Two New Analyses Show Women Have “Much at Stake” Under Stupak Amendment

Jodi Jacobson

Two new studies show what many have already argued: Implementation of the Stupak-Pitts Amendment would likely result in the almost total loss of coverage for abortion care, including in situations where life and health are at risk.

Two new analyses, one by the Kaiser Family Foundation (KFF) and the other by George Washington University, show just how much the Stupak Amendment would undermine women’s basic human rights to exercise choice over childbearing, to access comprehensive reproductive health care, to access abortions (a legal procedure in the United States), and to ensure they are covered by insurance for unanticipated pregnancy-related conditions that could, absent coverage, leave them and their families with enormous debt.

The Kaiser Study

"Women have much at stake in the ongoing national debate on health reform," states a new brief by KFF, which continues:

Comprehensive coverage and the scope of benefits are at the heart of making health care accessible to women. The decisions that policy makers enact regarding access and coverage of abortion are sure to be the subject of tremendous discussion and debate, and could affect care for millions of women today and in the future.

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The KFF brief compares the bill passed 10 days ago by the House of Representatives with those still working their way through the Senate.  (It was written prior to release today of the omnibus Senate bill by Majority Leader Harry Reid.)

"The way that the final House bill addresses abortion coverage has
the potential to affect many women," notes KFF, underscoring the incorrect ways in which the media has portrayed this issue. 

"[A]bortion is one of the most common surgical procedures performed on women. In 2005, there were more than 1.2 million abortions in the United States. It is estimated that at current rates, about a third of women will have had an abortion by age 45." 

The Kaiser brief first reviews current law, noting:

  • Current federal law bans the use of any federal funds for abortion, except in the event of rape, incest, or the woman’s life endangerment, as specified in the federal Hyde Amendment, which has been in effect since 1977.
  • This amendment is not a permanent law but is attached annually to Congressional appropriations bills, and has been approved every year by the Congress.
  • The broadest reach of the Hyde Amendment is on Medicaid, basically limiting federal Medicaid funding for abortions to life endangerment, rape, or incest cases in most states. States can choose to broaden the circumstances to cover other “medically necessary” abortions for women on Medicaid with their own funds and 17 states do, but in the majority of states women on Medicaid only have coverage in cases of rape, incest, or when the pregnancy is documented by a physician to be a threat to the life of the woman. Over the years, the Hyde Amendment has been broadened to limit federal funds for abortion for federal employees, in the Indian Health Service, and women in the military.

 

The House bill expands coverage to many of the nation’s uninsured by extending Medicaid eligibility to all qualifying individuals with incomes up to 150% of the federal poverty level and establishing a national health insurance exchange–a sort of marketplace where individuals with incomes above 150% of poverty can purchase insurance coverage. Initially, the Exchange would be open to all qualifying people who are uninsured and employees of some small businesses, with the possibility of opening it to more people over time. It would offer multiple insurance plans from which individuals can choose including at least one publicly financed plan as well as several privately operated plans. To help individuals purchase insurance, the federal government will provide subsidies (in the form of premium credits) to eligible individuals and families with incomes between 150% and 400% above the poverty level.

The House bill also extends premium credits to individuals with employer-sponsored insurance if their share of premiums exceeds 12% of their income, which could make an additional 1 million people eligible for purchasing coverage in the Exchange.

"In total," notes Kaiser, "it is estimated that 86% of participants in the Exchange would receive subsidies."

Kaiser notes:

The House bill places a number of restrictions on coverage of abortion, with the most direct impact on the plans that will be offered in the new Health Insurance Exchange. According to the legislation, the public plan within the Exchange would be prohibited from providing coverage for abortions beyond those permitted by current federal law (to save the life of the woman or in cases of rape or incest). The House bill also prohibits federal premium credits that low-income individuals will receive from the federal government from being used to purchase a health plan in the Exchange that includes coverage for all but federally permitted abortions. Although it is not required, private insurers may opt to offer a plan in the Exchange that covers abortions beyond those permitted by federal law. These insurers, however, will be required to also offer an identical plan that does not cover abortions for which federal funding is prohibited.

