Guttmacher Institute: State Laws & Policies – Regulating Insurance Coverage of Abortion

NEW YORK, Sept. 1 -- The Guttmacher Institute, a research and policy organization that says it is committed to advancing sexual and reproductive health and rights worldwide, issued the following research associated with state laws and policies on Aug. 31, 2023:

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Background

State governments have found multiple ways to limit insurance coverage of abortion, including through bans on abortion coverage in public employees' insurance policies. Several states have restricted abortion coverage in other private health insurance plans, especially following passage of the Affordable Care Act (ACA) in 2010, which provided for the establishment of state-level health insurance exchanges. While these coverage restrictions on private health plans are in place in half of the states, other states have taken steps to protect abortion access and affordability by requiring insurance plans to cover abortion. The laws in these states either require abortion coverage or require the coverage if a health plan includes coverage for prenatal care. Some states choose to use their own Medicaid funds to cover abortion, although the Hyde Amendment prohibits the use of federal funds for abortion except in cases of life endangerment, rape or incest.

Visit our state legislation tracker (https://www.guttmacher.org/state-policy) for policy activity on all sexual and reproductive health topics.

Highlights

* 7 states require abortion coverage in private health insurance plans.

- 2 states require plans that cover prenatal care to cover abortion.

- 8 states require abortion coverage with no copayments.

* 11 states have laws in effect restricting insurance coverage of abortion in all private insurance plans written in the state, including those offered through health insurance exchanges established under the ACA.

- 8 states limit coverage to cases of life endangerment.

- 1 state limits coverage to cases of life endangerment, rape, incest, fetal impairment and "substantial and irreversible impairment of a major bodily function."

- 1 state limits coverage to cases of life endangerment and "substantial and irreversible impairment of a major bodily function."

- 1 state limits coverage to cases of life endangerment, "substantial and irreversible impairment of a major bodily function," rape and incest.

- 9 states permit abortion coverage beyond specified exceptions through purchase of a separate rider and payment of an additional premium.

* 25 states restrict abortion coverage in plans offered through health insurance exchanges.

- 7 states limit coverage to cases of life endangerment.

- 4 states limit coverage to cases of life endangerment and "substantial and irreversible impairment of a major bodily function."

- 1 state limits coverage to cases of life endangerment, "substantial and irreversible impairment of a major bodily function," rape and incest.

- 9 states limit coverage to cases of life endangerment, rape and incest.

- 1 state limits coverage to cases of life endangerment, rape, incest, fetal impairment and "substantial and irreversible impairment of a major bodily function."

- 1 state limits coverage to cases of life endangerment, rape, incest and cases of "grave, long-lasting physical health damage."

- 2 states prohibit any abortion coverage.

* 21 states restrict abortion coverage in health insurance plans for public employees.

- 8 states limit coverage to cases of life endangerment.

- 11 states limit coverage to one or more of these exceptions: life endangerment, threat to the pregnant person's health, rape, incest and fetal abnormality.

- 2 states prohibit any abortion coverage.

* 20 states have more than one of the above restrictions.

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Original text here: https://www.guttmacher.org/state-policy/explore/regulating-insurance-coverage-abortion