For Low-Income Women, Lack of Coverage Leads to Anxiety, Unnecessary Delays in Terminating Pregnancies

Elisabeth Sowecke

Low-income women--even many ostensibly covered by Medicaid--face numerous obstacles to obtaining early, safe abortion services, leading to higher costs and later abortions than need be the case. The DC Abortion Fund is struggling to close the gap.

Regardless of the current state of health care insurance in this country, a woman obtaining abortion care can expect to pay for the surgery on her own.

Perhaps, for example, her insurer claims to cover elective abortion services but there are in reality no in-network providers in her region. Or perhaps her insurer fails to reimburse payment for abortions—jeopardizing a clinic’s ability to afford to provide quality care if they are willing to accept her claim.

Her insurer may not cover elective abortion at all or she may be uninsured, a government employee without coverage for abortion care, or a member of the military or undocumented.

Certainly, she is out of luck if her health care coverage is through Medicaid in one of 32 states or Washington, DC , where Medicaid refuses to cover the fees for abortion services unless her life is imminently threatened or she was raped and has filed a police report.

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For residents of the District of Columbia, the hope of vital changes to Medicaid coverage of abortion services is on the horizon. As reported by Rewire:

Last week, the House of Representatives passed a spending bill, the Financial Services and General Government Appropriations Act, that included a provision for lifting the ban on Washington, D.C.’s use of local funds to pay for abortion services for low-income women. Efforts to lift the ban now move to the Senate.

In theory, if also approved by the DC council, Medicaid would then cover abortion services for recipients in DC.

Currently, a woman seeking abortion care in DC will need anywhere from $250 to $6,000 to cover the cost of a surgical abortion and the longer the delays in obtaining a procedure—the longer it takes her to confirm her pregnancy, choose the most realistic solution for herself and her family and raise the money to personally afford the health care fees–the more expensive the surgery will be.

For a single, uninsured mother of one child to qualify for Medicaid coverage in DC, her annual income cannot exceed $42,000. The average annual income for a single mother of one child who qualifies for financial assistance from the DC Abortion Fund is approximately $7,000—more than 50 percent less than the federal poverty guideline for a two-person household. As a mother in DC, she is inevitably insured by Medicaid, but because she chooses to terminate an unintended pregnancy in order to continue to provide for her family, she may need to raise up to $6,000 within no more than three weeks—if not sooner—in order to afford to secure an abortion and exercise what is her basic right to safe health care. The greater the obstacles to obtaining an early-term procedure the longer the delays and the more expensive and risky it becomes for the woman. It is that simple.

The DC Abortion Fund (DCAF) is the only local fund in the metropolitan area dedicated to pledging financial support to DC residents who cannot afford the full cost of an abortion. We see first-hand when women choose to have an abortion. They face a multitude of state and national restrictions designed to deny their access to this procedure. These restrictions disproportionately affect low-income women.

On average, a DCAF client is a mother of one to three children, employed part-time—if employed at all—and living with family members or friends. She is the primary provider for her children and needs to afford food, clothing, shelter and utilities, possibly childcare, transportation and education—all on a monthly basis.

A majority of the women we serve have scoured every corner to gather payment for an abortion. They borrow money from several family members and friends, sell their children’s things, delay payment of rent and utilities and appeal to several local and national funds—in addition to DCAF—in order to terminate an unintended, unwanted, and unaffordable pregnancy.
As a local fund, working in partnership with local clinics, and women and families desperately seeking clinical services, we dwell in the cracks of the system where crucial details of real lives go ignored and vital necessities are still denied to our most vulnerable neighbors.

Our volunteer case managers connect with women and girls who are eleven or twelve years old, who are homeless, imprisoned, physically or mentally ill, raped and beaten—women unable to access the comprehensive care they need because they live in a community unwilling to acknowledge and empathize with their condition and unwilling or unable to address the root causes of the circumstances with which they are faced.

Due to the modest capacity of the fund, we are often forced to turn women away unless they are completely destitute. We stare head-on at the tremendous and frightening gap in dignified, health care coverage. We sense the weight of needs unmet. We feel the strong force of our clients’ efforts to overcome the barriers imposed on them.

We assertively welcome the possibility of national recognition and local support of this troubling burden to women’s lives and the health of their families. We diligently look forward to the day when Medicaid covers the cost of an abortion in DC and in every deprived state. We dream of a time when accessing reproductive health care services in this country and all over the world is no longer similar to traversing a rough and tumble landmine laced with quagmires and bombs. We believe the time is ripe for turning the hopes and dreams of the families we serve into reality.

As a grassroots fund, we exist because we understand that neither national nor local health care systems currently fulfill every individual’s unalienable rights. We also provide assistance to women who live in the state of Maryland where Medicaid voluntarily claims to cover abortion services. However, not one DCAF partner clinic in MD currently accepts Medicaid due to a dismal history of reimbursement failures. We consider Maryland Medicaid recipients our most underserved clientele due to the grave misconception that there are policies in place to cover their health care needs.

