States Lead the Way in Promoting Coverage of Abortion in Medicaid and Private Insurance

Adam Sonfield, Guttmacher Institute and Elizabeth Nash, Guttmacher Institute

Advocates and policymakers working to ensure that everyone can afford an abortion scored a number of important victories within just a few days of each other: On June 13, Maine Gov. Janet Mills signed a law expanding abortion coverage in private insurance and Medicaid. Just one day earlier, Illinois Gov. J.B. Pritzker had signed a law expanding private insurance coverage of abortion as part of a broader abortion rights law. The same week, New York City allocated $250,000 to a nonprofit abortion fund to directly assist patients, including patients traveling from other states.

This burst of action builds on a nationwide push to overturn the Hyde Amendment, which currently bans abortion coverage under Medicaid and other federal health coverage programs. Expanding coverage will help people overcome one substantial barrier to abortion—the cost of abortion services—and will be particularly important for people with low incomes, people of color and people with disabilities.

Medicaid and Abortion Funds

The actions by Maine and New York City represent new public investments in abortion at a time when many other states are fervently restricting access to care.

Once its new law is implemented, Maine will provide abortion coverage for all state residents who rely on Medicaid for their health insurance. The state will fully pay for any abortions that are barred from receiving federal reimbursement under the Hyde Amendment, which has exceptions only in cases of rape, incest or when the patient’s life is threatened. Maine will be the 16th state to cover all or nearly all abortion care for Medicaid enrollees, joining Illinois, which was the most recent state to take this step in 2017.

New York City, meanwhile, appears to be the first city to allocate money to an abortion fund, and made the move in part to help low-income people in other states who travel to New York for care.

Private Insurance Coverage

On a parallel track, Illinois and Maine will require private insurance plans regulated by the state to cover abortion. Illinois’ requirement took effect immediately (or whenever a health plan is renewed), and Maine’s requirement takes effect January 2020. The two states are the fifth and sixth to adopt an abortion coverage requirement, joining California, New York, Oregon and Washington. Illinois, New York and Oregon have taken the extra step of prohibiting patient cost-sharing for abortion.

These private insurance requirements are part of a recent trend pushing back against conservative attempts at the state and federal levels to eliminate private coverage of abortion. Notably, the six states that require private insurance coverage of abortion account for more than one-quarter of women of reproductive age nationwide (17.2 million women aged 15–44 in 2017, out of 64.1 million). That’s more than the number (14.0 million) in the 11 states that bar abortion coverage in all state-regulated private insurance plans. It is also notable that states are pursuing these requirements despite a concerted effort by the Trump administration to undermine them: Administration officials have asserted that laws like these may violate the Weldon Amendment, a refusal of care law they are interpreting expansively.

Building Toward a Federal Fix

These state-level actions hold great promise for expanding people’s access to abortion care, and they provide momentum toward a nationwide solution. Even under its new Democratic leadership that supports abortion rights, the U.S. House of Representatives has included the Hyde Amendment and similar abortion coverage restrictions in its appropriations bills for fiscal year 2020.

Yet, because of sustained efforts led by reproductive justice groups and the All* Above All coalition, opposition to Hyde has gained traction among progressive policymakers and has emerged as an issue for the 2020 presidential campaign. Every major Democratic presidential candidate is now on record opposing the ban, echoing the 2016 Democratic party platform

Moreover, the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act continues to pick up cosponsors and attention in the House and Senate. That bill would restore abortion coverage to people nationwide who get their coverage or care through Medicaid and other federal programs. It would also prohibit states and the federal government from interfering in private insurance coverage of abortion, including in the Affordable Care Act’s health insurance marketplaces. 

In addition, most of the major federal proposals to move closer to universal health coverage include provisions aiming to override federal abortion coverage restrictions and to require comprehensive reproductive health coverage, including abortion coverage. These include Medicare for All proposals to cover all U.S. residents under government-run health plans, and many "public option" proposals to allow people to buy into a publicly funded program like Medicare or Medicare.

Source URL: