States Adopt Abortion Restrictions on Health Insurance Exchange Policies

Fifteen states have laws that will restrict coverage of abortion by health insurance policies sold through health insurance exchanges mandated by the Affordable Care Act to be in place in states by Jan. 1, 2014. Only two of those states totally restrict abortion coverage with no exceptions for endangering the life of the mother, rape or incest. Four of the 15 states allow insured individuals to purchase separate riders, at their own expense, to cover abortion services.  

  Download the Excel Version of the Table: "State Policies to Prohibit Insurance Coverage of Abortions."
Several states have enacted legislation to restrict abortion coverage offered by any insurance plan under the state’s health insurance exchange. The state exchanges—to be in place by Jan. 1, 2014, under the Affordable Care Act—will be a marketplace for individuals who do not have coverage through their employers or those who meet income guidelines. Experts predict as many as 24 million Americans will purchase private health insurance through state exchanges.1 Federal tax credits will subsidize health insurance costs for income-eligible individuals who purchase insurance through the state exchanges.
  • Fifteen states—Arizona, Florida, Idaho, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Oklahoma, Tennessee, Utah and Virginia—restrict abortion coverage by policies sold under the health insurance exchanges:2
    • Thirteen states provide some exceptions for abortion coverage in the cases of endangering the life of the mother, rape, incest or severe health impairment of the mother, and in a one state, fetal abnormality.
    • Only two of those states, Louisiana and Tennessee, restrict all abortion coverage with no exceptions.
  • Four states—Arizona, Kentucky, North Dakota and Oklahoma—allow individuals to purchase separate riders to cover abortion at an additional expense borne entirely by the insured individual. This provision ensures that no public funding for health insurance subsidies may cover abortions. 

A smaller number of states have banned abortion coverage in any private insurance plan sold in the state.

  • Idaho, Kansas, Kentucky, Missouri, Nebraska, North Dakota, Oklahoma and Utah ban insurance coverage of abortion in any plan written in the state.3
  • In all the states except Utah, separate abortion riders are permitted.
  • In some states, the ban was already in place before the passage of federal health care reform. In others, the total ban followed the ban for health insurance exchanges plans.

    • The laws in Nebraska and Utah, for instance, do not take effect until Jan. 1, 2012.4

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

  • Four states—Illinois, Missouri, Nebraska and North Dakota—limit coverage for abortion with only a life endangerment exception.
  • Eight states —Arizona, Mississippi, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina and Virginia—limit coverage to two or more exceptions.
  • Two states, Colorado and Kentucky, restrict coverage for abortions with no exceptions.
Debate over the issue of abortion coverage in insurance plans under the state exchanges will not likely go away any time soon.
  • Supporters of abortion restrictions argue that exchanges are established with tax dollars and the compromise struck by President Obama to ensure passage of the Affordable Care Act in 2010 specifically prohibits use of tax dollars for abortions.
  • Opponents of the restrictions worry that if too many states prohibit abortion coverage, insurance policies may begin to regularly exclude abortions from coverage. A similar tipping point was reached as more states mandated coverage of contraception until it eventually became the norm rather than the exception.5


1 Kaiser Family Foundation. “A Profile of Health Insurance Exchange Enrollees.” March 2011. 
2 Guttmacher Institute. “Restricting Insurance Coverage of Abortion.” Aug. 1, 2011. 
3 Ibid.
4 CSG analysis of 2011 Nebraska Legislative Bill 22 and 2011 Utah House Bill 354
5 Tavernise, Sabrina. “Abortion Opponents Use Health Law to Put Restrictions in Private Insurance.” The New York Times, April 8, 2011.