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The Affordable Care Act and abortion

Comparing the U.S. and Western Europe

Published online by Cambridge University Press:  22 December 2015

Deborah R. McFarlane*
Affiliation:
University of New Mexico
*
Correspondence: Deborah R. McFarlane, Department of Political Science, MSC05 3070, 1 University of New Mexico, Albuquerque, NM 87131-001. Email: dmcf@unm.edu
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Abstract

The 2010 Affordable Health Care Act (ACA) treats abortion differently than any other health service, precluding public funding for abortion and imposing other restrictions on American states. To determine whether the ACA’s abortion restrictions are uniquely American or have counterparts in other national health systems, this study employs a cross-sectional design comparing abortion restrictions in the ACA with those in 17 Western European countries. Using a six-item scale, the intensity of abortion restrictions is compared across Western European nations. A similar scale is employed for a five-state sample of state-level abortion restrictions. Although the United States is not alone in having abortion restrictions, how abortion is proscribed in the ACA has no counterpart in Western Europe. Unlike many Western European countries, the ACA’s restrictions focus on abortion funding, not the length of gestation or the health of the pregnant woman.

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Articles
Copyright
© Association for Politics and the Life Sciences 2015 

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References

Owings, Maria F. and Kozak, Lola J., “Ambulatory and inpatient procedures in the United States,” Vital and Health Statistics, 1996, Series 13. Data from the National Health Survey, 1998 (139): 1–119.Google Scholar
Guttmacher Institute. “An overview of abortion in the United States: Slide and lecture presentation,” 2011, http://www.guttmacher.org/presentations/ab_slides.html (accessed October 22, 2015).Google Scholar
Jacobs, Lawrence R. and Skocpol, Theda, Health Care Reform and American Politics: What Everyone Needs to Know (New York: Oxford University Press, 2012), p. 3.Google Scholar
Steinmo, Sven and Watts, John, “‘It’s the institutions, stupid!’ Why comprehensive national health insurance always fails in America,” Journal of Health Politics, Policy and Law , 1995, 20(2): 329372.Google Scholar
Hacker, Jacob S., “Why health reform happened,” in Health Politics and Policy, 5th ed., Morone, James A. and Ehlke, Daniel C., eds. (Stamford, CT: Cengage Learning, 2013), pp. 116122.Google Scholar
Burgin, Eileen and Bereznyak, Jacqueline, “Compromising partisans: Assessing compromise in health care reform,” The Forum , 2013, 11(2): 214.CrossRefGoogle Scholar
Burgin and Bereznyak, 2013.Google Scholar
Benson, Clea, “A new kind of abortion politics,” CQ Weekly , 2010, 68: 740746.Google Scholar
Washington Post (Staff of), Landmark: The Inside Story of America’s New Health Care Law and What It Means for Us All, large print version (Detroit, MI: Thorndike Press, A Part of Gale, Cengage Learning, 2010).Google Scholar
Burgin and Bereznyak, 2013.Google Scholar
Jacobs and Skocpol, 2012, p. 118.Google Scholar
Jacobs and Skocpol, 2012, p. 118.Google Scholar
Jost, Kenneth, “Abortion debates: Should the states enact new restrictions?,” CQ Researcher , 2010, 20(31): 134.Google Scholar
Kulczycki, Andrzej, “Abortion and reproductive health,” in Global Population and Reproductive Health, McFarlane, Deborah R., ed. (Burlington, MA: Jones and Bartlett, 2015), p. 188.Google Scholar
Kulczycki, 2015, pp. 171–197.Google Scholar
Sedgh, Gilda, Singh, Susheela, Shah, Iqbal H., Åhman, Elisabeth, Henshaw, Stanley K., and Bankole, Akinrinola, “Induced abortion: incidence and trends worldwide from 1995 to 2008,” Lancet , 2012, 379: 625632, at p. 625.Google Scholar
