Colorado Has a Road Map for Expanding Reproductive Health Care

And it starts with immigrants and survivors of sexual violence.

[PHOTO: Doctor wearing hijab and glasses talks to female patient]
New socioeconomic realities have led many women, particularly women of color, to change their fertility preferences, at a time when access to birth control has been stymied, the Guttmacher Institute reported. Getty Images

As conservative-led states continue to pass a torrent of restrictions on reproductive health care, Colorado lawmakers are working to expand access for some of its most vulnerable residents.

Two bills up for consideration in Colorado, which has long been a reproductive rights stronghold, would increase reproductive health access for low-income immigrants and survivors of sexual violence. Should they pass, the effects would be far-reaching, both in terms of the lives they’d impact and the statement they’d make about who deserves access to care.

One piece of legislation would provide contraceptives to undocumented immigrants in Colorado using state Medicaid dollars. If the bill passes, Colorado would become one of only a few states to offer reproductive health benefits for undocumented immigrants.

The bill’s advocates point to the urgent needs of undocumented communities, and the severe health-care disparities they face.

In written testimony to Colorado lawmakers, A.U., a mother of three from Mexico who lives in rural Colorado, said that being undocumented means living in fear of needing basic health care.

“Living in this country has given me the possibility of offering my children a better future, which I am deeply grateful for,” wrote A.U., who said that she came to the country over a decade ago. “Unfortunately, surviving in this nation can sometimes be very difficult, even more difficult when you talk about access to health care.”

E.M., another mother who came to a rural Colorado town from Mexico, offered her own testimony.

“When I got here everything was different,” she wrote. “It wasn’t like the stories you hear back in your country. Undocumented people like me, we have little to no rights, and that includes access to health care.”

As a single mother of four, E.M. said it’s difficult to make ends meet, and she’s constantly worried about affording health care for her kids.

“I am proud to be in this country, and I know one day the government will listen to us and will provide the support we need to access care and plan our pregnancies,” E.M. said.

Undocumented people like E.M. and A.U. are ineligible to enroll in Medicaid or to purchase coverage through the Affordable Care Act marketplaces. Due to the extremely limited options available for health coverage, most have difficulty accessing basic care, including reproductive health care.

The pandemic has made a bad situation worse, particularly when it comes to family planning. According to data from the Guttmacher Institute, new socioeconomic realities have led many women, particularly women of color, to change their fertility preferences, at a time when access to birth control has been stymied. Thirty-four percent of women surveyed last spring said they now want to have fewer children or to delay having children, and 1 in 3 reported having trouble getting contraceptives or other reproductive health care. Those sentiments were significantly more common among women of color, particularly Hispanic women.

Colorado lawmakers are offering a road map for making incremental but significant change, working with what they’ve got to cut away at red tape that pushes care out of reach.

And while many can bank on some financial relief after President Joe Biden signed a massive COVID-19 stimulus bill into law, undocumented immigrants will continue to weather the crisis with scarce public assistance.

“This is such a structural problem, so we are just trying to address some minimal part of it right now,” said Karla Gonzales Garcia, policy director for the Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR). “I say minimal, but at the same time, you’re talking about giving people the opportunity to manage their pregnancies.”

Garcia has been working for years to expand reproductive health benefits for immigrant communities in Colorado. While this bill only provides contraception, she’s hopeful it will be a critical first step toward offering the full range of reproductive health coverage to people without legal status, like Oregon began doing after passing the Reproductive Health Equity Act in 2017.

“This is creating the basis,” she said. “It’s a long-term strategy so we can keep adding.”

“We are proposing this expansion with the idea that providing the resources for our community members to manage their reproductive health, to manage their bodies and their pregnancies—it has a long-lasting effect for them realizing and achieving their goals,” Garcia added.

According to Garcia, many of Colorado’s undocumented immigrants live in “contraceptive deserts”—rural corners of the state where convenient, affordable family planning services are hard to come by.

“They need to drive sometimes over an hour,” Garcia said. “And guess what: A lot of them don’t have a car. They’re in low-income communities. They may have to spend a whole day of work to try to do this, and that could be two to three days worth of food for them.”

In another effort that would particularly benefit rural Coloradans, Democratic lawmakers are pushing a bill that would stop forcing rape survivors who qualify for an abortion covered by Medicaid to travel to Denver to get care.

The Hyde Amendment bans federal funding for abortion in most cases. And, like a majority of states, Colorado has a law of its own that prohibits public funding for abortion, limiting affordable options for people on Medicaid. There are, however, exceptions for cases of life-threatening medical emergencies, rape, and incest.

But Colorado’s abortion funding ban includes an extra restriction: The few patients who do qualify for a Medicaid-covered abortion can only get care at a hospital. Because most hospitals only offer abortion during medical emergencies, the only option available for low-income Coloradans who use Medicaid and become pregnant after surviving sexual violence is in Denver.

“It reminds me of a Texas-style TRAP law because it’s about buildings,” said Jack Teter, regional director of government affairs for Planned Parenthood of the Rocky Mountains. “Yeah sure, it’s legal, but there’s only one place in the state to get it.”

“It’s not medically necessary in any way shape or form. And it only applies to some of the most vulnerable patients that we serve,” Teter added.

For those living in rural parts of the state, the restriction forces them to make a long and costly journey rather than getting care at a more convenient local abortion provider. Eliminating the restriction would make life easier for low-income sexual violence survivors. The bill passed a third reading in the Colorado Senate on Tuesday morning.

Taken together, these two pieces of legislation address a critical question for reproductive justice advocates: How can we use public resources to serve those who need care most?

It’s a question made exceedingly difficult by the discriminatory nature of abortion funding bans, which is not well understood. There’s a lack of understanding around public funding bans in general—if you got your news from conservatives on Twitter, you’d think that taxpayer-funded abortion is the norm.

But support for doing away with public funding bans is increasing, thanks in large part to decades of organizing by women of color.

Colorado’s public funding ban for abortion was passed as a constitutional amendment by voters in 1984, which makes it immune to a quick fix by lawmakers. But Colorado keeps getting bluer and bluer, and other states are paving the way. In 2017, Illinois repealed its public funding ban, and Maine followed suit in 2019.

There’s light on the horizon regarding federal policy as well. In a historic first, nearly all of the 2020 Democratic presidential candidates, including Biden, openly opposed the Hyde Amendment. And congressional Democrats are more united on the issue than ever.

Still, it will be difficult for Democrats in the Senate to overcome their razor-thin majority and do away with the policy—especially considering the conservative Democrats within their ranks. (See: Joe Manchin.)

In the meantime, Colorado lawmakers are offering a road map for making incremental but significant change, working with what they’ve got to cut away at red tape that pushes care out of reach and expanding benefits where they can.