An Early Look at Insurance Coverage of Abortion

In 1970, abortion was legal in the U.S. only, for the most part, when it was necessary to save a woman’s life. Reform was under way at the state level, but Roe v. Wade was still three years in the future. And legal access wasn’t the only impediment for women who wished to terminate unintended pregnancies; cost was an issue for many, and the extent to which insurance covered the procedure was unclear. Against this backdrop, health economist Charlotte Muller studied abortion-related coverage available from major insurers, to explore the role that insurance might play, and what types of coverage changes might be desirable, once abortion was legalized and became widely available. Using her findings, she developed guidelines for what she considered a “model” plan.

Muller found that coverage was inconsistent, largely insufficient to cover costs, often poorly described in policy documents and frequently tied to restrictions. Some contracts, for example, excluded single women or daughters of the insured; others required a waiting period or covered only procedures provided in hospitals. In Muller’s plan, therefore, benefits would be clearly spelled out in the insurance contract; coverage would include policyholders’ wives and unmarried dependent daughters “up to the maximum feasible age the group can afford”; waiting periods would not be required; and procedures would be covered whether performed in hospitals or in other legally permitted locations.

If some of the specifics of Muller’s findings seem out of date today, her overall conclusion—sorry to say—still resonates: A punitive response to unintended pregnancy does not benefit women, their families or society. While abortion remains legally available in the United States, it also must remain financially accessible. Insurance carriers are in a position to, in Muller’s words, “stretch to … accommodate to social change.” As cuts to public funding streams and ever rising health care costs threaten to put abortion out of reach for increasing numbers of women, this may be a time when it is appropriate for carriers to do so.

Cover illustrations of Margaret Sanger © Matthew and Eve Levine