Here’s how the rules work. Insurers may include abortion coverage as part of health care plans approved under the state exchanges to be created by the health care law. All enrollees in such a plan must make a payment of not less than $1 per month into an account exclusively for paying for abortions.

A notice about abortion coverage must be provided in the paperwork only at the time of enrollment. Monthly bills do not have to break out the abortion premium, and the rule specifies that advertising about the policy only need provide information about “the total amount of combined payments.”

The Bioethics Defense Fund has pointed out that these rules raise significant religious liberty concerns, because people who don’t want to pay for abortions will end up doing so in three ways. First, many will unknowingly buy a plan that covers abortion without realizing it, because the rules are designed to squelch transparency. Second, employers will choose plans that cover abortion, contrary to an employee’s wishes. Third, many people will be compelled to buy a plan that covers abortion, because there won’t be alternatives that have the coverage or provider networks they need. The Bioethics Defense Fund explains that this situation amounts to millions of dollars in subsidy to Planned Parenthood and other abortion providers.

The mandates in the health care law have added another dimension to the religious liberty concerns and caused many who were unaware to begin asking questions, but the problems are not new.

When officials at Colorado Christian University heard about the health care law’s mandate that abortifacient contraception be covered, they decided to mount a legal challenge. As administrators began to scrutinize their health insurance policy, they discovered to their horror that their plan had covered abortion for years. It had simply never occurred to them to check. One professor said, “I suspect this is not unique to CCU. I bet everybody’s looking at their policies now …”

Kathryn Jean Lopez, editor of National Review Online, published a report from the Bioethics Defense Fund and then did a follow-up article to point out that the issue had gotten almost no coverage in the media. And does anybody actually read their insurance policies?

Consider recent events in the State of Kansas. Pro-life groups there lobbied the legislature to pass a law requiring that insurance policies could offer coverage for elective abortion only on a separate rider.

As a result of the law, insurance companies in Kansas sent notices to policy holders offering them a rider to cover abortion for an additional $6.95 a month. Upon receiving this notice, one woman was so appalled she dropped her health insurance and joined Samaritan Ministries. She sent us a copy of the notice.

This woman works for a pro-life ministry that takes an explicit stand against abortion. Although she is highly informed about pro-life issues, she didn’t realize that her insurance company did indeed sell policies that cover abortion.

The simple, clear, notice informing her that her insurance company would cover abortion for an additional monthly fee is what caused her to recoil at the idea her money was going to a company that pays for abortion.

Stories like these raise so many questions.

How many insurance companies offer abortion coverage? How many policies cover abortion? How many people don’t realize that abortion coverage is buried in the fine print, or disguised with terms like “preventative care” or “reproductive services”?

How many church boards have bothered to check whether the health insurance policies for the church staff cover abortion? How many church members have inquired? How many churches know if their insurance provider sells policies that cover abortion? What would it take to switch policies or companies? Are there even feasible alternatives available that don’t cover abortion? How many know about Samaritan Ministries?

We won’t know until we ask.