Abortion is an essential part of comprehensive reproductive health care for women. It is a medical procedure that more than 920,000 U.S. women obtain every year. Access to reproductive health care, including abortion, helps to ensure that a woman can make the important decision of whether and when to have children that is best for her and her family. Yet, accessing reproductive health care can be costly, making insurance coverage critical for women who are seeking an abortion. Without coverage of abortion, many women are forced to forgo care – threatening both their physical and economic health.
Despite the importance of insurance coverage of abortion, some state politicians have taken steps to withhold coverage from women who have decided to have an abortion. State laws prohibit private insurance plans from offering coverage of abortion and other state laws withhold coverage of abortion from women who are insured through the Medicaid program. In contrast, some states promote women’s health and economic security by ensuring that plans provide insurance coverage that includes abortion.
States Ensure that Women Have Insurance Coverage of Abortion
Some states require insurance plans to provide comprehensive coverage that includes coverage of abortion.
- Three states – California, New York and Oregon – require nearly all insurance plans to provide coverage of abortion.
- Seventeen states use their own funds to make sure women enrolled in Medicaid have coverage for abortion.
- Thirteen of these states provide coverage under court orders requiring provision of abortion coverage for individuals enrolled in Medicaid.
- Four of these states voluntarily provide abortion coverage for individuals enrolled in Medicaid.
States Deny Women Access to Insurance Coverage of Abortion in Private Plans
Before the federal health care law, also known as the Affordable Care Act (ACA), most private health insurance plans covered abortion. Unfortunately, the ACA allows states to prohibit private insurance plans from offering comprehensive health insurance that includes abortion.
- Twenty-six states have laws that prohibit insurance plans from offering coverage of abortion as part of a comprehensive health care plan sold in the insurance Marketplaces set up by the ACA.
- Eleven of those states go even further and prevent all private insurers in the state – whether in the Marketplace or elsewhere – from offering coverage of abortion as part of a comprehensive health care plan.
This means that a woman in those twenty-six states will not be allowed to purchase a health plan in the Marketplace that covers abortion services and also may not be able to purchase a plan that provides insurance coverage for abortion at all – just because of where she lives and how she is insured.
Most of these state laws contain exceptions for only the most extreme situations, such as when the pregnancy endangers a woman’s life or was the result of rape or incest. But some do not even allow plans to cover abortion in those extreme circumstances.
- Louisiana and Tennessee do not allow a woman in even those difficult or life-threatening circumstances to have insurance coverage of abortion.
- Nine states do not even allow private insurance plans to cover abortion when a woman is pregnant as a result of rape or incest.
Some of the state laws that prohibit insurance companies from providing a comprehensive plan that includes abortion allow insurance companies to offer separate coverage for abortion. However, supplemental coverage for abortion is unworkable and does not provide a genuine option for coverage.
- Shortly after implementation of the ACA, insurers in several states where supplemental coverage is allowed reported that no such plans were actually offered. Since then, there has been no evidence that this type of coverage has become available.
- Obtaining supplemental coverage for a specific procedure is impractical and undermines the purpose of health insurance, which is to protect against unforeseen risk. Health insurance companies do not require individuals to guess which surgeries, specialist visits, or medication they might need.
States Withhold Coverage of Abortion from Women Qualified and Enrolled in Medicaid
Federal law, known as the Hyde Amendment, withholds abortion coverage from those qualified and enrolled in the Medicaid health insurance program for people struggling to make ends meet, except in the limited circumstances of life endangerment, rape, or incest. Despite the fact that states can – and should – use their own funds to cover abortion beyond these limited circumstances, some states have chosen not to do so.
- Thirty-three states withhold Medicaid coverage from women who need medically necessary abortions – denying a woman coverage because of her income and how she is insured.
- South Dakota only covers abortion for a woman whose life is endangered – denying a woman coverage when she is pregnant as a result of rape or incest, in violation of federal law.
- Congress has prohibited the District of Columbia from using its own locally-raised funds to provide D.C. residents enrolled in Medicaid with coverage of medically necessary abortion.
