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Abortion Coverage

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

Learn all about abortion access in America — including Roe v. Wade and six-week abortion bans

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 is targeting them.

  • The administration proposed a rule that would impose additional billing requirements for abortion coverage — an onerous task for both insurers and consumers.

  • The billing rule would make it much more difficult  for people to get abortion coverage through health insurance plans under the Affordable Care Act (ACA) because plans will drop abortion coverage entirely rather than jump through unnecessary bureaucratic hoops.

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


  • 5-24-2018

    Administration proposes to undermine the ACA non-discrimination provision in marketplace and other federally administered insurance plans

  • What to expect next

    People across the country could lose access to coverage that includes abortion.

  • 11-7-2018

    Administration proposes rule to impose onerous 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 proposed billing rule would create extremely confusing administrative burdens for insurers and consumers alike when it comes to accessing health coverage for abortion. If implemented, it would make it almost impossible for health insurance plans in ACA marketplaces to cover abortion.

By the administration’s own account, nearly 1.3 million people could potentially lose abortion coverage. Without insurance coverage, an in-clinic abortion in the first trimester can cost up to $1,500.

In another proposed rule, the administration would 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 current administration’s proposed rule would 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 includes a “refusal” policy that encourages providers and insurers to deny care and coverage for anything “related to abortion.”

Background on Abortion Coverage

Deterring Insurers from Covering Abortion

The proposed billing rule would tack costly administrative burdens onto insurers — which would likely deter them from covering abortion altogether.

Existing Ban on Federal Health Care Coverage for Abortion

The administration says the billing rule will 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 woman’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 1.3 Million Women

About 1.3 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, women’s options are unfairly limited.

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

The billing rule establishes 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 administration's billing rule comes amid state-level efforts to deny women insurance coverage for abortion. So far, 11 states have passed bans on abortion coverage in all plans and 26 have 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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