What a Ban on Insurance for Abortions Means for Women with High-Risk Pregnancies

UPDATE: Governor Greg Abbott signed House Bill 214 into law on Tuesday, August 15. The measure passed the Senate on August 13 by a vote of 20 to 10, and in the House on August 9 by a vote of 92 to 46. The House bill is identical to the Senate version, SB 8. All amendments proposed to both bills — including adding exceptions for fetal anomaly and rape — failed. The law takes effect December 1.

On the day before her abortion, Kristyn Ingram and her husband flipped through books of baby names. They chose one if it was a girl, and another for a boy.

The next morning — December 8, 2006 — Ingram, then a fourth-year medical student in San Antonio and 17 weeks pregnant, received the abortion pill cytotec to induce labor at her local hospital. She got an epidural. After 12 hours she delivered a girl, dead. They named her Annabelle Cartwright Ingram.

Ingram and her husband, Ross, wanted a baby. But a screening when she was 16 weeks pregnant found Potter syndrome, a rare condition in which fetal kidney failure prevents the lungs from developing. Knowing that the chance of survival was extremely low, the Ingrams decided to terminate the pregnancy.

“We were completely devastated,” said Ingram, who slept with Annabelle’s hospital blanket the week after. The couple wears matching rings with blue topaz — Annabelle’s birthstone. “But the idea of bringing a baby into the world to suffocate and only know pain was unacceptable.”

Ingram’s abortion was covered by her health insurance, costing her between $200 and $400 out of pocket, she told the Observer. But under a bill up for consideration in the Senate Business and Commerce Committee Saturday, Ingram said she would have been on the hook for the full cost — close to $10,000 for the second-trimester procedure and hospital stay. It’s a price tag that would have been “completely out of the realm of possibility” as a medical student paying for school, she said.

Senate Bill 8 would ban private insurance plans in Texas from covering abortion, without any exception for cases of fetal anomaly, like Ingram’s. If a person wants abortion coverage, the proposal says it “does not prevent” him or her from buying supplemental coverage outside of a qualified health plan. But the bill does not require that such plans exist. One of three anti-abortion measures on Governor Greg Abbott’s special session agenda, SB 8 does include an exception for “medical emergencies.” But under Texas law, medical emergencies are defined as a “life-threatening physical condition” that “places the woman in danger of death or a serious risk of substantial impairment of a major bodily function.” Critics say the definition is so narrow that it could force someone facing a high-risk pregnancy to pay thousands of dollars out of pocket — or put off an abortion until their life is in danger.

“This has a direct impact on access to health care in tragic circumstances …  and to add insult to injury, the Texas Legislature is going to say, ‘Oh by the way, your insurance company won’t cover this safe thing that your doctor recommends,’” said Blake Rocap, legal counsel for NARAL Pro-Choice Texas. “They would have to wait until they’re basically actively miscarrying, and then it’s super dangerous — we’re talking about hospitalization; it’s much more expensive for the insurance plan, and much more dangerous for the mother to wait that long.”

Consideration of SB 8, authored by Senator Brendan Creighton, R-The Woodlands, with a House companion from Representative John Smithee, R-Amarillo, comes the day after the Senate Health and Human Services committee sent two anti-abortion bills to the full Senate for approval. On Thursday, reproductive-rights attorneys filed a lawsuit against Texas’ anti-abortion law passed during the regular session.

The measure to ban abortion coverage in private plans is a longtime favorite of anti-abortion advocates, who say they shouldn’t have to pay into health coverage that includes a procedure they vehemently oppose. A similar bill passed the Senate in the regular session, and passed out of committee in the House.“This is long overdue,” said Joe Pojman, executive director of Texas Alliance for Life.

But terminating a pregnancy is by nature unplanned. Even if supplemental abortion coverage were available, people would be unlikely to buy it, the bill’s critics say. “Most people don’t go into a pregnancy thinking something bad will happen and they’ll need to terminate — especially a planned pregnancy,” Ingram said. “I would never have bought a supplemental abortion insurance policy because I’d never have thought I’d need it.”

Ingram, who turns 36 this month, has four healthy kids now, who “all know they had an older sister.” Each year on Annabelle’s birthday, the family decorates their Christmas tree with an angel ornament.

Ingram said she’s lucky to have had the resources and support she did during her abortion and that her medical background made a big difference. “I have no guilt whatsoever about my termination because I saw the ultrasound, I knew what it meant, I knew the outcome,” she said.

But had SB 8 been in place 11 years ago, she would have been in trouble.

“In medicine, we know all kinds of things can go wrong,” Ingram said. “But I had the innocence of a first pregnancy where you assume everything will go right and you’ll take home a baby at the end.”