State-Level Policies on Insurance Coverage of Abortion: Impact of Current and Past Trends

Bans on private insurance coverage for abortion have received less attention than other well-publicized efforts to limit abortion access, especially over the last three years. This study tracks state actions on abortion coverage, delves into the political environment surrounding state legislation, and explores how these laws interact or interfere with abortion access in the individual markets and new Marketplaces.

Study Design

This qualitative study documents the enactment of state legislation affecting insurance coverage of abortion, resulting in a new timeline and state tabulation of the history of this effort. Additional research tracks related factors, including if legislation passed in response to federal or state action, state policies on ACA implementation, or previous state legislative initiatives.

Findings

This analysis finds that while many women will gain coverage as a result of the ACA, there will be wide variation in whether coverage includes abortion, depending on where women live. Initial findings suggest a strong overlap between states not expanding Medicaid and passage of the highest number of restrictive abortion insurance regulations. This results in extremely limited or no access to abortion services, disproportionately affecting low-income and currently uninsured women. 

Conclusions

Access to abortion already varies greatly between states, and legislation banning abortion coverage is another avenue for widening this gap. Women in states with more restrictive legislation could lose access to abortion services altogether. Comparing current trends and the role of previous legislation will provide policymakers and advocates a better understanding of the political environment surrounding enactment of policies affecting abortion access.