08/15/2014 12:17 pm ET Updated Oct 15, 2014

Abortion Coverage and the Affordable Care Act

The Affordable Care Act (ACA) accomplished many wonderful things for women. It eliminated gender bias in insurance, required preventive screening without co-pays, and made family planning services part of a standard health insurance package. It did not, however, change the status quo that stigmatizes and marginalizes abortion, given that it maintains policies that discriminate against women based on their insurance or income.

Nearly one in three women will have an abortion before age 45 -- as many as 1 million a year. Before the Affordable Care Act, abortion was often covered as a matter of course in the private market, with data showing that at least three-quarters of private plans (including employer-based plans) offered some kind of coverage. Under the new law, while individuals can obtain financial assistance to purchase private insurance through the marketplace, those payments cannot be used to purchase abortion coverage except in the narrow circumstances defined by the federal Hyde Amendment -- cases of rape, incest or when a woman's life is at risk.

States are also permitted under the law to ban abortion coverage altogether from insurance plans offered through the marketplace, and 24 states have done just that. Most states stuck with the Hyde exclusions, but Texas and Tennessee went further, barring abortion coverage completely in their marketplace plans. Where states do permit abortion coverage, the law requires that at least one marketplace plan deny abortion. In a recent study of a sample of states, the Guttmacher Institute found that it is difficult, if not impossible, to determine which insurance plans offer abortion coverage in those states. And in states where abortion is barred, that fact is not made clear.

In fact, many states have launched a de facto war to prevent women from having access to abortion services no matter their circumstances. They have enacted laws to harass patients with longer waiting periods and absolute abortion bans at 20 weeks. They have sought to disrupt clinic operations with onerous and completely unnecessary building codes and staffing requirements. The courts are full of lawsuits on behalf of abortion providers and the women they serve seeking to blunt the impact of such laws or to overturn them completely. Winning these battles is critical if women are to have access to abortion care in the future.

At the federal level, under the Hyde Amendment, abortion coverage is denied to the one in seven women of reproductive age enrolled in Medicaid, as well as to federal employees, Peace Corps volunteers, and others who access health care through public programs. Without coverage, a woman must scramble to find the money to cover her care, get the time off from work to meet medically unnecessary waiting requirements, and find the time and means to travel when abortion facilities are few and far between due to punitive regulation. Such discrimination falls hardest on women struggling to make ends meet, who are disproportionately women of color, and who already experience limited access to the comprehensive services and resources they need to prevent an unintended pregnancy.

NCJW is a proud member of the All Above All campaign, which is working to restore comprehensive coverage of abortion so every woman can make her own decisions about ending a pregnancy no matter her insurance or her income. All Above All is now on the road in a 12-city trip to raise awareness about this very important step in the journey toward making the right affirmed under Roe v. Wade a reality for all.

Generations of women have grown up under Roe v. Wade thinking that abortion is their right and their decision, one they should be able to make guided by their own faith and circumstance, without interference by judges, legislators, or politicians. Our courts and legislative bodies have an obligation to protect every woman's ability to make her own decision about whether to become a parent, choose adoption, or end a pregnancy, without discriminating against women based on the type of insurance they hold, their income, or other extraneous factors.

Were our lawmakers to fully, boldly act to safeguard women's autonomy and decision-making, they would undo the harmful state coverage restrictions woefully allowed under the ACA, and end bans that deny abortion coverage to women enrolled in federal programs. Abortion is health care that a woman may need in her lifetime, and it should be both available and affordable to all consumers on the same basis as other pregnancy related health benefits. Updating our state and federal laws to make true access a reality would go far to normalizing the exercise of what is, after all, a constitutional right.