Because of similar obstacles, Women’s Choice of Oakland, California closed this spring due to California’s chronic low and slow reimbursements for MediCal services. In theory, California also voluntarily claims to cover abortion services for Medicaid recipients but in practice there are many roadblocks to accessing services.

If DC Medicaid does eventually cover abortion services for low-income women in the district, we must be vigilant to ensure accountability and that the local government complies with the law and genuinely fulfills its obligations.

We see the availability of quality abortion care services and family planning resources for every human being as the baseline for a healthy and progressive society and we will continue to subsidize the cost of abortion care until we have no more cases to address.
Our hope for a brighter day is unwavering and our dedication to our neighbors is steadfast.

In direct support of the women we serve and our local abortion providers, we will know when to stop relentlessly pleading for your donation because we will truly see that a woman’s right to safe health care no longer depends on what’s in her wallet.

Donations to the DC Abortion Fund can be made through this link.

News Politics

Anti-Choice Democrats: ‘Open the Big Tent’ for Us

Christine Grimaldi & Ally Boguhn

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Read more of our coverage of the Democratic National Convention here.

Democrats for Life of America gathered Wednesday in Philadelphia during the party’s convention to honor Louisiana Gov. John Bel Edwards (D) for his anti-choice viewpoints, and to strategize ways to incorporate their policies into the party.

The group attributed Democratic losses at the state and federal level to the party’s increasing embrace of pro-choice politics. The best way for Democrats to reclaim seats in state houses, governors’ offices, and the U.S. Congress, they charged, is to “open the big tent” to candidates who oppose legal abortion care.

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

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Democrats for Life of America members repeatedly attempted to distance themselves from Republicans, reiterating their support for policies such as Medicaid expansion and paid maternity leave, which they believe could convince people to carry their pregnancies to term.

Their strategy, however, could have been lifted directly from conservatives’ anti-choice playbook.

The group relies, in part, on data from Marist, a group associated with anti-choice polling, to suggest that many in the party side with them on abortion rights. Executive Director Kristen Day could not explain to Rewire why the group supports a 20-week abortion ban, while Janet Robert, president of the group’s board of directors, trotted out scientifically false claims about fetal pain

Day told Rewire that she is working with pro-choice Democrats, including Sen. Kirsten Gillibrand and Rep. Rosa DeLauro, both from New York, on paid maternity leave. Day said she met with DeLauro the day before the group’s event.

Day identifies with Democrats despite a platform that for the first time embraces the repeal of restrictions for federal funding of abortion care. 

“Those are my people,” she said.

Day claimed to have been “kicked out of the pro-life movement” for supporting the Affordable Care Act. She said Democrats for Life of America is “not opposed to contraception,” though the group filed an amicus brief in U.S. Supreme Court cases on contraception. 

Democrats for Life of America says it has important allies in the U.S. House of Representatives and the U.S. Senate. Sens. Joe Donnelly (IN), Joe Manchin (WV), and Rep. Dan Lipinski (IL), along with former Rep. Bart Stupak (MI), serve on the group’s board of advisors, according to literature distributed at the convention.

Another alleged ally, Sen. Bob Casey (D-PA), came up during Edwards’ speech. Edwards said he had discussed the award, named for Casey’s father, former Pennsylvania Gov. Robert P. Casey, the defendant in the landmark Supreme Court decision, Planned Parenthood v. Casey, which opened up a flood of state-level abortions restrictions as long as those anti-choice policies did not represent an “undue burden.”

“Last night I happened to have the opportunity to speak to Sen. Bob Casey, and I told him … I was in Philadelphia, receiving this award today named after his father,” Edwards said.

The Louisiana governor added that though it may not seem it, there are many more anti-choice Democrats like the two of them who aren’t comfortable coming forward about their views.

“I’m telling you there are many more people out there like us than you might imagine,” Edwards said. “But sometimes it’s easier for those folks who feel like we do on these issues to remain silent because they’re not going to  be questioned, and they’re not going to be receiving any criticism.”

During his speech, Edwards touted the way he has put his views as an anti-choice Democrat into practice in his home state. “I am a proud Democrat, and I am also very proudly pro-life,” Edwards told the small gathering.

Citing his support for Medicaid expansion in Louisiana—which went into effect July 1—Edwards claimed he had run on an otherwise “progressive” platform except for when it came to abortion rights, adding that his policies demonstrate that “there is a difference between being anti-abortion and being pro-life.”

Edwards later made clear that he was disappointed with news that Emily’s List President Stephanie Schriock, whose organization works to elect pro-choice women to office, was being considered to fill the position of party chair in light of Rep. Debbie Wasserman Schultz’s resignation.

