Much attention has been paid in recent weeks and months to comments by conservative politicians who’ve staked out an extreme-right “no exceptions” position on abortion, with a particular focus so-called “rape exceptions.” Presidential candidate Mitt Romney, while not distancing himself from supporting the Todd Akins and Richard Mourdocks of the world, has attempted to position himself as more “moderate” on the issue of abortion by stating that he will make abortion a crime in all cases except to protect the life of the woman, and in the cases of pregnancies that result from rape or incest. In taking this position he intends to be seen as reasonable, perhaps even compassionate. But when the rubber hits the road,we see that focusing on abortion exceptions is distracting political theater, and, more importantly, disastrous public policy.

Last week, in a segment profiling this ongoing debate, Rachel Maddow asked a question: how would a President Romney implement the policy he’s endorsed, namely to ban abortion in all but a few exceptional cases. Good question. Sadly, the question was left unanswered. Ms. Maddow offered some hypothetical scenarios: (who decides when a woman has been raped? a court? a cop? Mitt Romney?) but did not take the  issue further. It’s too bad she didn’t.

Now, I love Rachel, but she missed something really big. We do not, in fact, need speculation or imaginative doomsday scenarios to know how something like a “rape exception” for abortion works in the real world. Due to existing real-life restrictions on insurance coverage for abortion, poor women live with this reality every single day.

The fact that Roe v. Wade still stands means little to a woman without enough money to afford an abortion if she needs one. For poor women, eligible for public health insurance through Medicaid, coverage for abortion is unfairly withheld, except in the “exceptional” cases of rape, incest, and to protect the mother’s life. This is known as the Hyde amendment. What this means in practice is that in order to access abortion services, a poor woman must do one of three things: qualify for one of those narrow exceptions or somehow raise hundreds or thousands of dollars on her own to pay for the procedure out of pocket. A third scenario—and one that has been documented in recent reports—is perhaps most concerning: a woman who cannot afford an abortion from a safe, legal provider may seek an illegal abortion, cross the border to seek an abortion in Mexico, or take extreme measures to end the pregnancy herself without the care of a health provider.

A woman trying to raise the money on her own, while the clock ticks on how far into pregnancy she can go and still access an abortion, is often faced with untenable decisions like forgoing electricity or rent, selling personal belongings, taking a second job, or borrowing money from family and friends.

A woman who qualifies for one the federal exceptions (rape, incest, or threat to life) has an altogether different, though no less formidable challenge. How does the government (in this case, a state Medicaid office) decide who has been raped for the purposes of enabling a woman to access insurance coverage for abortion? Depends who you ask.

South Dakota, for example, in clear violation of federal law, simply refuses to provide coverage for abortion in the case of rape or incest. Some states require a doctor’s note (or two!) to “prove” rape or incest. Other states require a police report—especially troubling given the tiny percentage of rapes that are ever reported to police. Some states don’t require a police report, but will tell you something different when you call the state Medicaid office. In fact, a recent study shows that Medicaid offices being misinformed, unhelpful, or even judgmental when a woman calls to inquire about insurance coverage for abortion through a rape exception is not at all uncommon. In one assessment, only 37 percent of women ended up getting eligible abortions funded by Medicaid. The result is that most women, even those who would qualify for an exception, are back to square one: raise the money on her own or carry a pregnancy to term against her will.

What does this mean? It means that poor women (for whom affordability is tantamount to access) are already living the logical conclusion of Romney’s so-called moderate position on abortion. It is only in very limited cases that poor women are even theoretically allowed to access safe and legal abortion, and the messy business of operationalizing these exceptions simply does not work. It turns out, surprise surprise, that bureaucrats are not in a great position to decide who has or not been raped and therefore who can access abortion under these unfairly restrictive policies.

These restrictions on coverage for abortion, including their unworkable and arbitrary “exceptions,” put abortion out of reach for women who already face numerous barriers to accessing health care, privilege one woman’s reasons for having an abortion over someone else’s, and don’t even do a good job of ensuring that a woman who qualifies for an exception actually, in practice, gets the case to which she’s legally entitled. On top of it all, these restrictions disproportionately impact women of color, who are more likely to need abortion services, and less likely to be able to afford them.

Any administration that banned abortion “with exceptions” would seek to force every single woman who needs an abortion to live a nightmare scenario: hope that you qualify for an exception, and that you can actually get it, or be denied access altogether. But we can’t forget that today, all over the country, many women are already living that nightmare.