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New fronts open in abortion wars

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Washington Post Staff Writer
Friday, March 11, 2011; 11:22 AM

A year after its passage, the health-care overhaul is opening fresh battlefields in an old and bitter debate. Almost immediately after the law came into effect, five states passed bills that will prohibit private health insurance plans sold on its new state-based insurance marketplaces from covering abortion, except in dire circumstances such as to save the mother's life.

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Now 22 more states are considering similar abortion bills.

The impact of those bills would be limited to individuals and small businesses who buy insurance on the so-called exchanges. But nearly half of those states are also contemplating an even more sweeping proposal: making it illegal for all private plans to cover abortion, regardless of whether they are sold on exchanges. That step, already the law of four states, would affect the type of plan used by the 14.5 million of women ages 18 to 45 - one-fourth of women in that age group - whose insurance is obtained for them by mid-sized and large employers, according to Paul Fronstin of the Employee Benefit Research Institute.

None of the pending state bills would affect plans that very large employers sponsor directly and that are regulated by Congress.

But the scale and scope of the current legislative push is unprecedented, say activists on both sides.

"I don't remember the last time I saw [so many] states try to do one thing on abortion," said Rachel Sussman, who tracks state-level antiabortion efforts for Planned Parenthood Federation of America.

The effort represents a new battleground in the long-running struggle over how much states should regulate abortion. Since the Supreme Court declared the procedure legal in 1973, antiabortion activists have mounted a succession of legislative attacks on its accessibility and funding.

Indeed, the current state-level push to ban abortion coverage in the exchanges is a response to the controversial attempt by drafters of the federal health-care law to ensure that it complies with long-standing congressional policy against using federal dollars to pay for abortions.

That challenge produced a dramatic showdown last year between Democrats opposed to abortion and those who support abortion rights, and the law was saved with a compromise:

Insurers are allowed to include abortion coverage in their exchange plans, but everyone who buys such a plan must make two separate premium payments - one covering the bulk of the policy and another, of as little as $1 per month, for the plan's abortion coverage. Any federal subsidies can be applied only to the first payment.

Antiabortion groups deride that arrangement as little more than an accounting gimmick.

"Money is fungible. . . . It all goes into the same pool," said Mary Spaulding Balch, state legislation director at National Right to Life. So unless states make it a "top priority" to exercise their option to ban abortion coverage on the exchanges, she said, the health-care law will usher in a massive expansion of federal funding of abortion.

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