Nothing Changes If Hyde Stands

Erin Kate Ryan

Massachusetts's recent health care reform has plenty in common with Sen. Barack Obama's proposed health care plan. Can we predict what will happen to public funding for abortion nationwide based on what's happening now in Massachusetts?

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.

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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 

 

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

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