Sedgh et al., 2012.Google Scholar
Sedgh et al., 2012.Google Scholar
Sedgh et al., 2012.Google Scholar
Sedgh et al., 2012.Google Scholar
Kulczycki, 2015.Google Scholar
Kulczycki, 2015, p. 176.Google Scholar
Wong, Joseph, “Comparing beyond Europe and North America,” in Comparative Policy Studies, Engeli, Isabelle and Allison, Christine Rothmayr, eds. (New York: Palgrave Macmillan, 2014), pp. 163184.CrossRefGoogle Scholar
Marmor, Ted, Freeman, Richard, and Okma, Kieke, “Comparative perspectives and policy learning in the world of health care,” Journal of Comparative Policy Analysis , 2005, 7(4): 331448.Google Scholar
Parsons, Wayne, Public Policy: An Introduction to the Theory and Practice of Policy Analysis (Cheltenham, UK: Edward Elgar, 1995).Google Scholar
Githens, Marianne and McBride, Dorothy E., Abortion Politics: Public Policy in Cross Cultural Perspective (New York: Routledge, 1996).Google Scholar
McBride, Dorothy E., Abortion Politics, Women’s Movements, and the Democratic State: A Comparative Study of State Feminism (New York: Oxford University Press, 2001).Google Scholar
Levels, Mark, Sluiter, Roderick, and Need, Ariana, “A review of abortion laws in Western-European countries: A cross-national comparison of legal developments between 1960 and 2010,” Health Policy , 2014, 118: 95104.Google Scholar
Marmor, Freeman, and Okma, 2005, p. 337.Google Scholar
McFarlane, Deborah R. and Meier, Kenneth J., The Politics of Fertility Control: Family Planning and Abortion Politics in the American States (New York: Chatham House Publishers/Seven Bridges Press, 2001).Google Scholar
Yeatman, Sara, “Measuring reproductive health,” in Global Population and Reproductive Health, McFarlane, Deborah R., ed. (Burlington, MA: Jones and Bartlett, 2015), pp. 83109.Google Scholar
Wellings, Kaye, Collumbien, Martine, Slaymaker, Emma, Singh, Susheela, Hodges, Zoe, Patel, Dhaval, and Bajos, Nathalie, “Sexual behavior in context: A global perspective,” The Lancet , 2006, 365(9460): 702710.Google Scholar
United Nations, Department of Economic and Social Affairs, Population Division, “Model based estimates of family planning indicators,” 2015, http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml (accessed October 22, 2015).Google Scholar
Haupt, Arthur and Kane, Thomas, Population Handbook, 5th ed. (Washington, DC: Population Reference Bureau, 2004), p. 22.Google Scholar
United Nations, 2015.Google Scholar
Alkema, Leontine, Kantorova, Vladimira, Menozzi, Clare, and Biddlecom, Ann, “National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: A systematic and comprehensive analysis,” Lancet , 2013, 381: 16421652.Google Scholar
United Nations, World Abortion Policies (New York: United Nations Department of Economic and Social Affairs, Population Division, 2013), http://www.un.org/en/development/desa/population/publications/policy/world-abortion-policies-2013.shtml (accessed October 22, 2015).Google Scholar
Kulczycki, 2015.Google Scholar
Guttmacher Institute, Facts on Induced Abortion in the United States (New York: Guttmacher Institute, 2014), http://www.guttmacher.org/pubs/fb_induced_abortion.html (accessed October 20, 2015).Google Scholar
United Nations, 2013.Google Scholar
Guttmacher Institute, 2014.Google Scholar
McFarlane and Meier, 2001.Google Scholar
Tribe, Laurence H., Abortion: The Clash of Absolutes (New York: Norton, 1992), p. 11.Google Scholar
Tribe, 1992.Google Scholar
Halva-Neubauer, Glenn A., “Abortion Policy in the Post-Webster Age,” Publius , 1990, 20(3): 2744.Google Scholar
McFarlane and Meier, 2001.Google Scholar
McFarlane and Meier, 2001.Google Scholar