Private plans participating in the Exchange may choose to offer
supplemental coverage for abortions in the form of riders that are totally
separate from other benefits, but that coverage must be paid for entirely with non-federal funds. Furthermore, the plans must be separately operated to assure that federal funds are not used to administer or operate plans that cover abortions.

According to Kaiser, an estimated 12.4 million women ages 15 to 44 are uninsured, 94% of whom would qualify for federal assistance (61% through Medicaid—7.5 million women; and 33% for federal
premium credits subsidies to purchase coverage—4.1 million women).

Impact of the House Bill:

Kaiser states that provisions in the House bill would "have direct effects on women seeking coverage in the Exchange as well as on plans that
offer coverage in the Exchange."

  • Women who choose the public option would not have abortion coverage nor would they have access to a rider.
  • Women who receive any level of federal subsidy cannot purchase coverage from a plan that offers abortion coverage, but they do have the option of purchasing a separate rider for abortion coverage alone, if offered by the plan.
  • Women who do not receive federal subsidies and seek coverage in the Exchange could be able to buy coverage from a plan that offers an abortion benefit, if such a plan is available.

Kaiser underscores what others have also noted:

It is unclear whether a woman would necessarily seek or know to buy a service-specific rider for abortion when she is choosing her insurance plan, or whether women without subsidies would necessarily know whether they are buying coverage from a plan that covers abortion or not. It is also unknown what the price differential would be between the two plans and how much the rider would cost, if offered. The House bill goes beyond the Senate committee bills by requiring the sale of a distinct insurance product that is designed specifically for those receiving subsidized coverage. For insurers, the House bill sets a number of restrictions, particularly the requirement to isolate federal dollars from private funds because a plan that receives any federal funds cannot provide abortion coverage. Although it is hard to predict the response of insurance plans to this type of law, some legal scholars contend that given the size of the potential pool of women and their families that will be eligible for federal subsidies under the exchange and other complexities, this might limit he development of insurance plans that offer either abortion coverage or a rider, and ultimately carry over to products offered in the employer market.

Many women who now have coverage for abortion care would lose it.

This complex combination of restrictions means that many women who will obtain coverage under health reform either through Medicaid or the Exchange would have to pay for an abortion out-of-pocket, the cost of which varies depending on factors such as location, facility, timing, and type of procedure.

A clinic-based abortion at 10 weeks’ gestation is estimated to cost
between $400 and $550, whereas an abortion at 20-21 weeks’ gestation is
estimated to cost $1,250-$1,800. The vast majority of abortions are
performed early in pregnancy. In 2004, 89% were in the first twelve
weeks of pregnancy and only 1% were at 21 weeks or later.  In general,
abortions performed in hospitals are more expensive than those
performed at clinics.

The House bill dramatically expands the Medicaid program, and extends insurance to qualifying uninsured individuals with incomes below 150% of the federal poverty line.

"The Medicaid program already serves millions of low-income women," notes Kaiser, "and is a major financier of reproductive health services. It is estimated that two-thirds of adult women on Medicaid are in their reproductive years."  In 33 states and the District of Columbia, state Medicaid programs do not pay for any abortions beyond the Hyde restrictions.  In these states, an estimated 4.5 million women ages 15-44 are currently uninsured and also have incomes less than 150% of the
federal poverty level.  Many of these women would likely qualify for Medicaid under the new House bill.

They will be forced to pay for their insurance with their rights.

The George Washington University (GWU) Study

This study, conducted by the George Washington University School of Public Health, focused on the implications of the Stupak Amendment for the health benefits industry on the whole; the growth of the public market for supplemental coverage: and the implications for covering abortions that are a consequence of an unexpected condition.

The study concludes that:

  • The treatment exclusions required under the Stupak/Pitts Amendment will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women, not only those whose coverage is derived through a health insurance exchange. [emphasis added]. 

 

Stupak-Pitts, according to the authors:

Can be expected to move the industry away from current norms of
coverage for medically indicated abortions. In combination with the
Hyde Amendment, Stupak/Pitts will impose a coverage exclusion for
medically indicated abortions on such a widespread basis that the
health benefit services industry can be expected to recalibrate product design downward across the board in order to accommodate the exclusion in selected markets.

  • The Amendment will inhibit development of a supplemental coverage market for medically indicated abortions. 

In any supplemental coverage arrangement, it is essential that the supplemental coverage be administered in conjunction with basic coverage. This intertwined administration approach is barred under Stupak/Pitts because of the prohibition against financial comingling. This bar is in addition to the challenges inherent in administering any supplemental policy. These challenges would be magnified in the case of medically indicated abortions because, given the relatively low number of medically indicated abortions, the coverage supplement would apply to only a handful of procedures for a handful of conditions. Furthermore, the House legislation contains no direct economic incentive to create such a market [and would leave in doubt] states’ ability to offer supplemental Medicaid coverage to
women insured through a subsidized exchange plan.  

  • "Spillover" effects as a result of administration of Stupak/Pitts will result in dramatically reduced coverage for potentially catastrophic conditions.

 

The authors write: "The administration of any coverage exclusion raises a risk that, in applying the exclusion, a plan administrator will deny coverage not only for the excluded treatment but also for related treatments that are intertwined with the exclusion."

The risk of such improper denials in high risk and costly cases is great in the case of the Stupak/Pitts Amendment, which, like the Hyde Amendment, distinguishes between life-threatening physical conditions and conditions in which health is threatened. Unlike Medicaid agencies, however, the private health benefit services industry has no experience with this distinction. The danger is around coverage denials in cases in which an abortion is the result of a serious health condition rather than the direct presenting treatment.

Noting that the entire industry may be pushed toward using life-threatening conditions as "the standard," the authors note that "it is likely that all women will risk coverage denials, regardless of the market in which their coverage is obtained," and will lose coverage for medically indicated abortions that may well threaten both health and ultimately life.

Under these circumstances, what is the norm today in the employer-sponsored market – broad coverage of medically indicated abortions – is likely to narrow considerably as the industry seeks to restructure its product design to meet the most restrictive demands. If this consequence flows, then the industry, confronting the challenges of distinguishing between enrollees for a handful of covered procedures and specific conditions, can be expected simply to eliminate certain procedures and conditions from coverage altogether, leaving women and families exposed.

"Stupak/Pitts and Hyde…presume that abortion is the immediate subject of the claim for coverage," note the authors. 

But this is not always the case.

High risk pregnancies themselves could be identified as potentially
abortion-related.

Conditions such as diabetes (observed in 1% of pregnancies) which are poorly controlled can lead to serious health consequences for both the woman and the fetus, including major congenital abnormalities, and a higher risk of spontaneous loss, which might in turn trigger an abortion if the pregnancy cannot be saved. Management of recurrent pregnancy loss or complicated multi-fetal pregnancies (increasingly prevalent with widespread use of assisted reproductive technologies) may also be considered abortion-related conditions. Similarly, uncontrolled hypertension, trauma during pregnancy, seizure disorders and other conditions, all require complex management and may
persist beyond the pregnancy, and may result in abortion-related care. These concerns have increasing individual and public health consequence as age at pregnancy, body mass index and associated metabolic and cardiovascular abnormalities, Cesarean section rates, multi-fetal pregnancy rates, and use of assisted reproductive technologies have all increased dramatically in recent years.

Additionally, state the authors, "in response to more limited access to abortion services, there may be an increase in self-induced abortion, potentially through increased self-administration of misoprostol. Coverage for treatment of complications such as hemorrhage and incomplete abortion in such cases could be denied."

