…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.
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?
Is Rick Perry’s Rejection of the Affordable Care Act Political Posturing or a Portent of What’s to Come?
On Monday, Texas Governor Rick Perry publicly rejected two major tenets of the Affordable Care act, saying the state would not participate in the individual state exchanges nor in the federal Medicaid expansion. In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius released yesterday, Perry wrote that the “Orwellian-named PPACA” would “make Texas a mere appendage of the federal government when it comes to health care.”
Texas, which has the highest rate of uninsured people in the country — about one in four Texans currently have no insurance — could receive over a hundred million dollars from the federal government over the next few years, enabling the state to dramatically expand Medicaid overage to low-income adults who are not currently eligible. But, instead, Perry wrote that he believes the Medicaid expansion would “exacerbate the failure of the current system, and would threaten even Texas with financial ruin.”
Texas is already in serious financial trouble, and Perry’s dedication to rejecting any help, or dipping into state reserves, has put it in ever more dire straits.