As the anti-choice community attempts a wide range of strategies to limit women’s access to abortion, one of its most successful tactics involves imposing indirect barriers to the procedure. If states simply make it too hard for women to get an abortion — whether that’s because there aren’t any nearby clinics, or because the procedure is too expensive, or because it’s too difficult to wade through all the red tape — then it won’t be necessary to enact an actual ban that directly challenges Roe v. Wade.
Abortion opponents have been extremely successful at this incremental strategy, particularly because some of these abortion restrictions don’t appear to pose a threat on the surface. For instance, the harsh regulations on abortion providers that are forcing clinics across the country to close their doors don’t immediately appear to be unreasonable, since they’re couched in terms of patient safety. And one of the next big fights over reproductive rights, insurance coverage for abortion, is similarly deceptive.
It’s perhaps understandable, considering the fact that the insurance industry confuses most Americans. Many people may not pay attention to the services that are covered in their plan, or understand why that has anything to do with abortion rights. But this has actually become a hugely important battleground for reproductive justice.
Thanks to the federal Hyde Amendment, the policy that prevents low-income women from using their Medicaid coverage to help pay for the cost of an abortion, insurance coverage for abortion has been an issue for decades. Since poorer women already struggle to afford abortion, the Hyde Amendment is a particularly insidious method of cutting off millions of women’s access to health care. And over the past several years, the issue has spread beyond Medicaid. The federal health law actually provided an opening for abortion opponents to impose further restrictions on abortion coverage in the new state-level marketplaces. Some states have gone a step further and enacted sweeping restrictions in the private market.
Now, according to a new report from the Kaiser Family Foundation (KFF), 34 states have some kind of limit on which insurance plans are allowed to cover abortion care:
Anti-Obamacare politicians sometimes claim that the health law represents an expansion of abortion coverage. That couldn’t be further from the truth. In fact, the health law maintains the artificial divide between abortion care and the rest of women’s reproductive health services. By KFF’s estimations, about half of the U.S. women of reproductive age who are gaining insurance under Obamacare won’t have access to abortion coverage for elective procedures.
“These coverage limitations are occurring at a time when many states are taking other actions to curtail access to abortion through multiple fronts,” KFF’s report notes, explaining that the combination of these anti-choice policies “will have the expected result of limiting access to and the availability of abortion services in some states.”
Maureen Shaw, the editor-in-chief of the women’s rights and issues site sherights.com, echoed that sentiment. “These coverage limitations, especially when combined with the current political maelstrom against abortion rights, are very dangerous. Poor and low-income women will shoulder the brunt of these restrictions and their health will suffer,” Shaw told ThinkProgress. “By targeting abortion care, politicians are sending a clear message that women do not deserve comprehensive health coverage.”
Nonetheless, anti-choice lawmakers aren’t satisfied. Congressional Republicans continue to push for even more restrictions on insurance coverage for abortion. Last week, a House Judiciary Committee advanced HR 7, a sweeping measure that ultimately threatens to discourage abortion coverage in both the private and public insurance markets. That measure would dramatically reshape KFF’s map by outlawing abortion coverage in every single state’s insurance marketplace.
“The status quo is that abortion has been regularly covered — not called out, not controversial — as part of general medical coverage in private health insurance,” Susan Wood, an associate professor of health policy at George Washington University and one of the individuals who testified against the proposed legislation, told ThinkProgress in an earlier interview. “HR 7 could really change the nature of the insurance market such that ultimately it becomes the norm not to cover abortion.”
According to the Guttmacher Institute, the varying restrictions on abortion coverage have created a confusing environment, and many women who have insurance simply assume that their plan must not cover abortion. If abortion opponents have their way, that assumption will eventually become a reality.