Health insurance companies would have to cover abortions only if people pay a separate premium for them, under a bill approved Tuesday in the S.C. House.
The measure, which was approved 69-41, would also expand the rights of doctors to refuse to perform an abortion.
The provision is part of the bill exempting South Carolina from having to provide abortion coverage in state-based insurance exchanges that are to be created under the federal health care law. At least five states have already opted out, as the federal law allows.
"It prevents taxpayers from paying for elective abortions. It prevents people who have private insurance from paying for other people who have abortions," said the main sponsor, Rep. Greg Delleney, R-Chester. "If you want abortion coverage, you can purchase it."
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The bill would also protect the jobs of doctors who refuse to conduct procedures because of their personal beliefs. The state already bars the firing or demotion of doctors who refuse to do an abortion. The expanded "freedom of conscience act" would cover other things, such as stem cell research, cloning, and euthanasia.
"It allows people of conscience not to have to choose between a career in health care and their conscience," Delleney said.
Democrats argue the separate premium idea is preposterous. They say women won't know ahead of time whether they'll be confronted with such a decision, especially in cases of rape and incest. Their attempts to exempt such cases were turned down by the GOP majority, which listed the abortion bills among its priority.
Opponents say if the separate premium becomes law, insurers likely won't offer coverage - and even if they did, women would be unlikely to ask for it.
Planned Parenthood called it a phony offer. Four other states have similar requirements: Idaho, Kentucky, Missouri and North Dakota. However, there's no evidence such policies exist. A fifth state, Oklahoma, has an exception for victims of rape and incest, according to Planned Parenthood.
Rep. James Smith, D-Columbia, said Republicans are dictating to private insurance companies how to run their business, and victimizing crime victims a second time by making them pay for an abortion out of pocket.
"It is a serious, massive overreaching of government power into the private contracting rights of individuals," he said. "In this one area, we're not interested in freedom and liberty and choice."
Earlier Tuesday, the House also approved a measure meant to protect a fetus that survives an abortion attempt. That bill mimics what's already federal law, which applies to federal facilities.