Comprehensive Coverage that Includes Abortion is Necessary to Protect Women’s Health and Economic Security
States should ensure that abortion is included in all comprehensive health insurance plans. When politicians deny women comprehensive health coverage that includes abortion, many women may face high out-of-pocket costs for these services and in some instances may be unable to obtain an abortion at all. The harm from these laws falls hardest on women struggling to make ends meet, women of color, and young women – but these laws jeopardize the health and economic security of every woman denied insurance coverage of abortion.
When a woman is denied coverage of abortion, she faces threats to her health.
- Many of the laws restricting coverage of abortion prohibit coverage even where it is necessary to protect a woman from serious, permanent, and even life-shortening health conditions. They would leave without coverage a woman for whom continuing the pregnancy will result in permanent damage to her health, such as damage to her heart, lungs, or kidneys, or a pregnant woman who is diagnosed with cancer and must undergo chemotherapy.
- Some women denied coverage of abortion will be forced to postpone an abortion while attempting to find the necessary funds. Although abortion is an extremely safe procedure, delays increase the health risks of the procedure.
- When a woman has decided to have an abortion, it is important that she have access to safe medical care, and providing health coverage of abortion means she can see a licensed, quality health provider.
When a woman is denied coverage of abortion, she may be forced to choose between basic necessities and obtaining needed care.
- Without coverage of abortion, a woman may need to raise money for the procedure and may have to forgo basic necessities such as paying rent, utility bills, or even buying food.
- More than half of women who get abortions without coverage spend the equivalent of more than one-third of their monthly income on the procedure and its associated costs.
When a woman is denied coverage of abortion faces increased costs and delays.
- A woman who has to pay for an abortion out of pocket may be forced to delay the procedure to raise the necessary funds.
- Fifty-eight percent of abortion patients say they would have had their abortion earlier if they could have. Nearly sixty percent of women who experienced a delay in obtaining an abortion cite the time it took to make arrangements and raise the money to pay for it.
When a woman is denied coverage of abortion, she may face long-term consequences.
- When a woman is living paycheck to paycheck, denying coverage for an abortion can push her deeper into poverty. One study found that a woman who is unable to get an abortion is more likely to be living in poverty and be unemployed one year later than a woman who received the abortion care she needed.
- Studies show that when political interference restricts Medicaid coverage of abortion, it forces one in four lower-income women seeking an abortion to carry an unwanted pregnancy to term.
For too long, politicians have interfered in women’s health decisions by banning comprehensive health coverage that includes coverage for abortion care. When it comes to the decision of whether to become a parent, it is vital that a woman is able to consider all the options available to her, however little money she makes, however she is insured, or wherever she lives. States should recognize this, and ensure that a woman has insurance coverage that meets her needs, including abortion.
State Laws Regulating Coverage of Abortion
|Coverage of Abortion for Women Enrolled in Medicaid||Coverage of Abortion for Women with Private Insurance Plans|
|Find the Law||Marketplace||All Plans||Find the Law|
|Alabama||Refuses to cover||Ala. Admin. Code r. 560-X-6-.09 (2016)||Bans||Does not ban or require||Ala. Code § 26-23C-3 (2012)|
