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Coverage for Abortion Services and the ACA

Issue Brief
  1. Legislation extends Medicaid coverage to all individuals with incomes up to 133% of the poverty level (FPL) and includes a provision to disregard first 5% of income, effectively extending Medicaid to all individuals with incomes up to 138% FPL.

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  2. Kaiser Family Foundation, Status of State Action on the Medicaid Expansion Decision, Updated August 28, 2014. Currently, 23 states have not expanded Medicaid, though many states are looking to expand Medicaid in the future. Indiana has an expansion plan pending, while Utah is in negotiation with CMS on its plan. Tennessee, Wyoming, and Maine are also considering expansion.

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  3. Kaiser Family Foundation, The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid, March 2014.

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  4. Kaiser Family Foundation, State-by-State Estimates of the Number of People Eligible for Premium Tax Credits Under the Affordable Care Act, November 2013

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  5. Senator Shaheen, “Shaheen Amendment Signed into Law” January 3, 2013

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  6. Kaiser Family Foundation, Medicaid’s Role for Women Across the Lifespan, December 2012

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  7. Guttmacher Institute, State Policies in Brief: State Funding of Abortion Under Medicaid, September 2014

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  8. The White House Office of the Press Secretary, Executive Order – Patient Protection and Affordable Care Act’s Consistency with Longstanding Restrictions of the Use of Federal Funds for Abortion, March 24, 2010

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  9. Michigan, Act 182: Abortion Insurance Opt Out Act

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  10. Guttmacher Institute, State Policies in Brief: Restricting Insurance Coverage of Abortion, September, 2014

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  11. The Patient Protection and Affordable Care Act, Section 1303 Special Rules

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  12. 45 CFR § 800.602: Consumer choice with respect to certain services

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  13. Office of Personnel Management, Letter to Representative Chris Smith, November 8, 2013

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  14. Wisconsin has not formally expanded Medicaid under the ACA, but extends coverage to adults up to 100% of FPL. Wisconsin does not have a coverage gap.

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  15. Ibid.

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  16. For a discussion of the methods used to derive the estimates of women in the coverage gap and eligible for tax credits see: KFF, The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid and KFF, State-by-State Estimates of the Number of People Eligible for Premium Tax Credits Under the Affordable Care Act. The estimates of the availability of abortion coverage were derived using a two-step process.  1) Using state level estimates we classified the number of uninsured women of reproductive age (19 to 49) legally residing in the United States in 2011/2012 into four groups:  those who were eligible for Medicaid, tax credits, had incomes below poverty and resided in a state that was not expanding Medicaid (coverage gap), or had incomes that were at or above 400% of the federal poverty level.  2) These calculations were then used to estimate the number of women with differing levels of abortion coverage based on whether or not their state permitted the use of state only funds to pay for abortions beyond the Federal Hyde limitations; enacted laws that banned coverage on the plans available through the state Marketplace beyond limited circumstances; and those enacting similar legislation affecting private plans available in the state.  The number of women with limitations in the scope of abortion coverage or who were in the insurance coverage gap was summed and divided by the number of uninsured women who were legally residing the state.  The policies used to determine the availability of abortion coverage were based on those collected by the Guttmacher Institute and available in: State Policies in Brief: Overview of Abortion Laws, September 2014.

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  17. Jones, R and K Kooistra. (2011). Abortion Incidence and Access to Services in the United States, 2008. Perspectives on Sexual and Reproductive Health 43(1), 41-50.

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  18. Guttmacher Institute. State Policies in Brief, Overview of Abortion Laws, September 2014

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  19. Guttmacher Institute, Facts on Induced Abortion in the United States, July 2014

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  20. Ibid.

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  21. National Journal, “Should Mothers Be Forced to Bear Disabled Children Against Their Will?”, October 2013

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  22. Jones, R. and K. Kooistra. (2011). Abortion Incidence and Access to Services in the United States, 2008. Perspectives on Sexual and Reproductive Health 43(1): 41-50.

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Appendix
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