As an obstetrician and gynecologist, I have the privilege of caring for women throughout their lives. I inform them about contraception and do their Pap smears. I offer them medical help over the course of their pregnancies, during childbirth, and after menopause. I also provide abortion counseling and services.
It is not my, or anyone’s, place to judge a woman’s reproductive decisions. My patients include students, stay-at-home moms, doctors, judges, and executives. Each of these women is unique, and their needs change over time. The same person who wants to prevent pregnancy may come to me later with questions about trying to conceive. The woman who is under my supervision to have her second child may seek information someday about abortion. They all need support, and they all need access to medical services. Unfortunately, our current insurance system makes this impossible for many.
When a woman needs to end her pregnancy, it is imperative that she have the means to see a licensed, trained, and quality provider for her procedure. But when elected officials push policies to deny insurance coverage for abortion care, they make it unaffordable for many women to receive such quality treatment. In turn, these women are effectively forced to seek alternate, potentially unsafe options. As a physician and as a woman, this concerns me immensely.
Since the first passage of the Hyde Amendment in 1976, Congress has repeatedly opted to withhold abortion coverage, except in cases of rape or incest, for everyone who qualifies for Medicaid—who, by definition, cannot afford to pay out-of-pocket for the procedure. This policy has a disproportionate impact on women of color, who are overrepresented both among those who use Medicaid benefits and among those who seek abortions. According to the Center for Women Policy Studies, more than half of economically disadvantaged women report delays in obtaining abortions, often because they had to raise the money to do so. Those longer waits can mean more physical, financial, and logistical complications for patients, or simply the loss of the legal right to terminate their pregnancies at all.
It’s not just the Medicaid program, however. Health coverage for abortion is currently denied for people who use benefits through any government-funded programs: federal employees, service members, Peace Corps volunteers, women in federal prisons or detention centers, and those who receive care through Indian Health Services.
Prohibitions are also included in state insurance regulations for private health plans in nine states and for public employees in 19. To make matters worse, 25 states have taken steps in recent years to withhold abortion coverage in the new exchanges created by the Affordable Care Act. While the act expands nationwide availability of important reproductive services, such as annual check-ups or contraception, ensuring access to abortion remains critically important unfinished business.
There are states that are making certain that people can afford to seek an abortion from a licensed, high-caliber provider when they need it. Fifteen include coverage through their state Medicaid program, and we have seen recent victories in defending these policies and defeating exchange bans in places such as West Virginia and Minnesota. Still, prohibitive policies push the procedure out of fiscal reach for too many women around the country.
Taking already complicated moments in a woman’s life and making them harder by denying her insurance coverage for safe, legal medical care is unconscionable. That is why many medical professionals have banded together, including undertaking a national road tour, to demand abortion access for all our patients.
To start, I believe that we need a federal bill that will lift the restrictions on publicly funded health coverage, both on a state and national level, and ensure that contraception, prenatal, maternity, postpartum, and abortion care are all included in federal programs. This, hopefully, will lead to legislation stopping similar limitations in the private sector.
I respect our elected officials, and I hope they will respect the expertise of medical professionals like myself. Let’s put women’s well-being ahead of political agendas and posturing—for once.