National Partnership for Women & Families

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Half of States Now Bar Abortion Coverage in ACA Marketplaces; Other States Considering Similar Measures

Half of States Now Bar Abortion Coverage in ACA Marketplaces; Other States Considering Similar Measures

April 2, 2015 — There are now 25 states that bar private health plans offered through the Affordable Care Act's (PL 111-148) insurance marketplaces from including abortion coverage, and lawmakers are set to consider similar measures in other states this year, National Journal reports (Owens, National Journal, 4/1).


The ACA requires insurers to keep funds for abortion coverage separate from those for other health services as a way to ensure that federal tax credits do not pay for abortion (Women's Health Policy Report, 2/20).

Arizona Gov. Doug Ducey (R) on Monday signed a bill (SB 1318) into law that made Arizona the latest state to bar women from purchasing health plans that include abortion coverage on the ACA's insurance marketplace (National Journal, 4/1).

The Kaiser Family Foundation in a January report found that about 60% of U.S. women who qualify for tax credits under the ACA are unable to access a plan that covers abortion through the law's marketplaces. At the time, researchers found that women in 31 states could not obtain abortion coverage through marketplace plans either because their state has prohibited such plans from including it or because no insurers in their area are offering it (Women's Health Policy Report, 1/23).

States' Approaches

Ten of the 25 states also restrict abortion coverage in non-marketplace private plans, according to KFF. Abortion coverage is also restricted in most circumstances for Medicaid beneficiaries. Lawmakers in several states have introduced bills this legislative session that would bar abortion coverage in the marketplace in their state.

For example, Texas lawmakers have introduced four bills (HB 1435, HB 3130, SB 575, SB 1872) this legislative session that would impose such a restriction, except in cases of endangerment to a woman's life. Two of those measures would also prohibit non-marketplace health plans from offering abortion coverage, although they would be allowed to offer a separate, supplemental policy. West Virginia lawmakers have proposed similar legislation (HB 2440, SB 236).

Michigan lawmakers also have introduced a bill (SB 214) that would only allow abortion coverage as a supplemental policy. Further, Montana lawmakers have introduced a measure (SB 349) that would require insurers that offer a plan with abortion coverage to also offer a plan without abortion coverage (National Journal, 4/1). The ACA requires marketplaces in all states to include at least one multistate plan that does not cover abortion services by 2017 (Women's Health Policy Report, 12/3/14).

Meanwhile, a bill introduced in Mississippi that would have restricted abortion coverage in health plans died in committee. A Virginia bill to lift the state's ban on abortion coverage in marketplace plans also died in committee.


Alina Salganicoff, vice president and director of women's health policy at KFF, said, "Not having abortion coverage for women can effectively limit their access to abortion services, because the cost is the primary issue."

Planned Parenthood of Arizona's Public Policy Director Jodi Liggett said in a statement, "Denying women the opportunity to use private funds for legal and safe abortion health care is an overreach. Further, forcing women and teens to prove rape or incest with insurance companies will only further traumatize victims" (National Journal, 4/1).