NARAL, Who Decides? The Status of Women’s Reproductive Rights in the United States (Washington, DC: NARAL Pro-Choice America Foundation, 2015), http://www.prochoiceamerica.org/government-and-you/who-decides/ (accessed October 22, 2015).Google Scholar
McFarlane and Meier, 2001.Google Scholar
McKeegan, Michelle, Abortion Politics: Mutiny in the Ranks of the Right (New York: Free Press, 1992).Google Scholar
Burgin and Bereznyak, 2013.Google Scholar
Alina Salganicoff, Adara Beamesderfer, Nisha Kurani, and Laura Sobel, Coverage for Abortion Services and the ACA, Henry Kaiser Family Foundation, September 2014, http://kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-and-the-aca/ (accessed October 21, 2015).Google Scholar
Mary Beth Musumeci, “A guide to the Supreme Court’s decision on the ACA’s Medicaid expansion,” Focus on Health Reform, August 2012, http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8347.pdf (accessed October 21, 2015).Google Scholar
Kaiser Family Foundation, Status of State Action on the Medicaid Expansion Decision, September 2015, http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ (accessed October 21, 2015).Google Scholar
Salganicoff, Beamesderfer, Kurani, and Sobel, 2014.Google Scholar
Meier, Kenneth J. and McFarlane, Deborah R., “State family planning and abortion expenditures: Their effect on public health,” American Journal of Public Health , 1994, 84(9): 4681472.Google Scholar
NARAL, 2015.Google Scholar
Salganicoff, Beamesderfer, Kurani, and Sobel, 2014.Google Scholar
U.S. Department of Health and Human Services, “Annual update of the U.S. poverty guidelines,” Federal Register, 2015, 80(14): 3236–3237, http://familiesusa.org/sites/default/files/product_documents/FPL-federal-register.pdf (accessed October 21, 2015).Google Scholar
U.S. Department of Health and Human Services, 2015.Google Scholar
Musumeci, 2012.Google Scholar
Salganicoff, Beamesderfer, Kurani, and Sobel, 2014.Google Scholar
Kaiser Family Foundation, Summary of Affordable Care Act, April 25, 2013, http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/ (accessed October 21, 2015).Google Scholar
Centers for Medicare and Medicaid Services, Center for Consumer Oversight and Insurance Information, Shared Responsibility Provision Question and Answer, Washington, DC: Department of Health and Human Services, October 28, 2013, https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/enrollment-period-faq-10-28-2013.pdf.Google Scholar
Kaiser Family Foundation, Health Reform Implementation Timeline (Menlo Park, CA: Henry J. Kaiser Foundation), undated, http://kff.org/interactive/implementation-timeline/ (accessed October 21, 2015).Google Scholar
Kaiser Family Foundation, Health Reform Implementation Timeline, undated.Google Scholar
Kaiser Family Foundation, 2013.Google Scholar
Usha Ranji and Alina Salganicoff, “Access to abortion and health reform,” Focus on Health Reform (Menlo Park, CA: Henry J Kaiser Foundation, 2010), https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8021.pdf (accessed October 21, 2015).Google Scholar
Salganicoff, Alina and Sobel, Laurie, Abortion Coverage in Marketplace Plans, Menlo Park, CA: Kaiser Family Foundation, January 2015, http://kff.org/womens-health-policy/issue-brief/abortion-coverage-in-marketplace-plans-2015/ (accessed October 21, 2015).Google Scholar
Salganicoff and Sobel, 2015.Google Scholar
NARAL, 2015.Google Scholar
Ranji and Salganicoff, 2010.Google Scholar
Salganicoff, Beamesderfer, Kurani, and Sobel, 2014.Google Scholar
Ranji and Salganicoff, 2010, p. 3, Table 1.Google Scholar
Kaiser Family Foundation, State Health Insurance Marketplace Types, 2015 (Menlo Park, CA: Henry J. Kaiser Foundation, 2015), http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/ (accessed October 22, 2015).Google Scholar
Salganicoff, Beamesderfer, Kurani, and Sobel, 2014, p. 2.Google Scholar
