A year after its passage, the health-care overhaul is opening fresh battlefields in an old and bitter debate. Almost immediately after the law came into effect, five states passed bills that will prohibit private health insurance plans sold on its new state-based insurance marketplaces from covering abortion, except in dire circumstances such as to save the mother’s life.

Now 22 more states are considering similar abortion bills.

The impact of those bills would be limited to individuals and small businesses who buy insurance on the so-called exchanges. But nearly half of those states are also contemplating an even more sweeping proposal: making it illegal for all private plans to cover abortion, regardless of whether they are sold on exchanges. That step, already the law of four states, would affect the type of plan used by the 14.5 million of women ages 18 to 45 – one-fourth of women in that age group – whose insurance is obtained for them by mid-sized and large employers, according to Paul Fronstin of the Employee Benefit Research Institute.

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