The Guttmacher Institute is widely praised as the pre-eminent authority on women’s health issues. They’ve released a report on the new health care law and the implications for reproductive health, and they give it mixed reviews. The top-line story here, however, is that they agree that reproductive services coverage in the exchanges – and eventually throughout the insurance market – are poised to die out over time, under the new law. While theoretically, women can still access coverage for services like abortion through the exchanges with their own money, in practice Guttmacher says this will be highly unlikely:

In practice, however, the complex, politicized arrangements the legislation necessitates militate heavily against the likelihood that many such plans will be purchased—or even offered. Consumers purchasing exchange plans that include abortion coverage would have to make two separate premium payments—one to cover abortion services and one to cover everything else. Insurance companies would have to jump through numerous, unprecedented hoops to estimate the cost of abortion coverage and ensure that the abortion payments never mix with other funds; they also are likely to face extensive public scrutiny and protest around their action. All told, according to an analysis by George Washington University’s Sara Rosenbaum, “the more logical response” for private insurers marketing plans within the exchanges—and eventually in the broader market as well—“would be not to sell products that cover abortion services.”

I don’t see what’s in it for insurers to offer abortion coverage, given the public spotlight on their actions from the militant anti-choice community and all the procedural obstacles.

Guttmacher adds that expanded Medicaid services for 15 million Americans will advance women’s reproductive health greatly by offering family planning services without cost-sharing to them. Of course, in over 30 states women cannot get coverage for abortions through Medicaid; 17 states allow coverage through their state participation in funding. Guttmacher also expects improvements in insurance coverage for reproductive health in the exchanges, setting aside the abortion issue.

As I have documented, the exchanges are expected to expand over time, allowing more and more businesses into the pool. In addition, the denial of abortion services coverage could have significant spillover effects into the employer-based insurance market. Therefore, over time we should expect a dissipation of access to abortion coverage throughout health insurance markets, making it harder for lower-income individuals without the means to get an abortion. And expensive chemical abortions may not get covered either, which would be a significant hindrance for women’s health.

David Dayen

David Dayen