Austin - The Republican-controlled Texas Legislature is poised to restrict insurance coverage for abortions over the objections of opponents who say doing so could force some women to make heart-wrenching choices because no exceptions will be made in cases of rape and incest.
A bill requiring women to purchase extra insurance to cover abortions except amid medical emergencies already cleared the state House after hours of emotional debate.
The Texas Senate could approve it on Saturday night, sending the restrictions to Republican Governor Greg Abbott to be signed into law.
State lawmakers debated other bills limiting insurance coverage for abortion during Texas' regular legislative session that ended in May, but Abbott called a special session and revived the issue.
Ten states already have laws restricting insurance coverage of abortion in all private insurance plans: Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, Oklahoma and Utah.
Medically necessary abortions
All make exceptions if the mother's life is endangered; only Indiana and Utah also make exceptions for rape and incest.
The measure's House sponsor, Republican representative John Smithee, said it applies only to "elective" abortions and promotes "economic freedom" by not forcing Texas policyholders who object to abortion to "subsidise" insurance coverage for women undergoing the procedure.
"What we're saying here is: If you want to buy this coverage, you can buy it," said Smithee, a Republican from Amarillo.
Outnumbered Democrats dismissed the bill as purely political, arguing that insurance companies already cover only medically necessary abortions.
They also said the law will require women to purchase insurance plans that insurers won't actually offer because too few women will buy them, not knowing in advance that they will be undergoing abortions.
Representative Chris Turner, head of the House Democratic Caucus, said the bill would effectively require women to buy "rape insurance.
"I think we all agree, rape, sexual assault, incest are horrible crimes," said Turner, of the Dallas suburb of Grand Prairie. He added of victims who wouldn't be eligible for abortion insurance coverage: "Let's not re-victimise that same person again."
Texas approved some of the nation's strictest limits on abortion in 2013, but those were mostly struck down by the US Supreme Court in 2016.
Still, abortion clinics around the state have closed and the number of abortions performed in the country's second-largest state has fallen from more than 82 000 in 2006 to around 54 300 in 2015.
"One of the talking points we've heard lately is abortion should be considered healthcare," Elizabeth Graham, director of Texas Right to Life, told a Texas Senate committee.
"Really, the definition of healthcare is to make a person well and to encourage health. The definition of a successful abortion is the complete death of the unborn child."
State policy analyst Elizabeth Nash of the Guttmacher Institute, a national research group that supports abortion rights, said she knows of no current analysis of the impact of states imposing coverage restrictions, nor the extent to which health plans offer supplemental coverage for abortion.
"My sense is that there isn't any identifiable impact of these restrictions since most women pay out of pocket already," Nash said by email.
A Guttmacher analysis in March said about 60% of privately insured abortion patients pay out of pocket, because their policy doesn't cover the procedure or because deductibles are high. But many women who get abortions are too poor to afford private insurance.
Nancy Northup, president of the New York-based Center for Reproductive Rights, depicted the insurance bans as "a shocking infringement" on women's right to opt for private insurance to cover a legal medical procedure.
In cases where a woman opts for an abortion after detection of a severe foetal abnormality, the costs can run into the thousands of dollars, she said.
The insurance bans also have been criticised by the American College of Obstetricians and Gynecologists, which says insurance coverage of abortion should be comparable to that of other essential healthcare services.