Nearly half the states are banning abortion coverage in the new health insurance exchanges almost four years after battles over the issue nearly derailed passage of the Affordable Care Act.
Michigan could become the 24th state to ban most abortions in exchange plans this week, after an unusual citizens’ petition drive that allows state lawmakers to resurrect a bill the governor had vetoed and vote it into law without his signature.
Federal law bans taxpayer-financed abortion, and that was addressed in the compromise that paved the way for final passage of President Barack Obama’s health law. But the law also allows states to ban abortion coverage in the exchanges — even if the state isn’t running its own exchange — and most of the GOP-led states have done so.
Twenty-one states have laws banning exchange plans from covering abortion in most cases. Two other states already had restrictions in place that applied to all private health plans, which now include those offered on the exchange. The abortion funding controversy arises in the exchanges because many people will get federal subsidies to buy the health plans.
Michigan legislators are expected to take a second stab at a ban this week. Gov. Rick Snyder, a Republican, vetoed it the first time. Anti-abortion activists collected more than 315,000 signatures to allow the legislature to take it up again, and if it passes it would become law without Snyder’s signature, under a provision in the state constitution.
State Sen. Rick Jones, a Republican who says he’d vote for the ban, predicts the ban will pass “overwhelmingly.” “I think what’s happening is we have a large number of citizens that believe it violates their religious beliefs that they should pay tax dollars for somebody to have an abortion,” he said.
If the measure failed, it would go to the ballot next November. Michigan voters appear to narrowly oppose the ban, according to a poll last month by the public relations firm Lambert, Edwards & Associates.
The sweep of the bans across the country is hardly surprising considering that states have passed record numbers of abortion restrictions in recent years.
Many activists who oppose federal funding of abortion were unhappy with the health law compromise, under which exchange plans can cover abortion but insurers are required to keep the funding streams separate. If a woman wants abortion coverage, she must pay a separate premium, with no federal subsidies.
That concession was enough to convince some anti-abortion Democrats, notably then-Rep. Bart Stupak of Michigan, to lend crucially-needed votes to pass the health care law. But the law also allows states to directly ban abortion coverage, something anti-abortion activists point to as evidence that lawmakers knew it didn’t go far enough in making sure federal funds aren’t used to pay for abortions.
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“I think because that provision was allowed in the Affordable Care Act, I think there are a lot of questions,” said Pamela Sherstad, director of public information for Right to Life of Michigan, which collected signatures for the proposed ban.
“Don’t get me wrong, I’m definitely glad there’s a provision for states to opt out and we’d like to take advantage of that provision,” she added.
The Michigan measure would ban abortion coverage in plans both on and off the exchanges except when the mother’s life is at risk. Six other state bans include only a life-of-the-mother exception, while 14 states also include the federal Hyde Amendment exceptions in cases of rape or incest, according to an analysis by the Guttmacher Institute.
A handful of the laws also allow abortion coverage in the exchanges if the mother’s long-term health is at risk or if there are severe fetal defects. A few—including Louisiana and Tennessee—ban it altogether, no exceptions.
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The flood of bans has frustrated abortion rights activists, who say the Affordable Care Act does enough to ensure federally funds aren’t use for abortion. The American Civil Liberties Union filed a lawsuit over Kansas’ ban, but it was dismissed last year by a federal judge.
“We’ve seen a nationwide, orchestrated attempt to restrict access to reproductive health care in many different ways,” said Elissa Berger, policy council for the ACLU. “It’s part of this nationwide effort that I think has surprised and angered a lot of people. Some politicians are laser-focused on pushing these measures.”
“These extreme restrictions are so unpopular that politicians can’t pass them through the regular democratic process,” Planned Parenthood Action Fund President Cecile Richards said in a statement. “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.”
But anti-abortion activists say state lawmakers are just ensuring that abortion restrictions apply equally to all federally-subsidized insurance plans. Thirty-two states and the District of Columbia prohibit abortion funding in their Medicaid programs, according to the Kaiser Family Foundation.
“Those states view it as aligning their policies for the poor with their participation in other kinds of tax benefits with respect to abortion coverage,” said Chuck Donovan, president of the Susan B. Anthony List Education Fund.
Natalie Villacorta contributed to this report.
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