In the first half of 2010, more than 900 measures related to reproductive health and rights were introduced in the 45 states in which the legislature met. Although legislators continue to grapple with unprecedented budget shortfalls, bills on reproductive health and rights have been the subject of widespread debate and action. At midyear, a total of 49 measures on reproductive health–related issues had been enacted in 20 states. Most notably, bills restricting insurance coverage of abortion, prescribing the provision of ultrasound services for women obtaining an abortion and permitting expedited partner therapy for sexually transmitted infections (STIs) have garnered significant attention. (Click here for a longer version of this analysis.)
Insurance Coverage of Abortion
Propelled by the enactment of the federal health care reform legislation in March, interest in state-level legislation on insurance coverage of abortion intensified through the second quarter of the year. By July 1, legislators had introduced measures on the subject in 18 states, with five new laws enacted. These measures fall into three categories:
- Coverage under all private health insurance policies written in the state: Over the course of the year, legislators in five states introduced measures to restrict or prohibit coverage of abortion in all private health plans (five states already have such laws). Legislatures in four of these states have since adjourned, but action in Michigan remains possible in 2010.
- Coverage in policies to be offered through new state insurance exchanges: Legislators in 14 states (including states that already have laws applying to all private plans) introduced measures that would limit coverage of abortion through the insurance exchanges that will be set up under health care reform by 2014. Legislation has been enacted in four states (Arizona, Mississippi, Louisiana and Tennessee), while legislation approved by the legislature in Missouri is awaiting action by the governor, and measures in Florida and Oklahoma have been vetoed.
- Coverage in policies offered to state employees: Measures introduced in eight states—and enacted in two (Arizona and South Carolina)—are directed at restricting abortion coverage in insurance provided to public employees. Including these new laws, which go into effect in July, 14 states restrict abortion coverage for public employees.
Ultrasound Requirements for Women Obtaining an Abortion
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Over the course of 2010, legislators in 18 states introduced bills aiming to further incorporate ultrasound into abortion procedures. These measures fall into the three following categories:
- Requiring abortion providers to offer women access to an ultrasound procedure: Legislators in eight states introduced measures to require that ultrasound services be offered to women seeking an abortion. Missouri was the only state in which a measure was approved, and the governor is widely expected to allow it to go into effect without his signature. Three other states currently require providers to offer ultrasound services to women.
- Adding requirements for providers already performing an ultrasound in preparation for an abortion: Measures enacted this year in Utah and West Virginia place requirements on providers performing an ultrasound in preparation for an abortion. These two new laws bring to 10 the number of states with such provisions.
- Mandating that women seeking an abortion first obtain an ultrasound: Legislatures in three states—Oklahoma, Florida and Louisiana—moved to enact or strengthen requirements mandating that women seeking an abortion first obtain an ultrasound. Oklahoma adopted the most stringent measure. It would require abortion providers to perform an ultrasound on every woman obtaining an abortion, display the image to each woman and provide a verbal description; the woman would be entitled to “avert her eyes” if she did not want to view the screen. The measure is identical to one passed in 2008 that was overturned by a state court on procedural grounds. The new law, written to avoid the procedural issues, was nonetheless challenged immediately upon enactment, and enforcement is currently blocked pending the outcome of the litigation.
Two other states that have existing ultrasound mandates sought to expand them, one successfully (Louisiana) and one unsuccessfully (Florida).
Expedited Partner Therapy
Continuing a welcome trend, legislatures in several states are moving to expand access to STI testing, treatment and prevention by enacting legislation allowing health care providers to prescribe STI treatment for a patient’s partner without having examined the partner. So far this year, measures to allow expedited partner therapy have been introduced in eight states and enacted in three—Maine, Rhode Island and Wisconsin. Another measure is awaiting action by the governor in Missouri. The three laws enacted so far this year bring to 17 the number of states explicitly permitting expedited partner therapy (AZ, CA, IL, IA, LA, ME, MN, NV, NM, NY, ND, OR, RI, TN, UT, VT and WI).