Virginia Governor Bob McDonnell has recommended an amendment to the state's new health care exchange which would prohibit insurance plans to be sold which cover abortions, exempting cases where the life of the mother is at risk, rape, and incest. Other states have restricted abortion coverage under the new health care exchanges, but the Virginia law would prohibit the ability of women to purchase an additional rider allowing for coverage of abortions.
It will be interesting to see how this plays out. If the state's health care exchange will be managed federally, as Virginia did not establish a state-managed exchange, then will the restrictions be allowed to remain? Will federalism — under which states are allowed to keep their own identities and laws — apply in this case where the state did not act in enough time to establish state governance over the health care exchange? Although ACA was declared (mostly) constitutional, seeing provisions such as these enacted will surely bring up legal challenges.
The bill is likely to pass, as Republicans control more than two-thirds of the seats in the Virginia House of Delegates. Last year, the state's Senate did defeat a measure to grant "personhood" to unborn children.
Some states have laws restricting abortion coverage under the new health care exchanges, but allow women to purchase insurance riders allowing them additional coverage. The Virginia law would prohibit these additions. Federal funding for abortions is restricted by the Hyde Amendment and those restrictions will continue under health care exchanges.
Health care exchanges set up under Affordable Care Act are an attempt to establish a marketplace in which small businesses and uninsured individuals will be able to "shop around" to purchase insurance plans. With the prohibitions in the governors' amendment, the likely scenario will be lower-income individuals will be unable to purchase insurance that will cover abortions. NARAL Virginia, a pro-choice organization, estimates the restriction will affect about 50,000 women in the state.
Health care exchanges established as a function of the Affordable Care Act are interesting. Only a handful of states passed exchanges in the time frame to allow for state, rather then federal, control over the exchanges. Virginia is one of the states which a health care exchange will be managed federally, delayed in the hopes that the Affordable Care Act would be overturned.