New Concerns for Women’s Reproductive Rights: Health Care Reform and Abortion Coverage


The 2009 U.S. health care reform debate surprised many as it quickly became apparent that abortion issues would be key in determining the legislation’s passage or failure. Final passage of the bill in March 2010 ultimately rested on an executive order from President Barack Obama, which reiterated Hyde Amendment provisions prohibiting the use of federal funds for abortions (except in cases of rape, incest, or life endangerment).

Regressing from the status quo, the order increases restrictions on women’s reproductive rights by:

1. Requiring a separate payment for abortion coverage (“abortion riders”) from policy holders who will participate in the new state insurance exchange system.
2. Reaffirming McCarran-Ferguson Act provisions (granting individual states authority over private insurance, free from federal regulation)– prompting a new wave of state measures that will restrict coverage beyond Hyde Amendment provisions.

According to the Guttmacher Institute, regressive legislation on abortion coverage has been introduced in 18 states, with 5 new laws already enacted (Arizona, Mississippi, Louisiana, and Tennessee; Missouri was awaiting action by the governor as of July 2010).

This legislation has a negative effect of women’s health, and fails to give a voice to the one in three women who will have an abortion in her lifetime. Women’s reproductive health care needs are multifaceted, and women need private insurance companies to offer comprehensive reproductive health care packages that include abortion care as a core service. Additionally, as two-thirds of private insurers currently offer coverage; new legislation is effectively taking away coverage women likely already have [1].  Finally, “abortion riders” violate women’s privacy (requiring a separate check for the coverage), are discriminatory (no other “elective” procedure requires a rider), and do not actually result in coverage [2].

Professional medical organizations [3] and the National Association of Insurance Commissioners are in an ideal position to educate their members on the new restrictions, offer workshops on lobbying (providing members with talking points), and engage in grassroots organizing in the states introducing new legislation.

Restricting abortion coverage beyond even Hyde Amendment provisions, Idaho, North Dakota, Missouri, and Kentucky have enacted laws that prohibit private insurance plans from covering abortions, unless the woman’s life is in danger. How many more states will be added to this list? (Map is circa 2009, pre-Health Care Reform. Data is from the Guttmacher Institute. Cartographer: Sarah Tedrow-Azizi.)


Additional Resources:
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[1] See Uneven and Unequal: Insurance Coverage and Reproductive Health Services, published by The Alan Guttmacher Institute in 1994.
[2] In North Dakota, which required riders before the Affordable Health Care Act, insurance companies simply did not offer any abortion coverage, rather than have to worry about the additional paperwork required to keep track of two separate payments.
[3] Abortion Care Network, American College of Obstetricians and Gynecologists, National Abortion Federation, National Coalition of Abortion Providers


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5 Responses to “New Concerns for Women’s Reproductive Rights: Health Care Reform and Abortion Coverage”

  1. papa4 Says:

    This is and will always be a very controversial subject which comes down to deeply held beliefs. Pregnancy, in the vast majority of cases (other than in rape and incest) is a condition of choice. Pregnancies can be prevented and abortions should not be used as a birth control device.

    The act of abortion results in the death of an innocent child. The Hyde ammendment was introduced because the majority of Americans, wether they personally believe in abortion or not, do not want their federal taxes being used for a medical act that is a personal choice.

    Insurance riders have been around since the beginning and have always been used for pre-existing conditions, elective surgery, eye and dental care, etc. As abortions are an elective surgery, it makes perfect sense that if a woman wants an abortions she should be required to pay for it through a rider or other similar insurance product.

    I would be much more in favor of federal tax dollars going toward insurance for birth control and methods to stop women from getting pregnant in the first place.

    Pregnancy is a choice, and our federal tax diollars should not be used for conditions that can be prevented and end the life of innocent children.

  2. mernabrownie Says:

    I agree. It is rather contrary to include health insurance payment restrictions for a specific procedure in legislation that is intended to increase health insurance coverage and therefore access to health care resulting in better health.
    Many priests and other clergy were vocally supportive of Roe vs Wade when it went in front of the Supreme court in 1972. They officiated at the funeral of women who died prematurely from illegal abortions. They also ministered to the orphaned children and widowed men who were also victims because a medical procedure was unsafe because it was illegal. Legalization was for medical safety and saving lives. And legalization did both.
    The political climate in the United States has allowed such an justice to proceed without regard to privacy and medical safety. Many in the medical profession recognize the injustice whereas a large conservative authoritarian sector of out profession is happy to dictate how other should behave.
    It is time for those in our profession with clearer heads to put health medicine first and oppose this infectious legislation.

  3. sftedrowazizi Says:

    I will have to respectfully disagree with the “pregnancy is a choice” argument, as even with *perfect* use, failure rates for every contraceptive currently available are never 0% (see: This is a terrible stigma for women who become pregnant while practicing safe sex.

    Furthermore, this post addresses new measures that are denying women coverage of abortion in cases of rape, incest, fetal anomaly, and when their health is in danger. Even more disconcerting are the measures in Louisiana and Tennessee which have prohibited private insurance coverage of the service even when the woman’s *life* is in danger.

  4. hbbos Says:

    Pregnancy is not always a choice that a women has the power to be involved in making. At the centre where I work, a survey of patients presenting for abortion showed a much higher than expected rate of domestic abuse, financial limitations to access birth control and other social factors. The choice to become pregnant is not theirs.
    The choice to not be pregnant should be theirs. Funding to help them prevent pregnancy is the ideal goal. Funding for abortion helps for the time being.

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