Battle over Abortion in Health Care Overhaul Moves to States

health care

While a lengthy and controversial debate over abortion almost killed the Democrats' health care reform overhaul in Congress last month, at least two states are now taking the matter into their own hands.

The state legislatures in Tennessee and Missouri have advanced legislation that would further prohibit abortion coverage from the health insurance exchanges that will be established in their respective states, the liberal blog Think Progress reports.

The health care bill that President Obama signed into law already prohibits using federal funding to finance abortion coverage, and it requires insurers to collect a separate check from any consumers it sells abortion coverage to. Even though some anti-abortion rights House Democrats thought the bill did not go far enough to keep tax dollars out of abortion coverage, Mr. Obama managed to win their support for the bill by signing an executive order backing up an already-existing ban on taxpayer funding for abortion.

Anti-abortion lawmakers were in large part concerned that tax dollars would be used to purchase abortion coverage on the health insurance exchange system the new legislation establishes -- a marketplace where individuals and small businesses can pool together to purchase insurance. The exchange system is state-based -- meaning every state will set up its own exchange and be largely responsible for writing and enforcing rules in the exchange.

The Tennessee House Commerce Committee passed a bill last week, Think Progress reported, that would bar any insurance plans on the Tennessee exchange from offering abortion coverage. Missouri is already one of the few states that already bars insurers from selling abortion coverage as part of an insurance package, according to Think Progress, and last month a Missouri Senate committee advanced a bill extending that law to its future exchange.

The state bills illustrate the power states will have in shaping health care reform under the new federal legislation. The state-based system gives politicians in states like Tennessee and Missouri the power to cater to their constituents' particular interests and needs. Many Republicans, such as former Massachusetts Gov. Mitt Romney (who signed into law a state health care bill that is in some ways similar to the federal legislation), say health care should be left up to the states.

However, the state exchange system could also create some pitfalls for the implementation of reform, as Hotsheet noted last month. Officials from some states will face more resistance than others from politicians or private entities not interested in seeing reforms implemented. Some contend federal enforcement of new regulations would be more effective than enforcement from state insurance commissioners.

"By leaving so much up to the states, the health law could end up creating a system in which there are significant disparities in health coverage and insurance regulation, at least partly depending on political will," Suzy Khimm of Mother Jones writes for the Washington Post.

Meanwhile, House Republicans are still saying the federal legislation provides taxpayer funding for the "abortion industry." House Minority Leader John Boehner is decrying a "controversial provision" in the law that leaves states free to offer Medicaid "family planning" services without receiving approval from the federal government. States that provide Medicaid family planning services, including contraception, will receive nine dollars in matching funds for every dollar spent without prior approval.

While states may be "free to offer" more services, many states are already finding the new health care laws to be a burden on their budget. Meanwhile, some states that already offer extensive state-based services, like Massachusetts, could see some of their expenses relieved by the federal government.