“It wouldn’t” help elect anti-choice politicians to office, said Edwards when asked about it by a reporter. “I don’t want to be overly critical, I don’t know the person, I just know that the signal that would send to the country—and to Democrats such as myself—would just be another step in the opposite direction of being a big tent party [on abortion].” 

Edwards made no secret of his anti-choice viewpoints during his run for governor in 2015. While on the campaign trail, he released a 30-second ad highlighting his wife’s decision not to terminate her pregnancy after a doctor told the couple their daughter would have spina bifida.

He received a 100 percent rating from anti-choice organization Louisiana Right to Life while running for governor, based off a scorecard asking him questions such as, “Do you support the reversal of Roe v. Wade?”

Though the Democratic Party platform and nominee have voiced the party’s support for abortion rights, Edwards has forged ahead with signing numerous pieces of anti-choice legislation into law, including a ban on the commonly used dilation and evacuation (D and E) procedure, and an extension of the state’s abortion care waiting period from 24 hours to 72 hours.

News Law and Policy

Three Crisis Pregnancy Centers Served for Breaking California Law

Nicole Knight Shine

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act.

The Los Angeles City Attorney is warning three area fake clinics, commonly known as crisis pregnancy centers (CPCs), that they’re breaking a new state reproductive disclosure law and could face fines of $500 if they don’t comply.

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act, advocates and the state Attorney General’s office indicate.

The office of City Attorney Mike Feuer served the notices on July 15 and July 18 to two unlicensed and one licensed clinic, a representative from the office told Rewire. The Los Angeles area facilities are Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

The law requires the state’s licensed pregnancy-related centers to display a brief statement with a number to call for access to free and low-cost birth control and abortion care, and for unlicensed centers to disclose that they are not medical facilities.

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“Our investigation revealed,” one of the letters from the city attorney warns, “that your facility failed to post the required onsite notice anywhere at your facility and that your facility failed to distribute the required notice either through a printed document or digitally.”

The centers have 30 days from the date of the letter to comply or face a $500 fine for an initial offense and $1,000 for subsequent violations.

“I think this is the first instance of a city attorney or any other authority enforcing the FACT Act, and we really admire City Attorney Mike Feuer for taking the lead,” Amy Everitt, state director of NARAL Pro-Choice California, told Rewire on Wednesday.

Feuer in May unveiled a campaign to crack down on violators, announcing that his office was “not going to wait” amid reports that some jurisdictions had chosen not to enforce the law while five separate court challenges brought by multiple fake clinics are pending.

Federal and state courts have denied requests to temporarily block the law, although appeals are pending before U.S. Court of Appeals for the Ninth Circuit.

In April, Rebecca Plevin of the local NPR affiliate KPCC found that six of eight area fake clinics were defying the FACT Act.

Although firm numbers are hard to come by, around 25 fake clinics, or CPCs, operate in Los Angeles County, according to estimates from a representative of NARAL Pro-Choice California. There are upwards of 1,200 CPCs across the country, according to their own accounting.

Last week, Rewire paid visits to the three violators: Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

Christie Kwan, a nurse manager at Pregnancy Counseling Center, declined to discuss the clinic’s noncompliance, but described their opposition to the state law as a “First Amendment concern.”

All three centers referred questions to their legal counsel, Alliance Defending Freedom (ADF), an Arizona-based nonprofit and frequent defender of discriminatory “religious liberty” laws.

Matt Bowman, senior counsel with ADF, said in an email to Rewire that forcing faith-based clinics to “communicate messages or promote ideas they disagree with, especially on life-and-death issues like abortion,” violates their “core beliefs” and threatens their free speech rights.

“The First Amendment protects all Americans, including pro-life people, from being targeted by a government conspiring with pro-abortion activists,” Bowman said.

Rewire found that some clinics are following the law. Claris Health, which was contacted as part of Feuer’s enforcement campaign in May, includes the public notice with patient intake forms, where it’s translated into more than a dozen languages, CEO Talitha Phillips said in an email to Rewire.

Open Arms Pregnancy Center in the San Fernando Valley has posted the public notice in the waiting room.

“To us, it’s a non-issue,” Debi Harvey, the center’s executive director, told Rewire. “We don’t provide abortion, we’re an abortion-alternative organization, we’re very clear on that. But we educate on all options.”

Even so, reports of deceit by 91 percent of fake clinics surveyed by NARAL Pro-Choice California helped spur the passage of the FACT Act last October. Until recently, a person who Googled “abortion clinic” might be directed to a fake clinic, or CPC.

Oakland last week became the second U.S. city to ban false advertising by facilities that city leaders described as “fronts for anti-abortion activists.” San Francisco passed a similar ordinance in 2011.