The Bigger Picture: The Politics of Health Reform, Medicaid, and Access to Abortion

Stephanie Poggi

Health reform was supposed expand care, not exacerbate existing inequalities. Will Obama and the majority Democratic Congress preside over the biggest cutback in reproductive health care for poor women and women of color in decades?

In the article below, the
National Network of Abortion Funds responds to
Susan Cohen’s article addressing the  potential impact of health care reform on the national abortion rate, "Politics Distorts Facts on Impact of Abortion Coverage." 

Anti-abortion forces are trying
to use the debate over health care reform to reinforce unjust bans on
abortion funding for poor women – and they hope to extend the denial
of coverage to millions of additional women.   

Even though a majority of voters
in a recent poll supported abortion coverage in health care reform,
abortion foes are working night and day to convince Congress to ban
abortion from health care reform.  (See national poll by the Mellman
Group, June 25, 2009.) 

One of the tactics on the anti-abortion
side is misuse of statistics.  For example, abortion opponents
claim that increased coverage through health care reform would send
the abortion rate skyrocketing.  They misinterpret data from the
Guttmacher Institute to make this point.  On Wednesday, in response
to such concerns, Guttmacher released a statement about the Hyde Amendment,
the law that bans federal Medicaid coverage of abortion. Guttmacher
notes that statistics on the impact of the Hyde Amendment cannot be
extrapolated to the health care reform debate.  They also confirm
that they do not expect to see a substantial rise in the abortion rate
if Hyde is repealed.  

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The National Network of Abortion
Funds (the Network) agrees with these points and appreciates Guttmacher’s
ongoing efforts to document the effect of the Hyde Amendment and to
work for its repeal.  We would
like to take this opportunity to fill in
details about the damaging reach of the Hyde Amendment and what it means
in women’s daily lives, as well as to reiterate a larger vision for
real reproductive health care for low-income women. 

As Guttmacher notes, one in
four women on Medicaid who would have an abortion if it were covered
are instead compelled to continue the pregnancy.  Painful as this
figure is, it is only a small piece of the impact of the Hyde Amendment. 
Many more women are harmed by its discriminatory reach every year. 
The tens of thousands of poor women on Medicaid who do manage
to obtain abortions despite the Hyde ban on Medicaid coverage do so
at enormous cost.  At the Network, we talk to women every day who
are sacrificing food and clothing for themselves and their families. 
In many cases, women have sold their cars or are living without electricity. 
Too often, they need to use their rent money to cover abortion care
and end up homeless.  Like so many other people who are devastated
by the cost of health care in the U.S., they and their families are
impoverished by the denial of coverage.  

In addition, Guttmacher’s
figures account only for those women enrolled in Medicaid at the time
they seek an abortion, not the many more who do not enroll because
Medicaid does not provide abortion coverage.  These women, too,
are negatively affected by the Hyde Amendment.  Finally, as Guttmacher
explains, if there is an expansion in Medicaid eligibility under health
care reform, many thousands more women – we don’t know the exact
numbers yet – will be denied abortion care because of the Hyde Amendment. 
Because of racial inequalities in the U.S., these low-income women will
be disproportionately women of color. 

Health care reform was supposed
to be about expanding care, not about expanding inequality. 
Yet, the Obama Administration and the Democratically-controlled Congress
are poised to preside over the largest
cutback in reproductive health care for poor women and women of color
in decades. Clearly, advocates face a stiff uphill fight to advance
a health reform package that truly meets the needs of women and families.
Let’s face the facts: this plan won’t be the one that pleases religious
conservatives who believe they can dictate what kind of health care
women receive.  It isn’t likely to be the one that continues
lining the pockets of health insurance companies and the pharmaceutical
industry. The plan we all need should, at minimum, contain a strong
public option, provide coverage to all people in the U.S., and cover
all
basic health care, including the full spectrum of reproductive
health care. 

Finally, on the question of
abortion rates, while the anti-abortion groups continue to mislead,
the real call to action is clear: we need to stop the denial of care
and the imposition of great hardship on so many women and families. 

The National Network of Abortion
Funds helped over 20,000 low-income women to pay for abortion care last
year.  The Network also leads the Hyde: 30 Years Is Enough Campaign
(www.nnaf.org). 

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