By: Maggie Crosby, ACLU of Northern California

The California Department of Managed Health Care today clarified that health plans sold in the state must cover abortion. The agency’s straightforward instruction to insurance companies, based on decades of California law, contains three important concepts that have all but disappeared with the erosion of abortion rights:

Abortion is basic health care. A pregnant woman has two medical options: childbirth or abortion. Abortion is a safe medical procedure—indeed, safer than childbirth at every stage of gestation. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. One in three women will have an abortion by age 45.

Abortion is a constitutionally protected personal decision. In California, our Constitution and our Reproductive Privacy Act guarantee that each woman has a right to decide about her own pregnancy. It’s not the boss’s business, it’s not the insurance company’s business, and it’s not the government’s business. Abortion and prenatal care must be treated equally.

Restricting abortion coverage is discrimination. Control over reproduction is fundamental to women’s ability to participate in social, economic and political life. Discriminatory policies (covering all prenatal care but only certain abortions) reinforces the archaic message that women’s role is motherhood.

In clarifying that insurance plans must treat abortion and prenatal care equally, the California agency aligns private insurance with public insurance. The state’s Medi-Cal program covers all pregnancy care for low-income women and girls—whichever option they decide. The state may not, and does not, weight that private decision.

The immediate effect of the agency’s guidance is to restore insurance benefits for the staff and faculty at Loyola Marymount University and to block efforts to restrict coverage at Santa Clara University. These large institutions, which receive public funds and employ people of different faiths, purchased plans that covered abortion only for life-threatening pregnancies. This restrictive definition of “medically necessary” abortions is a relic of the era when abortion was a crime. Approval to market such restrictive health plans in California was an error and an aberration in a state with a proud history of protecting reproductive health.

The long term effect of today’s decision is to ensure that as more California residents have health insurance, access to abortion will remain a reality. The Department of Managed Health Care deserves applause because in protecting abortion access, it conveys simple truths that have become obscured in the political effort to stigmatize abortion: childbearing is a personal decision, abortion is basic health care and control of reproduction is critical to women’s autonomy.

This is what it means to take seriously the principle that access to abortion is a fundamental right.

Maggie Crosby is senior staff attorney at the ACLU of Northern California.

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