While much media attention is trained on Washington and the stalemate in Congress, state legislatures continue to pass new laws regarding reproductive healthcare. In the past few weeks, two states have enacted nearly opposite laws regarding private insurance coverage of abortion, just one more move in the direction of entirely different realities for abortion access depending on where you live.
Texas Gov. Greg Abbott signed a law on August 15 that some are calling “rape insurance,” because it requires private insurers to exclude abortion coverage from standard policies and instead sell abortion coverage to women at an additional and separate cost. The only exception is if a pregnancy endangers the life of the mother. This action, one of many the Texas legislature has undertaken over the past six years to limit abortion access, is likely in response to Congress’ failure to repeal or replace the Affordable Care Act (ACA). Private insurance plans generally include abortion coverage, in part because it’s an affordable procedure, particularly in comparison to the cost of covering pregnancy and delivery, which is required coverage under the ACA.The ACA did not include requirements regarding abortion coverage in private plans.
On the same day that Texas passed its private insurance law, Oregon Gov. Kate Brown signed a law that goes further than the ACA in covering reproductive health care without any out-of-pocket costs. House Bill 3391 increases access to contraceptive drugs like IUDs, and procedures like sterilization and abortion, without any additional costs.
State legislation related to private insurance coverage of abortion began in earnest in 2010 after the ACA was passed. Many states have laws on the books regulating or restricting abortion coverage: Texas joined eight states that have laws limiting insurance coverage of abortion except in cases of life endangerment. Twenty five states already restrict coverage of abortion in plans offered through the ACA exchange, and 21 states limit abortion coverage in insurance for public employees.
These latest policy changes just move the needle further on what has been in progress for decades—abortion access in the United States is shaped more by where you live than federal laws. This unfortunately means that access to abortion is also further racialized, as states like Texas have much larger communities of color than states like Oregon. The non-Hispanic White population of Texas made up just 45 percent of the state’s population based on the 2010 census, whereas Oregon is 76 percent non-Hispanic White. The majority of Black people live in the South. These states have the most restrictive abortion access laws and policies.
The Oregon/Texas dichotomy represents a larger trend of an almost equal number of laws that states are introducing that would improve or limit reproductive healthcare. This is a major change from the last six years, where state legislatures introduced restrictive laws way more often than proactive or supportive ones. According to a report released by Guttmacher in April and covered by Mother Jones, “state legislatures across the country have introduced some 1,053 reproductive-health-related provisions since January, and that of those proposed measures, 431 would restrict access to abortion services, while 405 would expand access to reproductive health services.” This may be a result of resources turning away from federal efforts and instead toward states, given the unfriendly climate in Washington towards reproductive rights.