In these circumstances, how are plan administrators to distinguish between the abortion procedure and the rest of the treatment? Will the entire cost of a course of treatment (e.g., surgery to repair a damaged pelvis following an automobile accident) be denied if violation for paying for the excluded abortions, may elect to deny the treatment altogether, claiming that it is all related to the excluded treatment.

"As the denial is appealed, the financial consequences for patients potentially will be enormous."

"One of the great challenges in insurance reform is the unintended consequences of regulation," write the authors.

The Stupak/Pitts Amendment is intended to reach only a specific part of the market. But the cumulative effect of the provision, in combination with existing federal laws governing Medicaid and federal employee health benefits (as well as the law of certain states) inevitably can be expected to move the entire health benefits industry away from its current inclusive coverage norms and toward a new norm of exclusion. The provisions of the legislation, as well as the technical challenges that arise in benefits administration, militate against the creation of a supplemental coverage market. Thus, if the result of national health reform is to move millions of women into a market that operates subject to the exclusion, then it is fair to predict that the entire market for coverage ultimately will be affected as a product tipping point is reached and virtually no supplemental market appears.

In addition, state the authors:

Given past experience and the sanctions that arise from a violation, it is reasonable to predict that in interpreting and applying the exclusion, health plan administrators will err on the side of coverage denial. This is because the legal risks associated with coverage determination are all on the side of incorrectly awarding coverage, not erroneously denying it. This balancing of risks can be expected to lead insurers to calibrate coverage determinations in a way that works against women whose medical conditions ultimately lead to an abortion that they never willingly sought. 

In short, as many have already argued, women will bear the brunt of a policy created based on ideology and discrimination, not public health, pushed through by those who appear to care little for either women’s rights or their lives and health.

Investigations Media

The ‘HUSH’ Documentary: Another Secret Recording Inside an Abortion Clinic

Sharona Coutts

HUSH relies almost exclusively on interviews with renowned anti-choice “experts” whose work has been discredited. They trot out many of the worn theories that have been rejected by medical and public health experts. The innovation of HUSH, however, is that it has reframed these discredited ideas within the construct of a conspiracy theory.

Another day, another secret recording made in an abortion clinic.

At least, that’s the very strong impression given by some of the scenes contained within the documentary film HUSH, which premiered late last year and is currently making the rounds of film festivals and anti-choice conferences in the United States and internationally, including the National Right to Life Convention that took place in Virginia last month.

The film is the creation of Mighty Motion Pictures and Canadian reporter Punam Kumar Gill, who says in the film that she is pro-choice, a “product of feminism.” It purports to tell the story of “one woman,” Gill, who “investigates the untold effects of abortion on women’s health.”

HUSH—which claims in the film’s credits to have received support from the Canadian government—attempts to cast itself as neither pro-choice nor “pro-life,” but simply “pro-information.” The producers insist throughout the film, in their publicity materials, and in private emails seen by Rewire that their film is objective and balanced.

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That’s how they pitched it to Dr. David Grimes, a highly respected OB-GYN and a clinical professor in the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine, who agreed to do on-camera interviews for the film. Grimes now says the producers and reporter misled him about their intentions.

“There was no balance,” Grimes told Rewire. “It’s a hatchet job. It’s obvious.”

Indeed, HUSH relies almost exclusively on interviews with renowned anti-choice “experts” whose work has been discredited, many of whom are featured in Rewire‘s gallery of False Witnesses. They trot out many of the worn theories that have been rejected by medical and public health experts—namely, that abortion is linked to a host of grave physical and mental health threats, “like breast cancer, premature birth, and psychological damage.”

The innovation of HUSH, however, is that it has reframed these discredited ideas within the construct of a conspiracy theory.

