General Articles

Abortion Coverage Restricted in High-Risk Insurance Pools

The battle over insurance coverage for abortions that raged over the course of the debate over health care reform legislation reared its ugly head yet again when anti-choice activists and politicians identified a remote possibility that Pre-existing Condition Insurance Plans, commonly referred to as “high-risk pools,” could cover what they consider to be “elective” abortions—abortions that are performed in cases other than rape, incest, or when there is a threat to the life of the woman. The high-risk pools are administered either by the states or the federal government, and were mandated in the Patient Protection and Affordable Care Act in order to provide insurance for individuals who have been denied coverage by private insurance companies because they have pre-existing medical conditions. These plans will exist only until 2014, when private insurance companies will be required to offer insurance to applicants regardless of health status, as mandated in the recently passed health care legislation. While the high-risk pools are subsidized by federal funding, those receiving coverage must pay premiums as high as $570 per month out-of-pocket.[1]
This latest kerfuffle over claims that health care reform would lead to the government funding “elective” abortions began in July 2010, “when the National Right to Life Committee (NRLC) warned that elective abortions would be covered under a Pennsylvania insurance program created by the health care reform law.”[2]  Despite the vehement denials of Pennsylvania officials and the fact that the plain language of the plan itself states that “[e]lective abortions are not covered,” anti-choice activists and politicians, notably House of Representatives Minority Leader John Boehner (R-OH), quickly mobilized to disseminate NLRC’s erroneous claims and condemn the administration of President Barack Obama.[3] Within 24 hours of NLRC issuing the press release that instigated the anti-choice outcry, a representative from the United States Department of Health and Human Services stated that “in Pennsylvania and in all other states abortions will not be covered” in the high-risk pools, “except in the cases of rape or incest, or where the life of the woman would be endangered.”[4]
Administration officials contend that the prohibition on coverage for “elective” abortions in the high-risk pools is consistent with the Executive Order that President Obama signed to reiterate the requirement that women purchase a separate insurance policy to cover abortion in the health insurance exchanges created as a result of the Patient Protection and Affordable Care Act. The Executive Order was the product of intense negotiations between the White House and Congressional Democrats who oppose abortion rights and was deemed necessary by the Obama administration in order to garner enough support for the bill and overcome unanimous Republican dissent. While the Executive Order does apply to insurance plans purchased through the state-based exchanges, it does not mention the high-risk pools at all.[5]  Neither is the question of whether or not “elective” abortion may be covered in the high-risk pools addressed in the health care reform legislation itself; thus, pro-choice advocates view the administration’s reactionary response to its anti-choice critics as premature and unnecessary. 
The prohibition on coverage except in the cases of rape, incest, or danger to the life of the woman in the high-risk pools is particularly damaging to the reproductive rights of the women who will participate in them. In order to be eligible for coverage in most high-risk pools, an individual must have been without insurance for at least six months and must have been denied coverage on the basis of a pre-existing medical condition. Given that, by definition, women who receive coverage through the high-risk pools are in less than optimal health, access to abortion care is vital as carrying a pregnancy to term may be detrimental to her condition. For instance, a woman suffering from depression may want to consider terminating her pregnancy depending on the severity of her condition and whether or not she could continue taking anti-depressant medication throughout her pregnancy. A woman diagnosed with cancer while pregnant, who would have to postpone possibly life-saving chemotherapy or radiation treatment, could consider having an abortion in order to access the care that she needs to have the best opportunity to preserve her health. Also troubling is that the restriction on abortion coverage in the high-risk pools is actually more limiting than that in the health insurance exchanges—in the exchanges, women can purchase a separate abortion insurance plan. Women in the high-risk pools are denied that option.
“We call on the administration to recognize that women who face the difficult decision of whether not to carry a pregnancy to term do not need another barrier to accessing a legal medical procedure or the added stress of finding the resources to pay for an abortion when may already have steep medical expenses, and hope the administration will reconsider its decision on this matter,” said Jen Heitel Yakush, director of public policy at the Sexuality Information and Education Council of the United States. 

[1] “Benefits and Premium Rates,”, accessed 16 August 2010, <>.

[2] Sarah Kliff, “Abortion groups caught off guard,” Politico, 30 July 2010, accessed 16 August 2010, <>.

[3] Solicitation for State Proposals to Operate Qualified High-Risk Pools, (Harrisburg, PA: Pennsylvania Insurance Department, 2010), accessed 16 August 2010, <>, 14. 

[4] U.S. Department of Health and Human Services, “Statement of HHS Spokeswoman Jenny Backus on the Pre-Existing Condition Insurance Plan Policy,” News Release published 14 July 2010, accessed 16 August 2010, <>.

[5] Robert Pear and David M. Hirszenhorn, “Obama Hails Vote on Health Care as Answering ‘the Call of History,’” New York Times, 21 March 2010, accessed 16 August 2010, <>.