More than half of reproductive-age women who are eligible for tax credits through the Affordable Care Act marketplaces can’t buy a health plan that covers abortion, either because that coverage is banned in their state or it’s simply not offered.
In a new analysis of ACA health plans available in 2015, the Kaiser Family Foundation found that 1.76 million reproductive-age women live in states that have enacted laws banning abortion coverage through health plans sold on the marketplace. Another 123,000 women live in states where there is no ban, but no health plans offer the coverage. That leaves about 1.26 million reproductive-age women whose incomes are low enough to qualify for insurance subsidies with access to health plans that offer abortion.
Overall, 24 states have enacted bans or restrictions on abortion coverage within ACA marketplace plans, and 7 states have no restrictions but the coverage is still not available.
Researchers with the Kaiser Family Foundation said that it is unclear why some ACA health plans do not offer abortion coverage even in states where there are no restrictions. However, they speculated that the complexity of the ACA’s abortion rules could be a factor.
Under the 2010 health law, federal funds are not allowed to be used to pay for abortions, and states have the authority to enact additional bans and restrictions on whether plans can offer the coverage. For those states where bans are not in place, the health plans must collect an additional fee for abortion coverage and keep this funding separate from federal dollars. Aside from the extra administrative work, these plans must also meet additional reporting requirements and undergo audits.