As if the rollout of the federal health law didn't have enough problems, abortion is back in the spotlight.
How the various health plans in the exchanges would or would not pay for abortion was one of the very last issues settled before the bill was passed in 2010. Now abortion's invisibility on the federal HealthCare.gov website has some people pretty upset.
The issue came up Wednesday when Health and Human Services Secretary Kathleen Sebelius testified on Capitol Hill.
"If someone, a constituent of mine or someone in this country has strongly held pro-life views, can you commit to us to make sure that the federal exchanges that offer that is clearly identified and so people can understand if they're going to buy a policy that has abortion coverage or not?" asked Rep. John Shimkus, R-Ill. "Because right now, you cannot make that determination."
Sebelius appeared to be caught off guard by the question.
"I don't know," Sebelius replied. "I know exactly the issue you're talking about — I will check and make sure that is clearly identifiable."
At least for now, though, it's not clearly identifiable, those on both sides of the abortion debate agree.
"The exchanges, by law, have a complicated scheme of including at least one plan that does not include elective abortion," says Chuck Donovan, president of the Charlotte Lozier Institute, an anti-abortion think tank.
That was part of the deal that got the law passed, so that abortion opponents could avoid policies that cover the procedure. But he says that not only is the information not on the website, sometimes it's not easily available by calling, either.
"We did what we were recommended to do, and that is call the individual insurers," he said. "And in many cases they don't have plan documents in front of them as they talk to you on the phone."
It should be noted that in 23 states there is little question. Those states have passed laws that ban all plans in their health exchange from offering coverage for elective abortion. Eight of those states have also banned private insurers outside the exchange from offering coverage for abortion as well. Most, but not all, include exceptions for life endangerment, rape or incest. Some of those states allow abortion coverage to be sold as a separate policy, called a rider, but so far there's no evidence that any plan is offering that.
Judy Waxman of the National Women's Law Center says this is a major change from what has traditionally been the status quo for abortion coverage in private health plans.
"Abortion has generally been covered because it is treated like any other medical service and is just part of outpatient care or doctor care, and really has not been singled out very much in private insurance," she says.
But the fight over the Affordable Care Act changed that. In order to ensure that no taxpayer money went to pay for elective abortions, it created a very complex system by which insurance companies would have to separate out a portion of each premium if they wanted to continue to offer abortion as a covered benefit.
Waxman says, as a result, there is at least anecdotal evidence that some insurers are dropping coverage, at least for this first year, just because of the added hassle.
"We had heard that some plans are saying that they are not going to offer it now because they have so much to figure out, and this little extra administrative activity they have to be involved in is something they want to figure out when things calm down a little," she says.
But it's the anti-abortion community that remains most upset. Anti-abortion lawmakers in Congress, led by Rep. Chris Smith, R-N.J., have introduced legislation that would require information about abortion coverage to be available directly on health exchange websites.
Donovan says it will help those on both sides of the debate.
"It's designed so that people have information about elective abortion coverage whether they're looking for it or they're looking to exclude it," he says. "They would have that information when they have their encounter with the plan and not have the information only after they bought it."
Abortion-rights supporters oppose the bill. "It is intended to discourage plans from covering abortion and maybe even go as far to say it is to discourage women from taking that plan and trying to put a stigma on the plan or the individual," says Waxman.
But for now, at least in states where coverage is allowed, whether or not abortion is a plan benefit remains largely a mystery.
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