U.S. Government Accountability Office, “Health insurance exchanges: Coverage of non-excepted abortion services by qualified health plans” (September 15, 2014), GAO-14-742R, http://www.gao.gov/products/GAO-14-742R (accessed April 13, 2015).Google Scholar
Salganicoff and Sobel, 2015.Google Scholar
U.S Government Acountability Office, 2014.Google Scholar
Salganicoff and Sobel, 2015.Google Scholar
NARAL, 2015.Google Scholar
NARAL, 2015.Google Scholar
NARAL, 2015.Google Scholar
NARAL, 2015.Google Scholar
NARAL, 2015.Google Scholar
NARAL, 2015.Google Scholar
NARAL Pro-Choice America, “The Truth About Crisis Pregnancy Centers.” (Washington, DC: NARAL Pro-Choice America, 2014), pp. 1–16, http://www.prochoiceamerica.org/media/fact-sheets/abortion-cpcs.pdf (accessed October 22, 2015).Google Scholar
National Conference of State Legislatures, “Insurance coverage for contraception laws,” updated February 2012, http://www.ncsl.org/research/health/insurance-coverage-for-contraception-state-laws.aspx (accessed May 22, 2015).Google Scholar
Jo Jones, William Mosher, and Kimberly Daniels, “Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995,” National Health Statistics Reports, No. 60 (October 18, 2012), http://www.cdc.gov/nchs/data/nhsr/nhsr060.pdf (accessed April 13, 2015).Google Scholar
NARAL, 2015.Google Scholar
Guttmacher Institute, 2014.Google Scholar
Institute of Medicine, Clinical Preventive Services for Women: Closing the Gaps (Washington, DC: Institute of Medicine of the National Academies, 2011), http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps/Action-Taken.aspx (accessed April 16, 2015).Google Scholar
U.S. Department of Health and Human Services, Health Resources and Services Administration, Women’s Preventive Services Guidelines: Affordable Care Act Expands Prevention Coverage for Women’s Health and Well-Being (Washington, DC: HRSA), http://www.hrsa.gov/womensguidelines/ (accessed April 16, 2015).Google Scholar
Laurie Sobel, Alina Salganicoff, Nisha Kurani, Jennifer Wiens, Kimsung Hawks, and Linda Shields, Coverage of Contraceptive Services: A Review of Health Insurance Plans in Five States, Kaiser Family Foundation (with the Lewin Group), April 2015, http://files.kff.org/attachment/report-coverage-of-contraceptive-services-a-review-of-health-insurance-plans-in-five-states (accessed April 16, 2015).Google Scholar
National Partnership for Women and Families, “Report: some insurers not covering all FDA-approved contraceptives without copays,” April 17, 2015, http://go.nationalpartnership.org/site/News2?abbr=daily2_&page=NewsArticle&id=47478 (accessed April 20, 2015).Google Scholar
Sobel, Salganicoff, Kurani, Wiens, Hawks, and Shields, 2015.Google Scholar
National Partnership for Women and Families, 2015.Google Scholar
National Partnership for Women and Families, 2015.Google Scholar
Burwell, Secretary of Health and Human Services, et al. v. Hobby Lobby Stores, Inc., et al. No. 13–354, argued March 25, 2014; decided June 30, 2014.Google Scholar
Schwartz, John, Between the lines of the contraception decision,” New York Times, June 30, 2014, http://www.nytimes.com/interactive/2014/06/30/us/annotated-supreme-court-hobby-lobby-contraception-decision.html?_r=0 (accessed September 2, 2015).Google Scholar
Liptak, Adam, Judge allows moral, not just religious, contraception objections,” New York Times, August 31, 2015, http://www.nytimes.com/2015/09/01/us/politics/judge-allows-moral-not-just-religious-contraception-exemptions.html?smid=nytcore-ipad-share&smprod=nytcore-ipad (accessed October 4, 2015).Google Scholar
National Women’s Law Center, “State of birth control coverage,” Health Plan Violations of the Affordable Health Care Act (Washington, DC: National Women’s Law Center, 2015), http://www.nwlc.org/stateofcoverage (accessed April 30, 2015).Google Scholar
