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Interactive: How State Policies Shape Access to Abortion Coverage

State and federal efforts to address insurance and Medicaid coverage of abortion services began soon after the 1973 Supreme Court’s Roe v Wade decision legalizing abortion. Starting in 1977, the Hyde Amendment banned the use of any federal funds for abortion, with exceptions for pregnancies that endanger the life of the woman, or that result from rape or incest. Some states use their own dollars to cover other medically necessary abortions under Medicaid or have been compelled to do so through judicial action. The passage of the ACA in 2010 led to renewed legislative efforts to limit coverage of abortions, this time in private insurance plans. The ACA specifically excludes abortion as an Essential Health Benefit, maintains the prohibition on using federal funds for abortion other than the circumstances defined by the Hyde Amendment, and permits states to ban abortion coverage from Marketplace plans. A handful of states had prior laws restricting abortion coverage in private insurance. After 2010, many more states enacted private plan restrictions and also banned abortion coverage from Marketplace plans, some of which are more restrictive than the Hyde limitations. This interactive map shows the increase in states with laws restricting abortion coverage in Medicaid and private insurance for the years 2000, 2010, and 2016, before and after the passage of the ACA.

Medicaid Coverage Limitations - State limits Medicaid coverage of abortion to the Hyde Amendment restrictions (only allowed in the cases of rape, incest or life endangerment).

Private Insurance Coverage Limitations - State has a law that prohibits coverage of abortions from being included in private insurance policies sold in the state (with certain exceptions). Private insurance includes individual, small group, and large group. Some states may allow abortion coverage to be purchased as a rider.

State Marketplace Coverage Limitations - State has a law that prohibits plans sold on state Marketplaces from covering abortion (with certain exceptions).

No Coverage Limitations - State does not limit coverage of abortion in private insurance or the state Marketplace and the state Medicaid program permits the use of state funds (non-federal) to pay for abortion in circumstances outside of those allowed by the Hyde Amendment.

Definitions and Sources

Medicaid Coverage Limitations - States that limit Medicaid coverage of abortion to the Hyde Amendment restrictions (only allowed in the cases of rape, incest or life endangerment).

  • Medicaid coverage of abortion more restrictive than the Hyde limitations: South Dakota violates federal law by only covering abortions in cases of life endangerment for Medicaid beneficiaries.
  • State-funded Medicaid coverage of abortion in circumstances beyond the Hyde limitations: Indiana, Utah and Wisconsin cover abortion in the case of danger to the woman’s physical health. Iowa, Mississippi and Virginia cover abortion in the case of fetal impairment. In Iowa, however, the Governor must approve any abortion paid for by Medicaid.
  • No Medicaid restrictions: 17 states use state-only funds to pay for all medically necessary abortions for women on Medicaid and do not place restrictions on Medicaid coverage of abortion.

Private Insurance Coverage Limitations - State has a law that prohibits coverage of abortions from being included in private insurance policies sold in the state (with certain exceptions). Private insurance includes individual, small group, and large group. Some states may allow abortion coverage to be purchased as a rider.

  • Rhode Island passed legislation in 1983 banning abortion coverage in the Private insurance plans, but this ban was found unconstitutional and is not in effect.
  • Kentucky amended the 1978 legislation banning abortion coverage in Private insurance plans in 1984.
  • Exceptions to coverage bans more restrictive than the Hyde limitations: Idaho, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, and Oklahoma allow coverage exceptions for only life endangerment of the woman.
  • Exceptions to coverage bans less restrictive than Hyde limitations: Utah also allows coverage for abortion in the case of severe health impairment of the woman and fetal impairment.
  • Purchasing additional coverage for abortion services: Arizona, Arkansas, Florida, Idaho, Indiana, Florida, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, Oklahoma, and Pennsylvania allow women to purchase additional riders for Marketplace plans and for Private insurance plans.

State Marketplace Coverage Limitations - State has a law that prohibits plans sold on state Marketplaces from covering abortion (with certain exceptions).

  • Exceptions to coverage bans more restrictive than the Hyde limitations: Arizona, Georgia, and South Dakota allow coverage in the case of life endangerment and severe health impairment of the woman only. Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, and Oklahoma only allow coverage in the case of life endangerment of the woman. Louisiana and Tennessee do not allow coverage in any circumstance.
  • Exceptions to coverage bans less restrictive than Hyde limitations: Indiana also allows coverage in the case of the woman’s severe health endangerment. Utah also allows coverage in the case of the woman’s severe health impairment and fetal impairment. Wisconsin also allows coverage in the case of the woman’s severe physical health impairment.

No Coverage Limitations -  States do not have laws limiting coverage of abortion in private insurance or the state Marketplace and the state Medicaid program permits the use of state funds (non-federal) to pay for abortion in circumstances outside of those allowed by the Hyde Amendment.

 

Sources:

Georgia General Assembly, 2013-2014 Regular Session- SB 98 “Federal Abortion Mandate Opt-Out Act.” Found at: http://www.legis.ga.gov/legislation/en-US/display/20132014/SB/98

Guttmacher Institute. (2011). Laws Affecting Reproductive Health and Rights: 2011 State Policy Review. Found at: http://www.guttmacher.org/statecenter/updates/2011/statetrends42011.html

Guttmacher Institute. (2013). Laws Affecting Reproductive Health and Rights: 2013 State Policy Review. Found at: http://www.guttmacher.org/statecenter/updates/2013/statetrends42013.html

Guttmacher Institute. (2014). State Policies in Brief: Abortion Policy in the Absence of Roe. Found at: http://www.guttmacher.org/statecenter/spibs/spib_APAR.pdf

Guttmacher Institute. (2014). State Policies in Brief: Restricting Insurance Coverage of Abortion. Found at: http://www.guttmacher.org/statecenter/spibs/spib_RICA.pdf

Guttmacher Institute. (2014). State Policies in Brief: State Funding of Abortion Under Medicaid. Found at: http://www.guttmacher.org/statecenter/spibs/spib_SFAM.pdf

LegiScan. North Dakota House Bill 1297. Found at: http://legiscan.com/ND/bill/1297/2011

NARAL Pro-Choice. Rhode Island- Insurance Prohibition for Abortion. Found at: http://www.prochoiceamerica.org/government-and-you/state-governments/state-profiles/rhode-island.html?templateName=template-161602701&issueID=18&ssumID=2810

National Conference of State Legislatures. (2014). Health Reform and Abortion Coverage in the Insurance Exchanges. Found at: http://www.ncsl.org/research/health/health-reform-and-abortion-coverage.aspx

National Partnership for Women and Families. (2011). In the News: Ohio Gov. Signs Ban on Abortion Coverage in Health Insurance Exchanges. Found at: http://go.nationalpartnership.org/site/News2?page=NewsArticle&id=32363&security=3161&news_iv_ctrl=3166

National Women’s Law Center. (2014). State Bans on Insurance Coverage of Abortion Endanger Women’s Health and Take Health Benefits Away from Women. Found at: http://www.nwlc.org/sites/default/files/pdfs/state_bans_on_abortion_covg_factsheet_4.7.14.pdf

 

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