Health-care law opens new fronts in abortion wars

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

Now 22 more states are considering similar abortion measures.

The impact of those bills would be limited to individuals and small businesses that buy insurance on the so-called exchanges. But nearly half of those states are also contemplating an even more far-reaching proposal: making it illegal for all private plans to cover abortion, regardless of whether they are sold on exchanges. That step, which has become law in four states, would affect the type of plan used by the 14.5 million 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 legislation 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 the 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 legislative attacks on its accessibility and funding.

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 overhaul to ensure that it complies with long-standing congressional policy against using federal money to pay for abortion.

That challenge produced a dramatic showdown last year between Democrats who oppose 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, 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 priority to exercise their option to ban abortion coverage on the exchanges, she said, the health-care law will usher in a major expansion of federal funding of abortion.