What we did not expect was that any health care “reform” proposal might actually roll back existing reproductive health coverage for millions of women.
Sen. Chuck Grassley, ranking member of the Senate Finance Committee, said in March that “there is almost anything compromisable in public affairs. Abortion is about the only issue I know of that's not compromisable.” That’s no surprise. But then in June, 19 anti-choice Democrats laid down the gauntlet in a June letter to Speaker Nancy Pelosi, threatening to withhold support for any reform package that does not include an explicit exclusion of abortion services.
Here’s a nutshell version of the current status quo regarding abortion coverage:
- The seven million very low-income American women (12 percent of women of reproductive age) who are covered by Medicaid have been denied abortion coverage since 1976, when the Hyde Amendment banned Medicaid from paying for abortions - currently, except in the case of rape, incest, or endangerment to the woman’s life. This means that if there is a fetal anomaly or nonviable fetus, for example, or “just” danger to the woman’s health (as opposed to her life), an abortion is not covered. And only 17 states make up for this lack of coverage by using their own funds to provide abortion care for low-income women.
- Others who do not receive Medicaid, but whose health insurance is subsidized by the federal government – including federal employees, members of the U.S. military, Peace Corps volunteers, and prisoners – are also barred from using their health coverage to access abortion.
- The majority – roughly 87% – of employer-sponsored private health care insurance plans do cover abortion services (according to a 2002 Guttmacher Institute study). This is NOT to say, however, that these women have actual access to abortion providers – that’s another story.
(For more discussion of this issue, check out NPR, American Prospect, Newsweek and Time.)
If efforts to drop the “A bomb” succeed in limiting coverage, here’s what might happen:
- Millions of low-income women will continue to be denied access to abortion coverage.
- If a public option plan is adopted, whatever portion of the 37 million currently uninsured Americans who choose such a plan might be subject to similar constraints on abortion services as those covered by Medicaid.
- If Congress adopts legislation that provides government subsidies to help people purchase health care coverage – current House proposals would help subsidize coverage for Americans earning up to 400% of the poverty level – these people too might also then be denied access to abortion coverage, similar to current federal employees.
- If legislators back a Massachusetts-style health insurance purchasing exchange – sometimes referred to as “an Orbitz for health plans” that would organize and impose certain structures on the health insurance market – all participating plans might well be required to adopt abortion exclusions. Again, people whose best option is to purchase insurance through such an exchange might be denied coverage for abortion services.
In other words, if anti-choice legislators have their way, not only might the millions of women who currently lack abortion coverage continue to be denied, women who currently DO have coverage might lose it.
What is also particularly scary is that anti-choice advocates are warping the discussion so that not just abortion, but broader reproductive health may be at stake. They claim that “family planning” is code for “abortion” – but in fact, often “abortion” becomes a code word for all reproductive health services, including comprehensive, medically accurate sex education (read: not just abstinence-only), contraception, and even screenings for STDs.
Simply put, reproductive care is basic primary care for many women of reproductive age. Rather than passing a blanket exclusion on any particular category of medical procedure (which is, after all, what abortion is), Congress should instead let medical professionals determine what health-care services should be included any reform proposal.
The majority of voters get this. According to a recent poll, voters overwhelmingly support requiring health plans to cover women’s reproductive health services (71% favor). And 72% reported that they would feel angry if Congress mandated by law that abortion would not be covered under a national health care plan.
Sen. Patty Murray (D-WA) apparently gets this; she’s said that ensuring that women have health care equal to men is a simple matter of fairness.
Let’s raise our voices and make sure that all of Senator Murray’s colleagues also get this. Tell your Senators and Representatives (click here to find out who yours are) that you want women’s reproductive health care covered – including abortion and contraception.
We need health care reform that is based on our basic health care needs – not politics.
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