…in order to guarantee abortion access for all, we have to put as much effort into making Medicaid a just and equitable system as we put into our efforts to repeal Hyde and guarantee private insurance coverage of abortion. Medicaid can be a critical resource in theory, but in order to meet the needs of low-income people, the system must function properly in reality. And we must address the reality, however complex and daunting, that repealing the Hyde Amendment doesn’t guarantee universal abortion care coverage for low-income people.
Forty Years After Roe, “Choice” No Longer Means Much in Michigan
From my vantage point in Michigan, celebrations of Roe v. Wade’s 40th anniversary have felt decidedly bittersweet. Earlier this month, Governor Snyder signed HB 5711 into law — Michigan’s anti-abortion super-bill, which will prohibit the telemed prescription of medical abortion, force all women seeking safe abortion care to undergo “coercion screenings,” and enact a number of costly regulations on abortion clinics and providers, inevitably forcing many clinics to close their doors. All of this is in a state that already required a 24-hour waiting period before obtaining an abortion, where minors cannot obtain an abortion without parental consent, and where 87 percent of counties do not have a single abortion provider. The meaning of “choice” here in Michigan — as in many other states in the country — has eroded a great deal since that day 40 years ago when the Roe decision was handed down. How did we end up here? And more importantly, how do we move forward?
The Public Funding Debate: If We Don’t Fight the Hyde Amendment, We Will Lose Everything
Sunday was the kind of anniversary you wish you didn’t have to celebrate: specifically, the 36th anniversary of the Hyde Amendment, one of the most restrictive reproductive rights laws in recent history. It restricts the use of federal funds for abortion services, meaning that people on publicly-funded insurance programs like Medicaid and Medicare (the low-income and the disabled) have to pay for abortion services out of pocket. The vast majority of the women affected by this ban are low-income, and if you are poor enough to qualify for Medicaid, you aren’t likely to be able to shell out anywhere from $300 to $3000 for an abortion procedure.
But, of course, that was exactly the point of the Hyde Amendment. “I would certainly like to prevent, if I could legally, anybody having an abortion: a rich woman, a middle class woman, or a poor woman. Unfortunately, the only vehicle available is the [Medicaid] bill,” said Henry Hyde, author of the amendment.
Unfortunately, though, it seems that we often forget this intention, and somehow decide that it’s okay to equivocate on this issue. Efforts to repeal the Hyde amendment are more often than not seen as unrealistic, and advocates work instead to maintain the status quo — low-income women denied access to abortion. Often the argument is that if we try and fight the public funding battle, we might lose ground in overall access to abortion. But I think that the exact opposite is true. If we don’t fight the public funding debate, we’re going to lose altogether.
The reason is that the public funding debate is simply a slippery slope toward outlawing abortion (and now even birth control) altogether.
Evidence-Based Advocacy: What Do Low-Income Women Think about Public Funding for Abortion?
Evidence-Based Advocacy is a bi-monthly column seeking to bridge the gap between the research and activist communities. It will profile provocative new abortion research activists may not otherwise be able to access.
September 30th marks the anniversary of the Hyde Amendment, which prevents Medicaid coverage of abortion in most circumstances. When activists and advocates talk about Hyde, we discuss the injustice of health care denial, the importance of grassroots abortion funds, and the stories of people who’ve sacrificed rent, food, and monthly bills in order to pay for an abortion their insurance won’t cover. And rightly so—there’s no denying that the more we talk about the horrific ramifications of the Hyde Amendment and the more awareness we raise, the better. We know what we think about Hyde. But what do women who are on Medicaid, the very people who are most affected by Hyde, think about the restrictions it places on their insurance coverage?
Amanda Dennis of Ibis Reproductive Health interviewed 71 low-income women who had abortions while living in Arizona, Florida, New York, and Oregon, states that represent those operating under Hyde’s restrictions and those that have pro-actively provided Medicaid coverage for abortion. These women ranged from 18 to 35 years old, most reported having some college education, and a majority of them had surgical, first trimester abortions within the past two years. All of them met their state’s Medicaid income qualifications.
Most of the women supported government funding for abortion care; in fact, 82 percent said that they support Medicaid coverage of abortion. When asked about whether funding should be available in specific circumstances, however, they wavered. The interviewees didn’t think abortion should be covered if a woman could not afford another child. Similarly, they didn’t think Medicaid should cover abortion if a woman was not in a relationship with the person with whom she had sex. These views held constant even for women who were themselves in these same circumstances when they had their abortions. For example, a majority of the women cited financial instability as the most salient factor in their personal abortion decision, yet when specifically asked if Medicaid should cover abortion as a result of not being able to afford another child, 40 percent said no. Similarly, women often used disparaging language to talk about people who seek abortions for reasons they don’t approve of, again, even if they themselves had abortions in those circumstances.
This seems contradictory: why would women who have abortions for financial reasons disapprove of Medicaid coverage of abortion for the exact same reason?