Last week, the National Women’s Law Center released its 2010 edition of Making the Grade on Women’s Health: A National and State-by-State Report Card. The Report Card is the fifth in a decade-long series assessing the overall health of women at the national and state levels. The Report Card shows that the nation and the states continue to fall short in meeting women’s health needs. However, what is so exciting is that the Patient Protection and Affordable Care Act (ACA), the new federal health care law enacted in March 2010, will address approximately two-thirds of the policy indicators that were examined in the Report Card. While there are still huge gains to be made, the Report Card illustrates that the ACA can, over time, lead to major improvements in the health status of women.
While the ACA holds tremendous potential for improving women’s health, the law restricts access to one vital component of women’s health care—abortion services. The Report Card found that the ACA failed to, or only partially addressed, the policy indicators on abortion. Even when a policy indicator was partially addressed, the ACA did not resolve the policy in favor of increasing access to abortion services.
The ACA treats abortion services differently from all other medical services. The ACA stipulates that abortion cannot be included in the required benefits that all plans must cover in order to participate in the Health Insurance Exchanges. The decision about whether or not to cover abortion services is left to each health plan, unless a state passes a law prohibiting or requiring abortion coverage in their Exchange-based health plans. Five states already have established bans on abortion coverage specifically for plans sold through the Exchange— Arizona, Louisiana, Mississippi, Missouri, and Tennessee.
In addition, the ACA does not preempt existing state laws that ban private insurance coverage of abortion. Five states currently prohibit abortion coverage in all private health plans, whether sold inside or outside of the Exchange (including Missouri which bans abortion coverage in its Exchange)— Idaho, Kentucky, Oklahoma, North Dakota. This means that in nine states, women will not be allowed to use their own private money to purchase an Exchange-based health plan that covers abortion services.
For now, in the remaining 41 states and the District of Columbia, insurers selling plans in the Exchanges can decide whether or not to cover abortion services. Under the ACA, federal subsidies cannot pay for abortion coverage except in the case of rape or incest, or if the woman’s life is endangered. If the health care plan provides coverage for abortion beyond these limited cases, the health care plan must follow “segregation” requirements. These health care plans must collect two payments from enrollees and keep the payments for abortion services separate from all other premiums. These segregation requirements may prompt some insurance companies to drop the abortion coverage currently provided and deter other insurance companies from providing coverage for abortion services.
Furthermore, the ACA does not remove state laws that impose unnecessary and burdensome requirements on women who seek abortion services. As noted in the Report Card, states can continue to enforce and pass laws requiring parental consent and notification, which may force minors to travel to other states or delay the procedure for fear of involving their parents. Similarly, states can continue to pass laws requiring women to receive biased counseling and endure mandatory delays before accessing abortion services. These state-mandated lectures often provide medically inaccurate information and go beyond informed consent, and mandatory delays create unnecessary burdens and may increase the risk of complications.
The ACA was a tremendous accomplishment in that it addressed many of the Report Card’s policy indicators on women’s health. However, the ACA must be evaluated in light of all health care services women may need. While the ACA provides for great potential in advancing women’s health, it does not make the grade on ensuring access to abortion services.