Notwithstanding a widespread misinformation campaign, the health care reform law passed by Congress in 2010—the Affordable Care Act (ACA)—does not mandate abortion coverage, either now or in the future. Rather, it maintains the legal status quo, under which insurance companies decide whether abortion will be covered in the plans they offer. In practice, however, the ACA includes substantial disincentives for insurers to include abortion coverage in the plans they market to individuals and small employers on health insurance exchanges that will become operational in 2014, and for consumers shopping on those exchanges to purchase a plan with abortion coverage.

All of this raises the question of how extensively abortion is currently covered.

Several major studies have been conducted on this issue

The best available evidence—from studies conducted by the Guttmacher Institute and the Kaiser Family Foundation—suggests that most Americans with employer-based insurance currently have coverage for abortion.

Differences between the Guttmacher and Kaiser studies

Bottom line

The actual level of coverage is probably somewhere between the estimates made by Guttmacher and Kaiser, meaning that most Americans with employer-based insurance currently have coverage for abortion.

Abortions paid for with private insurance

A Guttmacher Institute study found that, in 2008, only 30% of abortion patients had private insurance. Among those who did have private insurance, about one-third used their insurance (see page 11 here) and nearly two-thirds (63%) paid out of pocket. In all, 12% of abortions were paid for with private insurance.

Several factors likely contributed to the lack of reliance on private insurance among women who had it:

Abortion coverage and abortion rates

Because private insurance coverage of abortion is already common, there is no evidence to support the claim that continuing to allow insurers to cover abortion under health care reform would somehow lead to a significant increase in the abortion rate. In fact, to the extent that the ACA increases access to contraceptive services, health care reform could end up helping many women avoid unintended pregnancies and thus the need for abortion.

Meanwhile, according to an analysis published in the March 2010 issue of the New England Journal of Medicine, the number of abortions and the abortion rate dropped in Massachusetts after the state adopted its own health reform law. In stark contrast to the ACA, publicly subsidized health insurance plans in Massachusetts must cover abortion. The number of abortions dropped 1.5% from 2006 to 2008, with the number of abortions obtained by teens decreasing by 7.4%. These declines occurred at the same time as the birthrate increased and the population grew. Numbers of abortions are now at the lowest level since the 1970s, continuing a long-term trend.