Tuesday would have been the last day of operation for 10 Texas clinics that provide abortion. But on Monday the U.S. Supreme Court, in one of its final actions this session, said the clinics can remain open while clinic lawyers ask the Court for a full review of a strict abortion law. Two dozen states have passed regulations similar to the ones being fought over in Texas.

Two years ago, when Texas passed one of the toughest laws in the country regarding abortion, the number of clinics offering the procedure dropped from 41 to 19. Amy Hagstrom Miller, chief executive of Whole Woman’s Health, has already closed two clinics in Texas because of the law and was about to close two more.

“Honestly I just can’t stop smiling,” Hagstrom Miller said. “It’s been so much up and down … so much uncertainty for my team and the women that we serve.”

The Texas law says doctors who perform abortions must have admitting privileges at a nearby hospital. But some hospitals are reluctant to grant those privileges because of religious reasons or because abortion is so controversial.

The law also requires that clinics meet the same standards as outpatient surgery centers. Those upgrades can cost $1 million or more.

“It’s an example of the rash of laws … that have taken a sneaky approach by enacting regulations that pretend to be about health and safety but are actually designed to close down clinics,” said Nancy Northrup, chief executive of the Center for Reproductive Rights, which is representing clinics in their fight to overturn the Texas law.

Supporters of the law say every woman deserves good medical care whatever the procedure.

“While we hope that she would not be compelled to choose abortion, we hope that her life would of course not be at risk should she choose to do that,” said Emily Horne of Texas Right to Life. “Pro-life does not just mean care for the life of the unborn child, it’s care for the life of the woman undergoing the abortion as well.”

The law has had a drastic effect in Texas, the country’s second most populous state, leaving most of the remaining clinics in major cities.

There’s just one clinic left along the Mexican border and one in far west El Paso – they were among the nine about to shut down.

If they had closed, the women there faced roundtrips of 300 miles or more to get an abortion.

Hagstrom Miller says all these clinic rules and the doctor restrictions are a deliberate strategy waged by anti-abortion groups. “They’re going state by state by state,” she said. “They can’t make it illegal, so they’re basically making it completely inaccessible.”

Other states that have passed similar laws are also facing legal challenges.

Emily Horne, of Texas Right to Life, says her group would welcome a legal review by the U.S. Supreme Court.

“With this case, issuing some more guidance on that could be very helpful for the pro-life movement in determining what courses to pursue, which laws they might pass in other states in the future.”

The clinics in Texas can stay open at least until the fall. If the court decides to take the case, it would hear arguments in its next term that starts in October.

This story is part of a reporting partnership that includes Houston Public Media, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

With summer vacations coming up, one reader this week asked about travel insurance, while others had questions about coverage of preventive services, including costs related to colonoscopies.

Q. We know now that anesthesia for a screening colonoscopy is covered with no cost sharing  as a preventive service under the health law. As a plan administrator, I am also struggling to find guidance on how to handle bowel prep kits for colonoscopies. Can you help?

A. Without some sort of bowel cleansing preparation–often a powerful laxative that scours out the colon–the exam, which involves inserting a flexible tube with a camera on the end into the rectum and snaking it through the large intestine to look for polyps and other abnormalities, couldn’t be done. When the federal government clarified last month that under the health law’s preventive services provisions consumers can’t be charged for anesthesia they receive as part of a screening colonoscopy, it didn’t address other services that are generally part of the exam, including bowel prep kits.

“The federal coverage mandate doesn’t include any ancillary services,” including bowel prep kits or even the pre-screen consults that can cost as much as $250, says Citseko Staples-Miller, senior specialist for state and local campaigns for the American Cancer Society Cancer Action Network. Some states may impose additional coverage requirements on insured plans. But aside from anesthesia, plans can generally decide for themselves under federal law whether to cover such services without cost sharing.

Q. Why should I buy travel insurance if it won’t cover pre-existing medical conditions? That’s exactly what I’d probably need it for.

A. It’s often easy to get that coverage if you need it. Most comprehensive travel insurance policies cover pre-existing conditions if you buy coverage within 14 to 21 days of making your first trip payment, says Lynne Peters, insurance product manager at insuremytrip.com, a website that offers plans from 25 companies.

Even if you miss that window, as long as you haven’t recently needed medical attention for your diabetes or bad back, for example, you may not run into trouble.

“Most policies have relatively short ‘lookback’ periods,” Peters says. That means that if you file a claim, the insurer will only review your medical records for pre-existing conditions for a specified period before your policy’s effective date, typically 60 to 180 days. As long as you haven’t received any medical treatment, testing, medication changes or recommendations from a physician related to your pre-existing condition during that timeframe, the claim wouldn’t be denied on that basis, Peters says.

Q. With too many children affected by prenatal exposure to illicit drugs, alcohol or tobacco, why doesn’t the federal government include prenatal screening in its list of preventive services that must be covered without cost sharing?

A. It’s standard practice to screen pregnant women for alcohol, tobacco and illicit drug use and intimate partner violence during their initial visit with an obstetrician/gynecologist, says Dr. Lisa Hollier, an obstetrician/gynecologist at the Center for Children and Women in Houston who is assistant secretary of the executive board of the American Congress Of Obstetricians And Gynecologists.

Screening involves asking a series of questions about substance use. It doesn’t involve urine or other tests that might discourage women from getting appropriate prenatal care because they fear running into legal problems, according to ACOG. 

In addition, the health law requires most plans to cover preventive services recommended by the U.S. Preventive Services Task Force without requiring consumers to pay anything out of pocket. The task force recommends that tobacco and alcohol screening be performed and counseling provided if necessary for pregnant women. It concludes that there’s not enough evidence to assess whether screening pregnant women for illicit drug use is clinically useful.

As a practical matter, the task force’s lack of endorsement for drug screening for pregnant women doesn’t mean plans won’t cover it.

While screening isn’t generally a concern, treatment can be.

“There are not many professionals who have specific expertise in managing these problems with pregnant patients,” Hollier says.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.