David Eggert | The Associated Press

LANSING -- If lawmakers vote to restrict insurance coverage of abortions in Michigan, it would affect a small number of abortions because the vast majority already are paid for out of pocket.

Of the roughly 23,000 reported abortions in the state last year — the second-fewest in 30 years — health insurance covered 739, or 3.3 percent, according to state statistics.

Low-income women on Medicaid already must pay out of pocket for abortions except when their life is at risk or in cases of rape or incest. Other women getting abortions are uninsured or their insurance doesn't cover abortions. Others have plans that allow abortions, but they might not want their employer or family to find out.

Under a Right to Life-backed initiative expected to be approved by the Republican-controlled Legislature soon, employers and others would have to buy extra insurance known as a rider to cover almost all abortions. Their primary plan could pay only if an abortion is needed to save the woman's life but not to protect her health or in cases of rape or incest.

The measure can become law without the signature of Republican Gov. Rick Snyder, who vetoed similar legislation last year.

A thrust behind the legislation is keeping taxpayer-subsidized plans on Michigan's new insurance marketplace from covering abortions, an option for states under the federal health care law. Yet the state says none of the 73 plans being offered to individuals covers elective or voluntary abortions. Three of the 68 small employer plans do and are sold by one insurer — United Healthcare Life Insurance Co. — said Caleb Buhs, spokesman for the Department of Insurance and Financial Services.

So the initiative will have a bigger practical effect on private plans sold outside the exchange.

Under the measure, employers barred from covering abortions in their primary plans could buy optional supplemental abortion coverage if they notify all employees, including telling them that the abortion insurance may be used by a dependent without notice to the employee. Insurers and HMOs wouldn't be required to offer abortion riders.

Most Americans with employer-based insurance probably have coverage for abortion, though surveys used to come up with the estimate have shortcomings, according to the Guttmacher Institute, a research group that supports abortion rights.

What's unclear is the extent to which the legislation would impact businesses and insurance companies.

Blue Cross Blue Shield of Michigan, the state's dominant insurer, sells plans that cover abortion and plans that don't, said spokeswoman Stephanie Beres.

"It's really a case-by-case basis on what decisions are made, each customer making their own decision," she said.

The Michigan Association of Health Plans, which represents competitors to Blue Cross, says core plans generally don't include abortion and it's usually added in riders that might also include rehabilitation, mental health and other services.

"Each plan decides its own offerings on its own, in a competitive atmosphere," MAHP spokesman Dave Waymire said.

Right to Life lobbyist Ed Rivet said most plans with maternity coverage usually include abortion, and the organization for years had to request a "negative" rider from Blue Cross to remove abortion from Right to Life's employee health plan. The federal health law now requires maternity care in plans offered to individuals who buy their own insurance or receive it from small businesses.

United Healthcare may have to collect two payments, one for abortion coverage and another for the rest of the premium, and segregate the funds into separate accounts. That's to ensure no tax subsidies are used to pay for most abortions as outlined under the health law. Federal law also says abortion riders sold through an exchange cannot cost less than $1 a month.

United Healthcare's exchange plans are compliant with state and federal law, said a spokesman who declined to elaborate on specifics of the plans' abortion coverage.

Both sides of the contentious issue say implementation of abortion insurance restrictions is murky, so they're focusing for now on the political fight — with proponents pressuring legislators to pass the initiative now and opponents urging them to leave it to a statewide vote next November.

"The women who are using health insurance to cover terminations of pregnancies often are women who are in their second trimesters or after who have wanted pregnancies where something went horribly wrong," said Sen. Rebekah Warren, an Ann Arbor Democrat.

"The largest cost frankly is the hospital stay. To have somebody who has a nursery waiting at home — a wanted pregnancy, something went wrong — to have to face the fact that they might have to pay $10,000 or $12,000 for a surgery they never even wanted is really despicable," she said. "We'd be telling women that you have to go and gamble or you have to buy rape insurance for yourself or your daughter."

But Rebecca Kiessling, a Rochester Hills anti-abortion activist who was conceived because of a rape, accused abortion rights advocates of wanting her and others like her dead. She said her birth mother, after being attacked by a serial rapist, tried to get two abortions but changed her mind because it was illegal.

"No child deserves to be punished for the crimes of their father. ... I owe my life to the law being there to protect me," she said.