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The Question of Abortion Coverage in Health Exchanges

The sounds of protests over abortion issues at state Capitols across the country are fading as legislatures conclude divisive debates over new restrictions. But advocates on both sides of the issue are quietly watching to see how another volatile fight will soon play — this one over how insurers will choose to cover abortion in new marketplaces under the health care law.

The marketplaces, which are also known as exchanges, will start enrolling people on Oct. 1 and begin providing health insurance coverage to consumers on Jan. 1. The federal health care law to some extent puts the choice about abortion coverage in the hands of insurers — most of whom have made their decisions but not announced them.

Already, critics of abortion have passed laws in 22 states that ban any abortion coverage in the exchanges.

North Carolina may be next. Both chambers passed different versions of a bill that restricts abortion, and one of the provisions under discussion would limit coverage in the marketplaces. The North Carolina bill was one of several that sparked controversy this year in state capitals from Madison, Wis., to Austin, Texas.

While the state battles have captured national interest, the decisions by insurers have not.

“This threat has gotten almost no attention,” said Donna Crane, vice president of policy at the National Abortion Rights Action League, a group that promotes access to abortion.

In states that have not banned abortion coverage in the marketplaces, abortion rights groups have sought to influence insurance commissioners and insurers through discussions about the law. The National Women’s Law Center is providing a two-page explainer that aims to help insurers meet the law’s requirements on abortion with the least amount of hassle possible.

Supporters of restrictions on abortion say they are eagerly waiting to find out more about insurers’ decisions.

“We haven’t talked directly to insurance companies, but we have some concerns,” said Mary Harned, staff counsel for Americans United for Life. “Basically one of the key things when the [health care law] was enacted was that there’d be consumer choice. When concerns over abortion coverage were raised, the reply was people in exchanges would have a choice of plans that cover abortion or don’t. Unless you’re in a state that opted out, what we’re seeing is a lot of the promises of choices are falling away.”

Perhaps the one thing that each side has in common is that both make the same passionate argument about limited choices.

So far, the landscape is mixed. In the 22 states that have banned abortion coverage in the exchanges, insurers cannot offer it. A few other states — including California and Connecticut — take the opposite approach and require plans to cover “medically necessary” abortions, in which a physician determines whether an abortion is needed for a health-related reason.

In other places, many insurers are continuing their typical practice of covering abortion for people who buy insurance on their own or through coverage for small companies. That’s the case for all the plans in Washington state and Vermont.

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