Under law, Maine puts minimal restrictions on a woman’s right to decide whether to continue a pregnancy. But practical barriers to abortion access, like cost and distance, can be as difficult to overcome as legal restrictions. Now Community Health Options, the largest Affordable Care Act insurer in Maine, has put up another roadblock, announcing last week that it’s dropping abortion coverage next year.

The move, which coincides with the start of the ACA’s enrollment period, was an economic one, not a political one, according to Community Health Options CEO Kevin Lewis. The Lewiston-based, member-run co-op needs to bring costs under control — it lost $31 million last year — and abortion is not considered an essential health benefit under the ACA. (Neither is adult vision care, which is also being dropped.)

Regardless of the motivation for eliminating abortion coverage, though, the decision is going to have reverberations. About 65,000 Mainers have individual or small-group policies through Community Health Options, accounting for 86 percent of the policyholders in the state’s ACA exchange.

Nationwide, the largest share of those enrolled comes from the 18- to 34-year-old age group; there are slightly more women than there are men, and policyholders tend to come from the lower end of the income spectrum. It’s hard to imagine that the demographic profile in Maine looks much different. This means that young, low- and moderate-income Maine women, who are more likely than their more well-off peers to face an unintended pregnancy, will either have to pay out of pocket or carry their pregnancies to term.

Granted, the ACA mandates coverage of birth control, but any form of contraception can fail when used inconsistently or incorrectly, or when interactions with other medications make it less effective. What’s more, the federal health reform law doesn’t mandate abortion coverage – though it does allow states to bar marketplace plans from covering abortion care. Twenty-five states have such policies in place, while only one — California — requires private insurance policies to include abortion coverage.

The federal government’s reluctance to stand up for women’s reproductive rights is reflected in a health care reform law that reinforces anti-choice efforts across the country. The ACA was supposed to expand access to reproductive health care for women who don’t earn a lot of money; instead in Maine, they’re being left behind.

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