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Abortion Coverage

is allowed in private insurance unless restricted by state law — but the Trump administration’s rules aimed to restrict that coverage and promote discrimination



Learn all about abortion access in America — including Roe v. Wade

Why It Matters

  • Abortion coverage varies from state to state and plan to plan. Some states ban coverage of abortion altogether; some plans just don’t cover abortion. But many plans do — and the administration was targeting them.

  • The Trump administration finalized a rule that aimed to impose additional billing requirements for abortion coverage in the individual ACA marketplaces by August 2020 — an onerous task for both insurers and consumers, especially given the COVID-19 pandemic.

  • The billing rule was designed to make it much more difficult  for people to get abortion coverage through health insurance plans under the Affordable Care Act (ACA).

  • The expected outcomes: This abortion insurance “segregation” rule was expected to take away people’s access to abortion coverage across the country. Some insurance plans were expected to drop abortion coverage (rather than jump through unnecessary bureaucratic hoops); premiums were expected to increase; and some people were expected to lose their coverage entirely if they didn’t understand the requirement to pay two separate bills.

Related Players

Donald Trump

President of the United States

Elected to Office: 11-8-2016
Mike Pence

Vice President of the United States

Elected to Office: 11-8-2016
Alex Azar

Secretary of Health and Human Services (HHS)

Nominated by Trump: 11-13-2017

How We Got Here & Where We're Going

  • What to expect next
    People across the country could lose access to coverage that includes abortion in June, when the Trump-Pence administration’s abortion insurance “segregation” rule must be implemented
  • 2-11-2020
    Planned Parenthood and ACLU sue the administration over its rule requiring insurers to send a separate bill for abortion coverage

  • 12-27-2019
    Trump-Pence administration finalizes rule make it more difficult for insurers to offer abortion coverage, which will in turn make it more difficult for people to get health coverage of abortion through plans sold on the ACA individual marketplaces

  • 10-15-19
    A federal judge from Texas ruled that he ACA’s non-discrimination provision (Section 1557) should not protect transgender people or people who have had abortions against discrimination in health care

  • 5-24-2018
    Administration proposes to undermine the ACA non-discrimination provision in marketplace and other federally administered insurance plans
  • 11-7-2018
    Administration proposes rule to impose onerous billing requirements on abortion coverage in ACA insurance plans


“I was fortunate... I was lucky to have access to the procedure and really lucky to have insurance cover it.”

Two Proposed Rules: Creating Confusing Administrative Burdens and Undermining Coverage

The billing rule was set to create extremely confusing administrative burdens for insurers and consumers alike when it comes to accessing health coverage for abortion. It was designed to make it much more difficult for health insurance plans in ACA marketplaces to cover abortion. By the administration’s own account, more than 3 million people would be affected. Without insurance coverage, an in-clinic abortion in the first trimester can cost up to $1,500.

In a separate, proposed rule, the administration tried to change the government’s interpretation of the ACA’s non-discrimination provision. Also known as Section 1557 and the Health Care Rights Law, the ACA’s non-discrimination provision prohibits discrimination on the basis of race, ethnicity, color, sex, national origin, disability status, and age.

  • Before the Trump-Pence administration came to power, the federal government interpreted this law in a way that protects people from discrimination based on gender identity, sex-stereotyping, termination of pregnancy, and more in marketplace plans and other health care programs that the government helps run.
  • The Trump administration’s proposed rule aimed to interpret the law more narrowly, rolling back protections for people who have had an abortion previously and for transgender people, among others.
  • The proposed rule also included a “refusal” policy that encouraged providers and insurers to deny care and coverage for anything “related to abortion.”


Background on Abortion Coverage

Deterring Insurers from Covering Abortion

The billing rule was set to tack costly administrative burdens onto insurers — which could deter them from covering abortion altogether.


Existing Ban on Federal Health Care Coverage for Abortion

The Trump administration said the billing rule would help align with federal requirements around separating funding for abortions. But the ACA already includes a harmful ban on federal funding being used for abortion (except in cases of rape or incest, or that endanger a pregnant person's life). The Obama administration required health plans to separate funds for abortion coverage, yet still ensure seamless coverage for consumers.

Washington Post
Threatening Abortion Coverage for More than 3 Million People

About 3 million people are enrolled in health plans that cover abortions and would be affected by the billing rule. When health insurance plans cover pregnancy and childbirth but not abortion, reproductive health options are unfairly limited.

American Academy of Family Physicians
Creating a Barrier Between Patients and Abortion Coverage

The billing rule established a confusing payment process that would act as a barrier to accessing abortion coverage. Consumers would be sent two separate health care bills — including one just for abortion coverage — which they’d have to pay with two different payments. The process would increase the risk that people miss their health care payments and completely lose their health insurance coverage.

Mirroring State Bans on Abortion Coverage

The Trump administration's billing rule came amid state-level efforts to deny women insurance coverage for abortion. At least 11 states passed bans on abortion coverage in all plans and at least 26 banned coverage in their exchanges.

Kaiser Family Foundation
How Much Does It Cost to Get an Abortion?

The cost of an abortion depends on where you get it, whether or not you have health insurance that will cover some or all of it, and other factors. Without insurance, the abortion pill can cost up to around $1000, and an in-clinic abortion in the first trimester can cost up to $1,500 — but it’s often less.


Related Policies

The Title X Gag Rule

The Health Agenda

Immigrant Access to Abortion


Birth Control Coverage

Global Gag Rule

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