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Tennessee, Missouri Begin To Ban Abortion Coverage in the Exchanges

Those fighting against the Stupak amendment in the Affordable Care Act in favor of the Nelson amendment left aside the fact that Nelson’s amendment left open the possibility for states to opt out of abortion coverage in the exchanges and impose a Stupak-like ban. It just moved the fight over abortion to the states. With the ink barely dry on the ACA, states have already begun to institute that authority.

Igor Volsky reports that Tennessee and Missouri have passed legislation out of committees in the state legislature which would bar insurance companies from offering abortion coverage on plans in the state insurance exchange, set for implementation in 2014. First, Tennessee, which cleared a House committee with this legislation:

No health care plan required to be established in this state through an exchange pursuant to federal health care reform legislation enacted by the 111th Congress shall offer coverage for abortion services. For purposes of this section, “abortion” has the same meaning as defined in § 39-15-201.

And Missouri passed this bill out of a Senate committee:

Under current law, health insurance policies are barred from providing coverage for elective abortions except through optional riders. This act extends this prohibition to health insurance policies offered through any health insurance exchange established in this state or any federal health insurance exchange administered within this state. In addition, no health insurance exchange operating within this state may offer coverage for elective abortions through the purchase of an optional rider.

Missouri and Tennessee are among the most restrictive states in the nation when it comes to abortion coverage. Missouri is one of five states which ban private insurance companies from offering abortion coverage inside a comprehensive plan (and nobody sells the “rider” that’s supposed to be the safety valve). Tennessee’s abortion laws are similarly restrictive.

This state opt-out was an inevitable by-product of a health care debate that too often became hijacked by the abortion issue. Lawmakers preferred to punt the issue to the states, and the states are acting as expected and in accord with past experience. You can say that the status quo will not really change under this law – women who had trouble accessing abortion in certain states will have the same trouble, and vice-versa – but the status quo is simply bad for women’s health.

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David Dayen

David Dayen

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