Dennis, Amanda, Clark, Jill, Córdova, Denisse, McIntosh, Jennifer, Edlund, Karen, Wahlin, Britt, Tsikitas, Lenore, and Blanchardt, Kelly, “Access to contraception after health care reform in Massachusetts: a mixed-methods study investigating benefits and barriers,” Contraception , 2012, 85: 166172.Google Scholar
Levels, Sluiter, and Need, 2014.Google Scholar
Outshoorn, Judith, “The stability of compromise: Abortion politics in Western Europe,” in Abortion Politics: Public Policy in Cross-Cultural Perspective, Githens, Marianne and Stetson, Dorothy McBride, eds. (New York and London: Routledge, 1996), pp. 141164, at p. 154.Google Scholar
Outshoorn, 1996.Google Scholar
Outshoorn, 1996.Google Scholar
Outshoorn, 1996.Google Scholar
Kamenitsa, Lynn, “Abortion debates in Germany,” in Abortion Politics, Women’s Movements, and the Democratic State: A Comparative Study of State Feminism, Stetson, Dorothy McBride, ed. (New York: Oxford University Press, 2001).Google Scholar
Bhatia, Juhie and Naili, Hajur, Part: 5: Spain’s abortion law under threat despite rescue,” Women’s Enews, February 9, 2015, http://womensenews.org/story/abortion/150208/spains-abortion-law-under-threat-despite-rescue#.VbaUMPksDv7 (accessed July 27, 2015).Google Scholar
Kassam, Ashifa, Spain’s prime minister, Mariano Rajoy, said it would have been wrong to introduce a law that the next government would have changed,” The Guardian, September 23, 2014, http://www.theguardian.com/world/2014/sep/23/spain-abandons-plan-introduce-tough-new-abortion-laws (accessed July 27, 2015).Google Scholar
International Planned Parenthood Association, European Network. Abortion Legislation in Europe, (Brussels, Belgium: IPPF European Network, 2009).Google Scholar
Dalby, Douglas, “Irish government apologizes in laundry scandal,” New York Times, February 19, 2013.Google Scholar
CBS News, “Ireland to pay $45 million to Catholic laundry workers,” June 26, 2013, http://www.cbsnews.com/news/ireland-to-pay-45-million-to-catholic-laundry-workers/ (accessed October 23, 2015).Google Scholar
Harrison, Shane, How Savita Halappanavar’s death called attention to Irish abortion law,” BBC News, April 19, 2013, http://www.bbc.com/news/world-europe-22204377 (accessed October 23, 2015).Google Scholar
CBS News, 2013.Google Scholar
Harrison, 2013.Google Scholar
Hakim, Danny and Dalby, Douglas, Ireland votes to approve gay marriage, putting country in vanguard,” New York Times, May 23, 2015, http://www.nytimes.com/2015/05/24/world/europe/ireland-gay-marriage-referendum.html?_r=0# (accessed July 27, 2015).Google Scholar
International Planned Parenthood Association, European Network, 2009.Google Scholar
International Planned Parenthood Association, European Network, Abortion Legislation in Europe(Brussels, Belgium: IPPF European Network, 2012).Google Scholar
Harrison, 2013.Google Scholar
Harrison, 2013.Google Scholar
International Planned Parenthood Association, European Network, 2009, p. 85.Google Scholar
International Planned Parenthood Association, European Network, 2009, p. 85.Google Scholar
Office on Women’s Health, U.S. Department of Health and Human Services, “Pregnancy: Stages of Pregnancy,” (Washington, DC: Office on Women’s Health), undated, http://www.womenshealth.gov/pregnancy/you-are-pregnant/stages-of-pregnancy.html (accessed October 24, 2015).Google Scholar
International Planned Parenthood Association, European Network, 2012.Google Scholar
International Planned Parenthood Association, European Network, 2012.Google Scholar
International Planned Parenthood Association, European Network, 2012.Google Scholar
International Planned Parenthood Association, European Network, 2009.Google Scholar
International Planned Parenthood Association, European Network, 2012.Google Scholar
