Abortion Coverage Severely Restricted in House Health Reform Bill

Women getting insurance through the government's new system probably won't have abortion coverage.

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The Saturday-night passage of the House health reform bill has left a bad taste in the mouths of reproductive-rights advocates. They're opposed to the last-minute addition of a controversial amendment that specifically prohibits abortion coverage in plans funded by the federal government. In an E-mail sent out about an hour before the reform bill passed, Planned Parenthood President Cecile Richards called the amendment "an unacceptable addition to the healthcare reform bill that, if enacted, would result in women losing health benefits they have today." Nancy Keenan, president of NARAL Pro-Choice America, called the amendment "anti-choice" and vowed to fight to remove this provision from the final version of any health reform bill. 

Both advocacy groups claim that women will lose their access to abortion coverage in private insurance plans that offer it. The procedure is now covered for most insured women, though not for Medicaid recipients or those employed by the federal government. That's because federal law—under the Hyde amendment—already prohibits taxpayer funds from being used to finance abortions. The new amendment put forth by Democratic Rep. Bart Stupak of Michigan and GOP Rep. Joe Pitts of Pennsylvania doesn't allow abortion coverage in the public plan option except in the case of rape or incest or to save the life of the mother. It also doesn't allow private insurance plans that participate in the health insurance exchange to provide abortion coverage—at least to those 80 percent of folks who will qualify for affordability tax credits. (These insurance plans can, however, still offer abortion coverage for policies that aren't government funded, such as those offered by employers in the private sector.)

Richards claims the House bill will alter the status quo by restricting "women's access to abortion coverage in the private health insurance market, undermining the ability of women to purchase private health plans that cover abortion, even if they pay for most of the premiums with their own money. This amendment reaches much further than the Hyde Amendment." Whether the status quo would truly be altered, however, is up for debate, since there's nothing in the health reform bill that stops private insurance plans from offering abortion coverage outside of the exchange. That means those of us getting coverage from our employers probably won't see a change in our plans' coverage of abortions. As I previously reported, an estimated 46 to 87 percent of employer insurance plans currently provide abortion coverage, according to two recent surveys.

While the Stupak-Pitts amendment does allow women who want abortion coverage to purchase a separate rider along with their insurance policy, Richards says these riders are "discriminatory and illogical" since "women do not plan to have unintended pregnancies or medically complicated pregnancies that require ending the pregnancy." The National Women's Law Center has found that while five states already require separate riders for abortion coverage, the riders don't appear to exist in any insurance plans, public or private, that are offered in these states. Thus, none of the women in these states—North Dakota, Kentucky, Idaho, Oklahoma, and Missouri—appear to have plans that cover abortions.

It's not clear yet whether the Senate health reform bill, which is still being drafted, will contain a similar abortion amendment. [Details on abortion coverage in the Baucus bill.] Reproductive-rights activists have vowed to wage a fight against any such amendment and are making their opposition known to senators and President Obama. The president declined to address abortion coverage when hailing the passage of health reform in the Rose Garden on Sunday, but that may change if the battle continues to heat up. Planned Parenthood spokesperson Tait Sye told me via E-mail, "We are going to work with and meet with anyone and everyone to try and get this provision out." Of course, the antiabortion groups will be working just as hard to keep the provision in.

What do you think? Should the current restrictions on abortion coverage remain in the final healthcare bill? Answer the poll below.

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