThinkProgress, “I think people have a hard time grasping that $600 can be an absolute barrier. It can be the difference between having your civil rights and not having them.”