Among the many arguments being made in the debate over health care reform is the claim that because very few women use private insurance coverage to pay for abortion services, loss of this coverage would have minimal impact. Those making this argument cite a Guttmacher Institute statistic showing that 13% of all abortions in 2001 were directly billed to private insurance companies (see Table 3, page 20, here).

However, that statistic alone misrepresents the situation on three counts:

• Our study included all women who obtained abortions in 2001, including women on Medicaid and those who are uninsured. If one looked only at privately insured women, the percentage of procedures billed directly to insurance companies would be substantially higher than 13%.
• Perhaps even more importantly, the 13% statistic does not include women who pay for an abortion up front and then seek reimbursement from their insurance provider. This is common when a medical provider does not participate in a patient’s insurance plan, as is often the case with small, specialized providers, including abortion providers.
• Lastly, some of the women whom our study identified as paying out of pocket likely had insurance coverage for abortion care, but may not have known they had it or chose not to use it for reasons of confidentiality. Given the stigma that still surrounds abortion, many women might not have wanted their insurer or employer—or their spouse or parent who may be the primary policyholder—to learn that they had obtained an abortion. That antiabortion activists who have worked for decades to perpetuate that stigma are now turning around and using it to argue why women should not be able to purchase insurance coverage for abortion is deeply cynical.

The best available evidence—from two studies conducted by the Guttmacher Institute and the Kaiser Family Foundation—suggests that most Americans with employer-based insurance currently have coverage for abortion. Further, as outlined above, direct billing does not equate to either extent of coverage or even use of coverage. Guttmacher’s 13% statistic, therefore, should not be cited as evidence that insurance coverage for abortion is not widespread or to suggest that restricting such coverage would have an impact on only a small minority of women.