(This memo was updated on September 18, 2009)

Notwithstanding a widespread misinformation campaign, none of the health care reform proposals pending in Congress would mandate abortion coverage. Rather, they would maintain the legal status quo—under which insurance companies decide whether abortion will be covered in the plans they offer. This raises the question of how extensively abortion is currently covered.

Two major studies have been conducted on this issue

The best available evidence from two studies—conducted by the Guttmacher Institute and the Kaiser Family Foundation (KFF)—suggests that most Americans with employer-based insurance currently have coverage for abortion.

• The Guttmacher Institute’s federally supported study, assessing levels of insurance coverage for a wide range of reproductive health services, found that 87% of typical employer-based insurance policies in 2002 covered medically necessary or appropriate abortions; the data can be found in Table 1 here.
• The Kaiser Family Foundation found that 46% of covered workers had coverage for abortion. The data were released as part of its 2003 Annual Employer Health Benefits Survey.
• Importantly, the 87% of plans that covered abortions did not include plans that offered abortion coverage only in very limited circumstances (such as rape and incest, or to protect the woman’s life). Only a very small number of respondents offered such limited coverage, and they were not included in the study’s findings.
• The study queried all large insurers (with at least 100,000 enrollees) and a random, nationally representative sample of small insurers.

Differences between the Guttmacher and KFF studies

• The Guttmacher study queried the medical directors of insurance companies and asked them about the typical insurance policy they wrote for employers.
• KFF queried employers’ human resources staff and asked about their firm’s coverage.

Both studies probably have shortcomings

• Guttmacher’s study asked about "typical plans" and might not account for the fact that some employers may purchase atypical plans, such as plans with high deductibles that would not cover a range of services, including abortion.
• The KFF study surveyed human resources staff, who might not know this level of detail about their coverage, and, in fact, it received a disproportionately high level of "don’t knows" (26%) in response to this specific question.

Bottom line

The actual answer is probably somewhere in between, meaning that most Americans with employer-based insurance currently have coverage for abortion.

Abortions paid for with private insurance

A 2003 Guttmacher Institute study found that 13% of all abortions in 2001 were directly billed by abortion providers to private insurance companies (see Table 3 on page 20 here). Some antiabortion activists have misused this statistic to claim that insurance coverage of abortion is not widespread. However, direct billing does not equate to either extent of coverage or even use of coverage.

• Our finding included all women who obtained abortions in 2001, including the numerous women on Medicaid or those who were uninsured. If one looked only at privately insured women—the group relevant to the question at hand—the number would (by definition) be substantially higher than 13%.
• The 13% does not include women who obtain reimbursement from their insurance company themselves, rather than having their provider bill the insurer directly—a common occurrence because many abortion providers are not a part of private insurance networks.
• Some of the women whom our study identified as paying out of pocket likely had insurance coverage for abortion care, but may not have known they had it or chose not to use it for reasons of confidentiality. Given the stigma that still surrounds abortion, these women might not have wanted their insurer or employer, or the primary policyholder (like a spouse or parent), to learn that they had obtained an abortion.