(Manuel Balce Ceneta/AP)

Prior to the health reform debate, there wasn’t much debate about whether private insurance plans should cover abortions. It was so little discussed that data on how many plans offer coverage is relatively sparse, although one Kaiser Family Foundation study  from 2002 says 87 percent do pay for the procedure (anti-abortion groups have, however, protested this number.)

But ever since the reform law passed, it’s been a hot-button issue. This legislative session alone, 24 states considered laws that would restrict insurance coverage for abortion. Thirteen of those laws passed. Eight bar any private insurance plan from covering abortion, while the rest only apply to plans purchased on the exchanges, the new health insurance marketplaces that will launch in 2014.

That’s a really big shift from just two years ago, when only five states barred private insurance plans from covering abortion. Here’s what the map looks like post-health reform, courtesy of the American Civil Liberties Union (larger version here):


Elizabeth Nash tracks state-level abortion restrictions for the Guttmacher Institute, which supports abortion rights, and says a shift of this magnitude is “very rare.”

“This is an issue that anti-choice activists have taken and run with,” she says. “They were encouraged by the health reform law, moved forward with full force and have been very successful.”

Planned Parenthood’s Rachel Sussman adds, “It’s a massive shift. The health reform debte was certainly a trigger point. Individuals opposed to abortion moved aggressively and really took the opportunity...to further attack access to reproductive health.”

Restricting private insurance coverage has been a top agenda item for anti-abortion advocates in the wake of the health reform law. Americans United for Life, the country’s oldest anti-abortion group, calls these bans the “cornerstone” of its push against health reform. At the National Right to Life state strategy conference I attended earlier this year, President David O’Steen counted bans on private coverage for insurance among his group’s top three priorities.

Americans United for Life president Charmaine Yoest says her group is working on a “two-pronged approach.”

“The vote today on Capitol Hill is important, but it is not the only game going on,” she says. “Many victories have been accumulated at the state level.”

The ACLU has attempted to push back against these bans in the courts but, so far, with little success. Last month the group filed a first-of-its-kind lawsuit, asking a judge to block Kansas’ new law barring abortion coverage on the health insurance exchange. The judge declined to do so, arguing that the group has failed to show that the law “actually has the effect of creating a substantial obstacle to obtaining abortions.” The judge didn’t rule on the merits, but rather indicated that the group would have to come back when they actually had proof of the law standing in the way of abortion access.

For now, these laws still stand. And, even though they don’t get as much attention, they’re much more likely to have an impact on access to abortion than any vote the House takes on the issue.