|Alaska||Covers||Alaska v. Planned Parenthood, 28 P.3d 904 (Alaska 2001)||Does not ban or require||Does not ban or require|
|Arizona||Covers||Simat Corp. v. Ariz. Health Care Cost Containment Sys., 203 Ariz. 454 (2002)||Bans||Does not ban or require||Ariz. Rev. Stat. § 20-121 (2012)|
|Arkansas||Refuses to cover||Ark. Const. Amend. 68, § 1||Bans||Does not ban or require||Ark. Code § 23-79-156 (2013)|
|California||Covers||Committee to Defend Reprod. Rights v. Myers, 625 P.2d 779 (Cal. 1981)||Requires coverage||Requires coverage||Committee to Defend Reprod. Rights v. Myers, 625 P.2d 779 (Cal. 1981); Cal. Health & Safety Code § 1340 et seq.|
|Colorado||Refuses to cover||Colo. Code Regs. § 2505-10:8.730 (2017)||Does not ban or require||Does not ban or require|
|Connecticut||Covers||Doe v. Maher, 515 A.2d 134 (Conn. Super. Ct. 1986)||Does not ban or require||Does not ban or require|
|Delaware||Refuses to cover||Del. Admin. Code § 1.15 (2017)||Does not ban or require||Does not ban or require|
|District of Columbia||Prohibited from covering by Congress||Pub. L. No. 112-10 § 1572, 125 Stat. 38, 138 (2011)||Does not ban or require||Does not ban or require|
|Florida||Refuses to cover||Fla. Admin. Code r. § 59G-4.001 (2017)||Bans||Does not ban or require||Fla. Stat. §§ 627.64995, 627.66996, 641.31099 (2011)|
|Georgia||Refuses to cover||Georgia Department of Community Health, Division of Medical Assistance, Policies and Procedures for
Hospital Services, § 911 (2011)
|Bans||Does not ban or require||Ga. Code Ann. §§ 33-24-59.17, 45-18-4 (2014)|
|Hawaii||Covers||State covers voluntarily||Does not ban or require||Does not ban or require|
|Idaho||Refuses to cover||Idaho Admin. Code r. 16.03.09.511 (2017)||Bans with only life endangerment exception||Bans with only life endangerment exception||Idaho Code Ann. § 41-1848 (2011)|
|Illinois||Covers||To be codified at 305 Ill. Comp. Stat. Ann. 5/5-5 (2018)||Does not ban or require||Does not ban or require|
|Indiana||Refuses to cover||405 Ind. Admin. Code 5-28-7 (2017)||Bans||Bans||Ind. Code §§ 27-8-33, 16-33-4-1 (2012); Ind. Code §§ 27-8-13.4, 27-13-7-7.5 (2014)|
|Iowa||Refuses to cover||Iowa Admin. Code r. 441-78.1(249A) (2016)||Does not ban or require||Does not ban or require|
|Kansas||Refuses to cover||Kansas Medical Assistance Program Provider Manual, § 8400 (2010)||Bans with only life endangerment exception||Bans with only life endangerment exception||Kan. Stat. Ann. § 40-2,190(b) (2011)|
|Kentucky||Refuses to cover||Kentucky Medicaid
Member Handbook, at 27 (2011)
|Bans with only life endangerment exception||Bans with only life endangerment exception||Ky. Rev. Stat. Ann. § 304.5-160|
|Louisiana||Refuses to cover||La. Rev. Stat. Ann. § 40:1061.6 (2017)||Bans with no exceptions||Does not ban or require||La. Rev. Stat. Ann. § 22:1014 (2011)|
|Maine||Refuses to cover||MaineCare Benefits Manual, ch. 2, § 90.05-2 A (2016)||Does not ban or require||Does not ban or require|
|Maryland||Covers||State covers voluntarily||Does not ban or require||Does not ban or require|
|Massachusetts||Covers||Moe v. Sec’y of Admin. & Fin., 417 N.E.2d 387 (Mass. 1981)||Does not ban or require||Does not ban or require|
|Michigan||Refuses to cover||Mich. Comp. Laws §§ 400.109a, 400.109e (2017)||Bans with only life endangerment exception||Bans with only life endangerment exception||Mich. Comp. Laws §§ 550.541-551(2014)|
|Minnesota||Covers||Women of Minn. v. Gomez, 542 N.W.2d 17 (Minn. 1995)||Does not ban or require||Does not ban or require|
|Mississippi||Refuses to cover||Miss. Code Ann. § 41-41-91 (2017)||Bans||Does not ban or require||Miss. Code Ann. §§ 41-41-97, 41-41-99 (2010)|
|Missouri||Refuses to cover||Mo. Rev. Stat. § 188.205 (2016)||Bans with only life endangerment exception||Bans with only life endangerment exception||Mo. Ann. Stat. § 376.805 (2012)|
