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About Half of States Have Banned Most Abortion Coverage in ACA Marketplace Plans

December 11, 2013 — Nearly four years after disputes over abortion coverage threatened the passage of the Affordable Care Act (PL 111-148), almost half of states have used a provision in the law to ban the coverage in health plans sold through the insurance marketplaces, Politico reports (Winfield Cunningham, Politico, 12/11).

The ACA does not prohibit abortion coverage and lets insurers determine whether they will offer it. However, the law requires health plans to segregate money collected for abortion coverage from other premiums. The law also requires that at least one multi-state plan, available in every state by 2017, does not cover abortion beyond cases when the pregnancy is a result of rape or incest or when a woman's life is endangered (Women's Health Policy Report, 12/5).

The ACA also allows states to enact additional restrictions on abortion coverage in their marketplaces, including when the federal government is operating a state's marketplace.

Bans To Date

So far, 21 states have enacted measures to specifically ban plans in their marketplaces from covering abortion in most cases, while two other states already had laws in place banning the coverage in private health plans, which now includes marketplace plans, according to Politico.

Michigan later this week could become the 24th state to restrict the coverage in its marketplace plans, using a provision in the state's constitution that allows lawmakers to vote a citizen's petition into law without the governor's signature. Michigan Gov. Rick Snyder (R) vetoed an identical proposal last year. The measure would apply to all plans in the state, not just those sold through the marketplaces.

The extent of abortion coverage bans varies from state to state, Politico reports. A few states ban abortion coverage with no exceptions, while six states bar such coverage in all cases except when a woman's life is endangered, and 14 states allow exceptions for both life endangerment and cases of rape or incest. A few other states also permit the coverage when a woman's long-term health is at risk or there are severe fetal anomalies.

Ongoing Debate

Antiabortion-rights activists who support bans on abortion coverage in marketplace plans have said the ACA does not go far enough to ensure public funds will not be used to cover the procedure.

Susan B. Anthony List Education Fund President Chuck Donovan said that states enacting the bans are simply "aligning their policies for the poor with their participation in other kinds of tax benefits."

Meanwhile, abortion-rights supporters said that the ACA already ensures federal funds do not go toward abortion coverage and that additional restrictions are not needed.

Cecile Richards, president of the Planned Parenthood Action Fund, said in a statement, "These extreme restrictions are so unpopular that politicians can't pass them through the regular democratic process. Instead, they're using every trick in the book -- votes in the middle of the night, special sessions, and procedural loopholes -- in order to pass these measures" (Politico, 12/11).