Fifteen states have passed laws restricting insurers from covering abortions and 12 others are considering similar measures. By contrast, a bill that has passed Washington's House and is working its way through the Senate would make the state the first to require all health insurance plans under its jurisdiction - except those claiming a conscience-based exemption - to include abortion coverage.
The measure, HB 2330, would do so by requiring insurers who cover maternity care, which Washington insurers are mandated to provide, to also pay for abortions. New York is the only other state considering similar rules, according to the Guttmacher Institute, which tracks women's health-related legislation.
Opponents say expanded coverage would lead to more abortions and higher health care costs for all - claims muddied by the already wide availability of abortion in the state and the fact that abortions cost insurers less than do live births. They also say the measure would violate federal rules barring discrimination against insurers who don't offer abortion coverage for moral reasons, putting at risk $6 billion in federal money.
The bill has "far reaching and alarming consequences" for the "unborn lives of the next generation," six members of Congress, including Rep. Cathy McMorris Rodgers, R-Wash., wrote to President Obama in a recent letter.
"The state of Washington, or any state for that matter, that receives federal funds is prohibited from mandating that insurance plans cover abortion," they wrote.
Supporters say the state is protected by its existing conscience exemptions and note the bill has a self-destruct clause nullifying it in the event it were found to conflict with federal law. They say it would simply ensure that women in Washington - one of four states to have legalized abortion before the landmark 1973 Roe v. Wade decision - continue to have easy access to abortions once federal health care reforms are enacted in 2014.
"Washington state has historically been in the forefront for women's reproductive rights," said Rep. Eileen Cody, D-West Seattle, who sponsored the measure. "We're just trying to maintain the status quo."
Cody and other abortion-rights advocates say the bill is necessary because of the uncertain status of abortion coverage under the federal Affordable Care Act, the implementation of which is a work in progress.
Under federal health care reform, each state will on Jan. 1, 2014 establish an online marketplace where both individuals and small business owners looking for employee health insurance can compare competing plans. In 2017, these exchanges, as they are known, are slated to expand to the large group plans under which most insured Americans are covered.
Plans made available on state exchanges will have to cover a so-called "essential benefits package," which must include emergency care, hospitalization, prescription drugs, mental health care and maternity care. Initially, the Obama administration was expected to provide states with a definitive list of essential benefits. Instead, it has left this task to the states until at least 2016. States are expected to define their essential benefits by selecting an existing, widely used insurance plan to use as a benchmark.
Stephanie Marquis, spokeswoman for the state's Insurance Commissioner's Office, says Washington will choose as a benchmark its most popular small group plan, which is currently the Regents BlueShield Innova plan. Because the selected plan will include abortion, she says, abortion will be an essential benefit that all plans - except for two federal options to be made available on the exchange and any others that object on moral grounds - will have to cover.
Whether the state can under federal law require abortion coverage in this manner is "an open question" says Judy Waxman, vice president at the National Women's Law Center, a group supportive of abortion rights.
On one hand, the Affordable Care Act restricts the federal government from including abortion as an essential benefit. On the other, proposed rules issued by the Department of Health and Human Services instruct states to set essential benefits based on a benchmark plan which may include abortion.
A spokeswoman for the department said it would not comment on the apparent discrepancy, describing it as a state issue.
This lack of clarity, says Cody, underlines the need for her measure.
"It's a perfect case in point of why we did the bill: that there be nothing to change the coverage in the future," she says.
The other reason for her bill, she says, is that under federal health reforms, insurers covering abortions will have to contend with added administrative hurdles. Because federal money may not be spent on abortion - a prohibition dating to 1976 - the insurers will under the federal reforms be required to collect two sets of premiums, one for abortion coverage and one for all other services. Abortion-rights advocates fear that insurance carriers may be tempted to free themselves of the added hassle and expense by eliminating abortion coverage.
Copyright 2012 The Associated Press.
