An unprecedented drive to ban insurance coverage of abortion has been gaining momentum since the health care law was signed a year ago, yet very little is known about it. If successful, this effort may be more devastating to women's reproductive health care than the hundreds of individual state laws that mandate counseling and sonograms, forced delays, and bans on specific procedures. Rather than chip away at reproductive rights bit by bit as these laws do, insurance prohibitions go for the jugular. They can do maximum damage by restricting or eliminating private coverage or making it extremely difficult to obtain, without the uproar that accompanies federal legislation and Supreme Court decisions. No wonder abortion opponents are intent on insurance bans!

At this point, it is critical to understand how much is at stake because these bans are moving through the states with remarkable swiftness, often relatively unnoticed. Although the exchanges where millions of people will buy insurance under the Affordable Care Act will not go into effect until 2014, after the Act was signed in March 2010 five states almost immediately passed bills to prohibit insurance plans on the exchanges from covering abortion except in dire circumstances such as to save the woman's life. Now, a year later, 22 more states are considering similar bills and nearly half of those are also considering making it illegal for all private plans to cover abortion.

Clearly, this is a coordinated, opportunistic attack that is either ignorant or callous -- or both -- about women's real lives and real needs. First, it is intended to reduce women's life options -- and therefore, from the perspectives of the many faith traditions that are pro-choice, an attack on women as moral decision-makers and on women's ability to make personal choices according to their own religious views and conscience. Second, it is an attack on the caring community that we seek to create, in which we have options that enable all of us to lead healthy lives and raise children with love and in a safe environment.

Throughout the legislative battle over the health care law, anti-choice legislators manipulated by the U.S. Conference on Catholic Bishops and extreme political organizations used abortion as a bargaining chip, purposely creating a furor and almost destroying good-faith reform efforts. The Democratic leadership -- determined to deliver on campaign promises to "fix" the badly broken health care system -- gave in to the threats of legislators who would vote for reform only if measures to restrict coverage of abortion were included. At first, it seemed that the restrictions would reaffirm existing Hyde Amendment provisions that federal funds would only be available to Medicaid recipients in the narrow cases of rape, incest or endangerment of the woman's life.

But it soon became clear that restrictions would apply to millions of additional women who would purchase insurance on the state insurance exchanges, the marketplaces being set up as part of reform that will be used by individuals of all income levels. The deal that was struck by Congress specified a "strict segregation" process. If an individual wanted coverage for pregnancy termination, she would have to purchase an entirely separate policy and pay for it with a separate payment, which would go into a separate fund! Because this system would be so difficult to administer and because states are not required to cover abortion, it is likely insurers will opt out of covering abortion at all, according to health experts. In addition, anti-choice Republicans introduced two bills to restrict coverage -- HR 3 (the "No Taxpayer Funding for Abortion Act") and HR 358 (the "Protect Life Act") -- as soon as Congress convened in January and, with their House majority, passed both. Along with low-income women who receive Medicaid, an estimated 14.5 million women who are insured by their mid-sized and large employers would be affected by this scheme, according to the Employee Benefits Research Institute. Contrast that to the fact that about 80 percent of private plans now cover pregnancy termination and the impact becomes clearer.

The challenge now is to educate policymakers and voters about the extreme nature of these restrictions and stop these bans. This a pro-choice country at heart -- some people may have reservations about abortion but they are firmly and consistently in favor of options that include family planning, contraception, and sexuality education and in favor of women making decisions with dignity and minimal governmental interference. Insurance coverage for pregnancy termination has had a low profile until now because it was not threatened. Now that it is, it is critical to understand its important role in helping to guarantee access to reproductive health care services. It is also critical to make it clear that the issue is not whether taxpayer money is being used for abortion. That is a red herring, a tactic to divert attention from the real goal of further restricting access to a procedure that one in three women will undergo at some point in her life.



Progress in expanding health care coverage to millions of Americans and doing away with injustices in the system is long overdue and should be celebrated. But victory at the expense of women's comprehensive reproductive health care is no victory at all.