International Planned Parenthood Association, European Network, 2009.Google Scholar
International Planned Parenthood Association, European Network, 2012.Google Scholar
International Planned Parenthood Association, European Network, 2012.Google Scholar
International Planned Parenthood Association, European Network, 2012, p. 74.Google Scholar
International Planned Parenthood Association, European Network, 2012, p. 77.Google Scholar
International Planned Parenthood Association, European Network, 2009, p. 85.Google Scholar
International Planned Parenthood Association, European Network, 2012, p. 85.Google Scholar
International Planned Parenthood Association, European Network, 2012, p. 59.Google Scholar
International Planned Parenthood Association, European Network, 2012, p. 59.Google Scholar
International Planned Parenthood Association, European Network, 2012, pp. 13–14.Google Scholar
International Planned Parenthood Association, European Network, 2009.Google Scholar
International Planned Parenthood Association, European Network, 2012.Google Scholar
International Planned Parenthood Association, European Network, 2009.Google Scholar
Guttmacher Institute, “Unintended Pregnancy in the United States,” Fact Sheet (July 2015), https://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html (October 24, 2015).Google Scholar
International Planned Parenthood Association, European Network, 2009.Google Scholar
Meier, Kenneth J., Haider-Markel, Donald P., Stanislawski, Anthony J., and McFarlane, Deborah R., “The impact of state-level restrictions on abortion,” Demography , 1996, 33(3): 307312.Google Scholar
Blank, Rebecca M., George, Christine C., and London, Rebecca A., “State abortion rates the impact of policies, providers, politics, demographics, and economic environment,” Journal of Health Economics , 1996, 15(5): 513553.Google Scholar
Salganicoff, Beamesderfer, Kurani, and Sobel, 2014.Google Scholar
NARAL, 2015.Google Scholar
Finer, Lawrence B., Frohwirth, Lori F., Dauphinee, Lindsay A., Singh, Susheela, and Moore, Ann M., Timing of steps and reasons for delays in obtaining abortions in the United States,”Contraception, 2006, 74: 334–344, http://www.guttmacher.org/pubs/2006/10/17/Contraception74-4-334_Finer.pdf (accessed October 4, 2015).Google Scholar
Department of Health, Abortion Statistics, England and Wales: 2010(London, UK: Abortion Statistics, 2011).Google Scholar
Inspectie voor de Gezondheidzorg. Jaarapportage 2010 van de Wet afbreking zwangerschap (Utrecht, The Netherlands: Ministry of Health 2011).Google Scholar
Pazol, Karen, Zane, Suzanne B., Parker, Wilda Y., Hall, Laura R., Berg, Cynthia, and Cook, Douglas A., Abortion surveillance–United States, 2008,” Morbidity and Mortality Weekly Reports (Surveillance Summaries), 2011, 60(SS15): 1–41, http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6015a1.htm#Tab8 (accessed October 4, 2015).Google Scholar
Inspectie voor de Gezondheidzorg, 2011.Google Scholar
Department of Health, 2011.Google Scholar
Salganicoff, Beamesderfer, Kurani, and Sobel, 2014.Google Scholar
Guttmacher Institute, 2015.Google Scholar
Outshoorn, 1996.Google Scholar
Russell Berman, “Why Republicans are voting to repeal ObamaCare–again,” The Atlantic, February 3, 2015, http://www.theatlantic.com/politics/archive/2015/02/why-republicans-are-voting-to-repeal-obamacare-again/385105/ (accessed October 24, 2015).Google Scholar
114th Congress, First Session, H.R. 7, No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2015. Passed January 22, 2015 and referred to Senate committee, https://www.congress.gov/bill/114th-congress/house-bill/7 (accessed October 24, 2015).Google Scholar
Somashehkar, Sandhya, House approves 20-week abortion ban,” Washington Post, May 13, 2015.Google Scholar