|Montana||Covers||Jeannette R. v. Ellery, No. BDV-94-811 (Mont. Dist. Ct. May 22, 1995)||Does not ban or require||Does not ban or require|
|Nebraska||Refuses to cover||Nebraska HHS Finance and Support Manual, § 10-005.09 (2003)||Bans with only life endangerment exception||Bans with only life endangerment exception||Neb. Rev. Stat. §§ 44-8402, 44-8403 (2011)|
|Nevada||Refuses to cover||Division of Health Care Financing and Policy, Medicaid Services Manual, § 603 (2011)||Does not ban or require||Does not ban or require|
|New Hampshire||Refuses to cover||See NH Healthy Families, Provider Manual, at 29 (2016)||Does not ban or require||Does not ban or require|
|New Jersey||Covers||Right to Choose v. Byrne, 450 A.2d 925 (N.J. 1982)||Does not ban or require||Does not ban or require|
|New Mexico||Covers||New Mexico Right to Choose/NARAL v. Johnson, 975 P.2d 841 (N.M. 1998)||Does not ban or require||Does not ban or require|
|New York||Covers||State covers voluntarily||Requires coverage||Requires coverage||N.Y. Ins Law § 3217 (2015); N.Y. Comp. Codes R. & Regs. tit. 11, § 52.2 (2016)|
|North Carolina||Refuses to cover||Specified in yearly appropriations, see e.g., H.B. 229, 1995 Reg. Sess. (N.C. 1995)||Bans with only life endangerment exception||Does not ban or require||N.C. Gen. Stat. § 58-51-63 (2013); S.B. 353, Gen. Assemb., 2013 Sess. (N.C. 2013)|
|North Dakota||Refuses to cover||N.D. Admin. Code 75-02-02-08 (2017)||Bans with only life endangerment exception||Bans with only life endangerment exception||N.D. Cent. Code § 14-02.3-03|
|Ohio||Refuses to cover||Ohio Admin. Code 5160-17-01 (2017)||Bans||Does not ban or require||Ohio Rev. Code Ann. § 3901.87 (2012)|
|Oklahoma||Refuses to cover||Okla. Admin. Code § 317:30-5-6 (2017)||Bans with only life endangerment exception||Bans with only life endangerment exception||Okla. Stat. tit. 63, § 1-741.3 (2011)|
|Oregon||Covers||Planned Parenthood Ass’n v. Dep’t of Human Resources, 687 P.2d 785 (Or. 1984)||Requires coverage||Requires coverage||H.B. 3391, 79th Leg., 2017 Reg. Sess. (Or. 2017)|
|Pennsylvania||Refuses to cover||18 Pa. Cons. Stat. Ann. § 3215 (2016)||Bans||Does not ban or require||40 Pa. Cons. Stat. § 33 (2013)|
|Rhode Island||Refuses to cover||39-3 R.I. Code § 0300.01 (2017)||Does not ban or require||Does not ban or require|
|South Carolina||Refuses to cover||S.C. Code Ann. § 1-1-1035 (2016)||Bans||Does not ban or require||S.C. Code Ann. § 38-71-238 (2012)|
|South Dakota||Refuses to cover with
only life endangerment exception
|S.D. Codified Laws § 28-6-4.5 (2017)||Bans||Does not ban or require||S.D. Codified Laws § 58-17-147 (2012)|
|Tennessee||Refuses to cover||Tenn. Code Ann. § 9-4-5116 (2003)||Bans with no exceptions||Does not ban or require||Tenn. Code Ann. § 56-26-134 (2010)|
|Texas||Refuses to cover||1 Tex. Admin. Code § 354.1167 (2017)||Bans with only life endangerment exception||Bans with only life endangerment exception||H.B. 214, 85th Leg., 1st Called Sess. (Tex. 2017)|
|Utah||Refuses to cover||Utah Code Ann. § 76-7-331 (2016)||Bans||Bans||Utah Code Ann. § 31A-22-726 (2012)|
|Vermont||Covers||Doe v. Celani, No. S81-84CnC (Vt. Super. Ct. May 26, 1986)||Does not ban or require||Does not ban or require|
|Virginia||Refuses to cover||Va. Code Ann. §§ 32.1-92.1, 32.1-92.2 (2016)||Bans||Does not ban or require||Va. Code. Ann. § 38.2-3451 (2013)|
|Washington||Covers||State covers voluntarily||Does not ban or require||Does not ban or require|
|West Virginia||Covers||Women’s Health Ctr. v. Panepinto, 446 S.E.2d 658 (W. Va. 1993).||Does not ban or require||Does not ban or require|
|Wisconsin||Refuses to cover||Wisc. Stat. Ann. § 20.927 (2017)||Bans||Does not ban or require||Wis. Stat. § 632.8985 (2012)|
|Wyoming||Refuses to cover||Who. Stat. Ann. § 35-6-117 (2017)||Does not ban or require||Does not ban or require|
|TOTAL||33 states and DC||26 states||11 states|