Texas Gov. Greg Abbott (R) signed a bill Tuesday afternoon, approved by the Senate over the weekend, that would prohibit all insurance companies from covering non-life threatening abortion care in standard health plans. Women, trans, and non-binary people will need to pay an additional insurance premium if they want their health plan to cover abortions performed outside medical emergencies; there will be no exceptions for instances of rape or incest. Opponents of the bill are calling it “rape insurance.”

Texas insurers will no longer include abortion in general health insurance plans — even in cases like rape, incest, or fetuses with fatal medical conditions. Abbott signed the bill with just one day left in the special session in the Texas legislature, which has been trying to pass a variety of draconian legislation over the past month.

Texas is not the first state to begin restricting insurance coverage of abortion, and it likely won’t be the last. States began ramping up restrictions in the private marketplace in 2010, when then-President Barack Obama signed the Affordable Care Act (ACA) into law. This legislative session, local legislators introduced 431 provisions that would restrict access to abortion services. (According to Guttmacher Institute, the number of abortion restrictions introduced is about on par with past years.)

According to Guttmacher Institute, as of August 2017:

25 states restrict abortion coverage in plans offered through the ACA exchanges.

10 states restrict abortion coverage in all private insurance plans.

21 states restrict abortion coverage in insurance plans for public employees.

18 states have more than one of the above.

On its face, the new legislation may not seem to have a huge impact. The majority of patients do pay for their abortion out-of-pocket; Medicaid is the second-most-common method of payment. And Texas already bars insurance companies from offering abortion coverage in private, state-offered, and ACA plans. But by strong arming insurance companies from covering these procedures, a larger stigma around abortion grows.


“The bill is trying to make people think of abortion as something else other health care,” Guttmacher Institute’s Adam Sonfield told ThinkProgress.

Credit: Kaiser Family Foundation, 2016

Republican members of Congress have tried to restrict private insurance from covering abortion but failed. During ACA-repeal efforts, Republicans tried to include language in their health reform bills barring federal money from being used to support any private insurance plan that covers abortion. In every iteration of repeal or replacement, Planned Parenthood was barred from federal funds. These efforts ultimately failed, but meanwhile, states like Texas have been scoring small victories.

“Middle and higher income women are experiencing what lower income women have been facing in this country for some time,” said Sonfield of the Texas bill.

In the 1970’s, former Representative Henry Hyde (R-IL) tried to limit every woman’s access to abortion. He succeeded with one demographic; the Hyde amendment blocks federal Medicaid funding for abortion service. “I certainty would like to prevent, if I could legally anybody having an abortion, a rich woman, a middle-class woman, or a poor woman,” Hyde said on the House floor. “Unfortunately, the only vehicle available is the HEW Medicaid bill.”

Now there’s a renewed effort to restrict access to abortion to every demographic, and Texas is a microcosm of this. Texas conservative lawmakers have introduced bills that would ban second-trimester abortions, partial birth abortions, and require patients to have “fetal funerals.”




Even when low-income people have access to health insurance, there are additional barriers to access — like traveling to clinics. A study published Tuesday in Obstetrics & Gynecology examined the association between distance traveled for an abortion and site of post abortion care among patients who use Medicaid to pay for the procedure. They found that when people have to travel long distances for abortion care they are more likely to seek follow-up care at an emergency department and less likely to return to the original abortion provider.

“It’s an intuitive finding,” the co-author of the study and associate professor at UC San Francisco’s Advancing New Standards in Reproductive Health Ushma D. Upadhyay told ThinkProgress. “You are not going to want to travel to your original abortion provider if it means traveling long distances.”

UPDATE: ThinkProgress added a secondary title to Upadhyay.