Michigan has recently been thrust into the national spotlight, now that state lawmakers have approved a measure requiring women to buy a separate insurance rider for abortion coverage. That restriction has been widely decried as a cruel and misogynistic policy, particularly since it doesn’t include an exception for victims of rape. Opponents have referred to it as a “rape insurance” law, emphasizing the particular burden that it places on victims of sexual assault. Pro-choice groups are considering a petition drive to attempt to repeal it.
That’s certainly been an effective messaging strategy to rally opposition to the legislation. A lot of people are fired up about “rape insurance.” But Michigan is hardly the only state that bars women from using their insurance plans to cover abortion care. It’s not even the only one that doesn’t make any exceptions for rape victims. On the contrary, this is actually quite a common policy on the state level.
First of all, it’s important to understand that restricting insurance coverage for abortion is an extremely popular method of cutting off access to reproductive rights. This type of indirect barrier to abortion access doesn’t seem as dramatic as a sweeping ban on abortion, and that’s why it doesn’t tend to grab as many headlines. But make no mistake: The anti-choice community is serious about making this type of reproductive care too expensive for most women to afford. Since an abortion procedure can cost anywhere between $300 and $10,000 out-of-pocket, one of the easiest ways to price individuals out of their abortion rights is to prevent them from using their health insurance to pay for it.
Low-income women in the country already face this reality. Thanks to the Hyde Amendment, federal dollars aren’t allowed to fund abortion, so most poor Americans can’t use their publicly-funded health insurance to cover an abortion. Thirty two states and the District of Columbia follow that federal standard for their state-based Medicaid programs. Many of these women simply don’t have the means to pay for the full cost of ending a pregnancy, and some end up being forced to carry their unwanted pregnancies to term.
And this type of abortion restriction has been steadily advancing in the private insurance market, too. North Dakota first banned private insurance coverage of abortion in 1979. Idaho, Kentucky, and Missouri placed restrictions on private abortion coverage in the 1980s. None has an exception for rape victims.
With the passage of the Affordable Care Act, which establishes state-run private insurance marketplaces, abortion opponents saw a new opportunity to restrict insurance coverage. Twenty three states rushed to ban their new marketplaces from offering any plans that include abortion coverage. And several decided to go even further, passing laws that restrict abortion coverage in the entire private market. Since 2011, Kansas, Nebraska, Oklahoma and Utah have all enacted sweeping restrictions for women purchasing private insurance.
Of the eight states that restricted private insurance coverage for abortion before Michigan joined them, just one — Utah — has included an exception for victims of sexual assault. The remaining seven states don’t have a rape exception. Technically, they all force women to buy “rape insurance.” There just wasn’t the same kind of public outcry surrounding them.
And lawmakers aren’t finished proposing these types of measures, either. Last month, Ohio lawmakers introduced their own version of this type of legislation. That bill doesn’t have a rape exception, either — and actually goes even further to avoid providing any type of options for women who want abortion coverage. Ohio’s bill doesn’t allow women to purchase a separate rider for abortion services.
Michigan’s “rape insurance” likely garnered so much attention because Americans react negatively when abortion restrictions demonstrate callousness toward sexual assault victims. Voters overwhelmingly favor legal abortion access for individuals who have become pregnant from rape. Nonetheless, even outside of measures specifically concerning abortion coverage, most of the new abortion restrictions enacted over the past year did not actually include an exception for rape victims.
And perhaps more broadly, it’s worth remembering that any type of restriction on abortion coverage — even if there is an exception for victims of sexual assault — ultimately prevents some women from getting the care they need. Particularly problematically, the atmosphere surrounding abortion funding has created a confusing situation in which most women don’t understand the full range of options available to them. An estimated 46 percent of insured women end up paying for the full cost of their abortion because they assume their provider must not cover the procedure. An additional 10 percent choose to pay with cash because the pervasive stigma surrounding abortion care has made them too ashamed to use their insurance, and they prefer the additional anonymity.