GOP Health Plan Would Ban States From Helping Low-Income Women Pay For Abortion Care

As congressional Republicans are deciding on a substitute for the Affordable Care Act, Rep. Todd Rokita (R-IN) has introduced the State Health Flexibility Act, which could prohibit states from providing abortion coverage to their residents.

Currently, the federal government matches state Medicaid spending on a per-claim basis and pays a fixed percentage of each state’s Medicaid costs so long as they adhere to certain federal guidelines. For instance, the Hyde Amendment already prevents states from spending any federal Medicaid funding on abortion services, with exceptions for rape and incest or when the life of the woman is threatened. Seventeen states have elected to provide more comprehensive abortion benefits, but pay for these procedures with state funding.

Rokita’s bill would dramatically change this. Like most Republican proposals, his legislation turns Medicaid into a block grant program that would give states a set amount from the federal government, letting them shape their own Medicaid programs with fewer federal standards and requirements. But states would be banned from covering abortion services, even with state funds, unless they buy separate health plans that include abortion insurance or only cover abortion care. As Mother Jones’ Nick Baumann explains, this would cost the 17 states that provide abortion coverage millions of dollars:

Those states do not generally purchase separate plans that cover abortion, several current state Medicaid officials and former state Medicaid directors told Mother Jones. Instead, they simply use state money to foot the abortion-related portion of the cost of the insurance. […] Under the GOP proposal, that practice would be illegal.

Rokita’s bill “would be a significant change from how current law operates today,” adds Judy Waxman, the vice president for health and reproductive rights at the National Women’s Law Center. […] Requiring states to purchase separate abortion-only plans “would be a change and one that would be harmful to women in those states,” Waxman says, noting that the current structure has stood for decades without interference from Republican or Democratic administrations.

So far, 30 House Republicans have co-sponsored the bill, and the Republican Study Committee included the proposal in its official budget.


As part of the December deal to avoid a government shutdown, Congress banned funding for abortion services in D.C. The anti-abortion policy rider prohibited D.C. from even using local taxes to pay for abortion services, reinstating a 13-year ban on abortion funding in D.C. that President Obama overturned in 2009.

Rokita touted his plan as a way to get the federal government out of the way and to give states greater flexibility — so long as that flexibility does not include letting the states create their own policies on providing abortions for low-income women.