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Details On Abortion Coverage Still Elusive In Some Health Plans

Abortion coverage was a key sticking point during the congressional debate on the new health law. Lawmakers eventually agreed to let states decide.
Mark Wilson
Getty Images
Abortion coverage was a key sticking point during the congressional debate on the new health law. Lawmakers eventually agreed to let states decide.

If you bought health coverage through one of the online insurance marketplaces, you might have a tough time determining whether your plan covers abortion services.

Though Health and Human Services Secretary Kathleen Sebelius got an earful from members of Congress about the problem at a hearing last November, little's been done yet to clear up the confusion in some states.

Both opponents and supporters of abortion rights agree that the logical place to include abortion coverage information would be in the "summary of benefits and coverage" overview. That's the information page that the federal health law requires all insurers to provide consumers to help them make apples-to-apples comparisons of their options. Health plans that cover abortion beyond cases of rape, incest and life endangerment also are supposed to disclose that information in the summary.

But the template that the federal government gave to insurers to use in developing these summaries didn't include abortion coverage.

"It's not in the template, and plans are just following that," says Gretchen Borchelt, senior counsel at the National Women's Law Center. "I think it's a lack of awareness on their part, a lack of familiarity with what should be included."

Abortion coverage was one of the key sticking points during the congressional debate on the health law, but lawmakers eventually agreed to allow states to decide whether their marketplace plans could provide coverage for it. Twenty-six states and the District of Columbia allow coverage of abortion in marketplace plans. Twenty-four states do not, although many of them generally make exceptions in cases of rape, incest or if the mother's life is in danger — mirroring the exemptions for federally subsidized health care, such as Medicaid.

A recent analysis by the Guttmacher Institute, a reproductive health research and policy organization that supports abortion rights, found that consumers would be hard-pressed in some states to find any information about whether the plans they were interested in covered abortion services.

Guttmacher researchers looked online at coverage descriptions in 12 states that permit marketplace plans to cover abortion services. They focused on the summaries of benefits and clicked through to other coverage details if available, just as consumers might do. The researchers found that only four of the 12 states had plans that noted clearly that abortion services were covered, while in six states the researchers were able to identify at least one plan that did not cover abortion.

No one is happy with the lack of information.

"Abortion should be considered basic health care, and consumers should know whether it's covered or not," says Kinsey Hasstedt, a public policy associate at Guttmacher who authored the analysis.

Abortion opponents are also frustrated. "The people we communicate with are looking for it," says Chuck Donovan, president of the anti-abortion Charlotte Lozier Institute, who has written about the lack of abortion coverage information on the exchanges. "We're hearing complaints about it."

Copyright 2021 Kaiser Health News. To see more, visit .

Michelle Andrews