Texas Is Poised to Ban All Insurance Coverage for Abortions, Forcing Women to Buy "Rape Insurance"

By Christina Cauterucci, Slate

15 August 17

he Texas Legislature is in the home stretch of a special session Gov. Greg Abbott called last month to push through a slew of his legislative priorities, including restrictions on where transgender people can use the bathroom. That bill is losing steam in the less conservative House, but another bill restricting abortion access is headed to the desk of the governor, who has indicated that he’ll sign it into law.

The bill would prohibit all insurance companies from covering abortion care in their standard plans, requiring women to pay extra premiums for coverage if they think they may need abortions at some point in the next year. The ban would apply not only to insurance plans on the exchanges established by the Affordable Care Act, but also to any plans sponsored by employers or purchased on the private market. A plan would only be allowed to cover an abortion in the case of a pregnant woman’s life-threatening health emergency and not those performed in cases of rape, incest, or extreme fetal abnormalities.

This weekend, the GOP-led Texas Senate approved the bill after it passed the House. (Similar bills were raised and debated during the regular legislative session, which closed in May, but none passed.) Right-wing legislators and advocates in Texas say they are currently forced against their will to help fund abortions simply by taking part in a health insurance system that covers them. Rep. John Smithee, who sponsored the bill in the House, said in floor debate that the bill promotes “economic freedom” for people who oppose abortion rights.

Half the states in the country prevent insurance policies purchased on ACA health exchanges from covering abortion procedures. Ten of those also restrict insurance coverage for abortion in all private insurance plans. Only two of those 10—Utah and Indiana—make exceptions for abortions sought in cases of rape and incest. That’s why Democratic Texas legislators say this bill would necessitate “rape insurance”—no one expects to have an unplanned pregnancy, and no one can predict the likelihood that she’ll be raped in a given year. It is a demeaning form of gender discrimination to ask women to lay down extra money just in case they get pregnant through sexual assault.

According to a national 2014 survey of abortion patients, 53 percent paid for the procedure or pill out of pocket, and another 24 percent paid for their abortion care with Medicaid. (Federal Medicaid dollars cannot go toward abortions in most circumstances, but a handful of states use their own health funding to cover abortion care for women on Medicaid.) Just 15 percent of abortion patients used private insurance to pay for their abortion care, while 61 percent of women with private insurance said they paid out of pocket, due to either high deductibles or a lack of coverage. Without insurance coverage, an abortion can cost between $300 for an early medication abortion in some places and a few thousand dollars for a surgical one later in pregnancy. The later, more expensive ones are often those performed under the most heart-wrenching circumstances, due to fetal anomalies undetectable in early pregnancy or a woman’s inability to access earlier health care because of her age, remote location, financial resources, or immigration status.

By restricting abortion care to those who can either afford an additional monthly health care expense or a hefty one-time payment out of the blue, Texas is ensuring that low- and middle-income women with health insurance will find it significantly more difficult to access a constitutionally protected medical procedure. To satisfy the whims of anti-choice advocates, the Texas Legislature has used one population’s personal beliefs to justify what amounts to a sexual-activity tax on Texas women.