Health insurance bans for abortion
While reproductive justice advocates fight tirelessly to ensure abortion remains legal, increasing barriers to accessing abortion care are making its legality all but beside the point in some parts of the United States. One of the growing stealth methods to deny women access is restricting insurance coverage of abortion.
Since the passage of the Affordable Care Act in 2010, states have been restricting abortion coverage in health insurance plans purchased through the exchanges, which were set up to help individuals and small business obtain affordable private health plans. Currently, 26 states have laws restricting insurance plans in the Marketplaces from offering abortion coverage, and 11 of those states ban all private health insurance from covering abortions. Most of those states have exceptions for rape, incest, or if the woman’s life is endangered, but two prohibit any abortion coverage. And nine states allow abortion coverage through buying a separate rider and paying an additional premium.
“When a woman has to pay out of pocket for an abortion, oftentimes we are finding that our patients don't have an extra $650 to $1,000 lying around,” said Julie Burkhart, founder and CEO of Trust Women, which provides reproductive health care, including abortions, in underserved communities and operates clinics in Wichita, Seattle, and Oklahoma. “Thirty-three percent of our patients need help with funding for an abortion, including those with private health insurance. And if you look at the states where there are insurance bans, those are the states with lower wages.”
Women seeking an abortion who qualify for Medicaid face barriers because of the Hyde Amendment, the federal legislation that went into effect in 1977 that blocks Medicaid funding for abortion coverage. “Hyde is particularly harmful for our community, as more than one in three Latinas is enrolled in a federal insurance program affected by Hyde and are routinely denied coverage for abortion care,” said Bethany Van Kampen, senior policy analyst at the National Latina Institute for Reproductive Health. “Without abortion coverage, a woman might sacrifice money that would otherwise be used to pay for rent and groceries to get the care they need. No one should ever have to make that decision.” The Hyde Amendment has been reauthorized by Congress every year, and although states can use their own funds for abortions for women in the Medicaid program, only 17 states have policies in place to do so.
“Cost is the biggest barrier when women are trying to get an abortion,” said Lindsay Rodriguez, communications manager of the National Network of Abortion Funds. “An insurance ban is an incredibly difficult barrier to overcome and many women cannot, and will end up continuing pregnancies and giving birth when they don't want to.”
In April, Wisconsin passed a bill banning abortion coverage for state employees, joining 21 other states with similar legislation. “The fundamental absurdity of this bill is that the reason people have health insurance is for covering the costs of preventative health care and unexpected health costs,” said Mike Murray, policy director at Wisconsin Alliance for Women’s Health. “As a man, I don't know if I'll ever get prostate cancer, but I'm covered by my insurance in the event that I do someday. So, what is happening with insurance coverage of abortion is completely discriminatory. Many public employees are at the lower end of the economic spectrum and they don't have a lot of extra resources for unexpected costs such as an abortion, which is about $500 for a first-trimester abortion. Half of Americans don't have the financial resources to handle a $400 unexpected cost.”
An anti-choice White House has motivated anti-choice legislators to pursue every possible measure to block access to abortion. “Opponents of abortion are using a strategy of restricting it by any means,” said Kelli Garcia, director of Reproductive Justice Initiatives and senior counsel at the National Women’s Law Center. “They feel emboldened, and are going back to restrictive measures they have already passed, and seeing what they can add on to it. We are seeing this with waiting periods, delays, everything. Before the ACA, maternity care wasn't covered, so historically women's health care in general was carved out of health insurance. Now, the state is trying to insert itself into what should be a private decision between a woman and her health care provider.”
Insurance bans also “create an unnecessary obstacle to obtaining the procedure by complicating the scheduling process, delaying the procedure, or putting it out of reach entirely,” said Julie Gonen, policy director at the National Center for Lesbian Rights. “It implies that abortion is something other than the medical procedure that it is. Insurance bans are a not-so-subtle form of economic coercion — a woman who has earned or qualified for health insurance is told that she may not actually use that coverage for a medical procedure that she has determined is right for her. These bans are just one more way that women have their agency diminished by third parties trying in every way possible to prevent them from making basic decisions about their own families.”
This can create additional stress around an already emotional decision. “What this is really doing is putting a distance between women and their health care providers and creating shame and stigmatization around a medical procedure,” said Rodriguez. “Many clinics try to adjust to women's financial needs, but they are right on the edge of being able to stay open, so there is only so much they can do. We are seeing skyrocketing calls for help, so we are having to say no more often. It's really important that people support their local abortion fund.”
Many women don’t even realize that their health insurance won’t cover an abortion until they are seeking one. “There have been so many separate attacks on reproductive health care in Wisconsin that it's hard to keep track even for me, and it's my job,” said Murray. “It's not fair to expect people to follow all of this, and as a result, many people are unaware of restrictions in their health insurance.”
In many states, it is difficult to even find a health clinic that provides abortions. “A right is a right in theory only if it isn’t accessible to all,” said Burkhart. “In this part of the country [the Midwest where there are few abortion providers] women are driving four to five hours to Wichita to get an abortion. Our society already tells us that abortion is taboo and we can't talk about it; [insurance bans] add another layer to that taboo. They also put women in a precarious position where you have to talk with your health insurance provider about abortion care. It takes a private decision out into the public.”
The insurance bans are particularly harmful to women without access to high-quality health care. “Due to lack of access to affordable health coverage, contraception, and sexual health information, Latinas are more likely to need abortion care,” said Van Kampen. “They’re also less likely to be able to afford it, as Latinas earn about 54 cents on the dollar compared to white men. Aside from insurance restrictions that already plague our communities, many will forgo any health care for fear of family separation and persecution under the climate of fear created by this administration’s cruel immigration policies.”
Additionally, the Department of Health and Human Services has proposed a rule that would weaken the Health Care Rights Law, the section of the Affordable Care Act prohibiting discrimination in health care and insurance coverage based on race, color, national origin, sex, age, or disability. “As with earlier rules showing the Trump administration’s eagerness to try and restrict access to health care for women and LGBTQ people, any rollback of the Health Care Rights Law will be met with a fierce response from these communities,” said Laura Durso, vice president of the LGBT Research and Communications Project at the Center for American Progress.
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