Americans are overwhelmingly in favor of national
health care reform. But would the type of reform proposed by presidential candidate Barack Obama have any impact on the
options for economically disadvantaged women facing unwanted pregnancies?

Without a repeal of the Hyde Amendment, which bans federal funding for abortion care, the likely answer to
that question is no.
Two
years after health care reform in Massachusetts — a reform that strongly resembles Obama’s proposal — was signed into law, hundreds
of women in Massachusetts are still unable to afford the reproductive
health care they seek.

Abortion Funding in Massachusetts, Pre- and Post-Reform 

In
1981, the Supreme Judicial Court of Massachusetts determined that, as
a matter of Massachusetts constitutional law, MassHealth (the
Massachusetts Medicaid program) must cover medically necessary abortions. In 1986, Massachusetts voters
rejected a referendum (58% to 42%) that would have amended the state
constitution and permitted the legislature to cut off public funding
for abortion. Thus, by the time then-Governor Mitt Romney signed
Massachusetts’s health care reform system into law in 2006, it was
firmly established that public health care plans in Massachusetts would
cover abortion services for the low-income women who qualified for these
plans. With the Hyde Amendment blocking federal money from paying
for Medicaid abortions, the state has paid for this particular service
for the past thirty years.

The
goal of the Massachusetts health care reform law was to ensure near-universal
coverage for the Massachusetts population. In simple terms: through
a set of rules that approach Byzantine complexity, the reform law created
a mid-level, sliding-scale public health care system, Commonwealth Care,
which provides services to low-income legal residents who do not qualify
for MassHealth, the state Medicaid system. In theory (and
by mandate), every adult in Massachusetts ought to be covered through
MassHealth, Commonwealth Care, or one of the bevy of private insurance
options.

As with many bureaucratic systems, though, there is a
forgotten population, one that is incapable of doing exactly what the
government is compelling it to do. This population includes, among
others, undocumented immigrants who do not qualify for public health
care due to immigration status, individuals who do not meet income requirements
for public health care but who nonetheless cannot afford private health
insurance, individuals who have private insurance with co-pays and deductibles
so high that they cannot afford to seek health care services, and individuals
who have recently changed jobs and are within the 30- or 60-day waiting
periods for employer-offered insurance required by many private insurers.
When seeking to end an unwanted pregnancy, the women of this forgotten
population often have the fewest resources.

Even
insured women find themselves in need of abortion funding. Private
insurers are not required to cover abortion procedures, and not all
women’s health clinics and doctors accept public health plans.
Young women insured through a parent’s family policy and married women
insured through a spouse’s policy cannot obtain abortions without
the policyholders knowing, a fact that can compromise the safety of
these women. MassHealth and Commonwealth Care will not follow
women who must leave the state to obtain their abortions, due either
to the parental consent law for minors or advanced pregnancy.
Lastly, federal copycats of the Hyde Amendment operate to prevent the
health care plans of military personnel, participants in the Indian
Health Services, persons on disability insurance, and federal employees
in Massachusetts from covering abortion services. (Narrow exceptions
for rape, incest, and the life of the pregnant woman exist.)

All
this in a state compelled by its constitution to provide public
funding for abortion.

If Massachusetts-Style Health Reform Went National

Were the nation to see a new federal public health insurance plan similar
to the one proposed by Senator Barack Obama, nothing would change in
Massachusetts. As regards public funding for abortion, it seems
likely that very little would change in the rest of the nation either.

Senator
Obama’s plan includes a menu similar to that in Massachusetts:
Medicaid (albeit with extended eligibility), a public health insurance
plan "similar to that
offered through the Federal Employees Health Benefits Program (FEHBP)" for small businesses and individuals
who do not have private group insurance available to them, and private
insurance, overseen by a newly created National Health Insurance Exchange
watchdog group. Under the plan, lower-income individuals who
do not qualify for Medicaid will be eligible for federal subsidies toward
either the public health insurance plan or a private plan of their choice.
The plan does not contain an individual mandate.

Under
Senator Obama’s health plan, more women would be covered by Medicaid — yet
the Hyde Amendment prevents federal Medicaid money from covering abortions
(except in the cases of rape, incest, or life endangerment).

And
a significant number of women would be covered by a FEHBP-lookalike — yet
the FEHBP is prohibited by federal
law from covering abortion
services (except
in the cases of rape, incest, or life endangerment).

So
what changes for poor women seeking abortions? Not much.
If Senator Obama’s plan were to go into effect while the Hyde Amendment were
still standing, the onus to cover abortions for Medicaid recipients would
continue to rest on the states. Currently, only 17 states cover
abortion as part of their state-administered Medicaid plans (the vast
majority due to court order). Thus, while Obama is on record as opposing the Hyde Amendment, the Amendment
would nonetheless limit the effects of his plan.

Were
the new public health insurance plan — the FEHBP-lookalike — to survive
Congress with coverage of abortion services intact (the likelihood of which
is certainly debatable), it would be a triumph — ideologically and practically — for
reproductive health advocates and the middle class. And yet, it
would still reinforce the status quo and abandon the
women with the fewest resources.

Abortion
services in Massachusetts, for example, range from $400-500 for first trimester procedures
to more than $3,000 for second trimester procedures. Even with
the financial assistance of abortion funds in the state, women must
miss utility payments, skip necessities such as food and childcare,
sell personal belongings, borrow money from friends and employers, attempt
to increase credit limits on high-interest and already overburdened
credit cards, and take on additional jobs such as yard work and house
cleaning to pay for abortion care. Poor women are more likely to lose
time between choosing
to have an abortion and actually obtaining one, due to the steps necessary
to collect funds from these various sources. This lost time often
results in more expensive and more complicated abortions.

Of course,
funding is only one of the many obstacles to abortion access for these
women, many of whom must travel long distances, lose wages for time
off, petition for judicial bypass of the parental consent law, locate
translation services, and keep the entire process a secret from friends
or family members.

In the 33 states
where Medicaid does not pay for abortions, the need is much greater
and the situation more dire.
And so, as is often the case, the women who bear the brunt of restrictive
abortion laws such as the Hyde Amendment are our nation’s youngest
women, poorest women, immigrant women, indigenous women, and, disproportionately,
women of color.

No
matter how many campaign promises are made, no matter how many options are proposed in health care reform plans — none of this changes so long as Hyde stands.

To
join the effort to repeal the Hyde Amendment, visit the Hyde — 30 Years
is Enough! Campaign.

Thanks
to Amy Katzen of Massachusetts’s Health Care For
All for
her assistance.

Related Posts 

• Toni Bond Leonard and Marlene Gerber Fried, 30 Years of the Hyde Amendment Is Enough!
• Mike Lillis, Extra Abortion Limitation for Native Americans Only
• Andrea Lych, Abortion Funds: Putting Women’s Needs at the Center