When Anti-Choice “Science” Goes Conspiracy Theory

As a piece of propaganda, the use of the conspiracy theory has the advantage of removing the debate over abortion’s safety from the realm of logic. In HUSH‘s topsy-turvy world, the medical establishment becomes the scare-quoted “Medical Establishment,” and the more distinguished or authoritative a person or organization, the more suspect they become.

For reasons that remain murky, the film’s thesis is that the world’s leading reproductive and health organizations—including the National Cancer Institute, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the World Health Organization, along with all of their staff, contractors, and affiliated experts—have been hiding information about the risks of abortion.

This is most apparent when the reporter, Gill, tells the viewers that “if women have the right to abortion, they should also have the right to know” about the risks she believes she has identified.

Later, the film shows graphics highlighting the states that have various informed consent laws—some of which are literally called “A Woman’s Right to Know” acts—that force providers to give patients false information about the safety of abortion. Rather than concluding that the authority of the state has been used to mandate that doctors provide medically unsound “counseling” using the very junk science that Gill presents throughout the film, she hews to the back-to-front logic of all conspiracy theories. In her view, the existence of these laws shows that the risks are real, but that the faceless, nameless “they” still won’t let women in on the their deadly secrets.

In Gill’s world, the unwillingness of organizations to speak with her becomes evidence that they are hiding something.

The American Congress of Obstetricians and Gynecologists tells Gill that it won’t fulfill her requests by giving her an interview because the science is settled; Gill sees this as a sign of conspiracy.

“This is where I started to feel equally suspicious of those denying any link,” Gill tells the viewer, her voice floating over inky footage of the U.S. Capitol at night. Lights from the Capitol dance on the velvety surface of the Lincoln Memorial Reflecting Pool, and Gill confides: “I felt like I was digging into something much deeper and darker.”

A comical scene ensues where Gill is astonished to find that turning up with a film crew on the grounds of the National Cancer Institute does not suddenly persuade it to grant her an interview with one of its experts.

“What was going on here?” says Gill in her voiceover. “It was like they really didn’t want any questions being asked.”

In fact, the National Cancer Institute had replied to Gill’s multiple requests with links to its website, which contains the conclusive studies that have long since dispelled the notion that any link exists between abortion and breast cancer. The film shows footage of those emails.

Furthermore, Grimes provided Rewire with copies of emails he had exchanged with the film’s producers during its production, in which he gave them citations to relevant studies and warned them that the work of the anti-choice “experts” they had approached had been thoroughly debunked.

After seeing the film, Grimes emailed the producers inquiring why they hadn’t simply asked him to connect them with additional experts.

“Had you truly wanted more pro-choice researchers to speak to these issues, I could have named scores of colleagues from the membership of the Society for Family Planning and Physicians for Reproductive Health who would have been happy to help,” Grimes wrote in a note he shared with Rewire. “You did not ask. That some organizations like the National Cancer Institute did not want to take part in your film in no way implies a reluctance on the part of the broader medical community to speak about abortion research.”

It seems that Gill—whose online biographies give no indication that she is a scientist—would not have been satisfied in hearing about existing research. She tells the viewers that, in her view, “more study is needed to determine the extent of the abortion-breast cancer link,” and concludes that “to entirely deny the connection is ludicrous.”

In an interview with Rewire, Grimes noted that doing such research would be viewed as unethical by reputable scientists.

“That issue is settled, and we should not waste limited resources that should be directed to urgent, unanswered questions, such as the cause of endometriosis and racial disparities in gynecologic cancers,” he said.

Grimes made his dissatisfaction clear to the producers. He wrote to them: “My inference after viewing the film is that you are suggesting a large international conspiracy of silence on the part of major medical and public health organizations, the motivation for which is not specified.”

The corollary to the suspicion cast over the most reputable research and representative bodies is that the film transforms the marginal status of the anti-choice “experts” into a boon.

Seen through HUSH‘s conspiracy theory lens, the fact that the work of people like Priscilla Coleman, David Reardon, and Angela Lanfranchi is rejected by the medical establishment becomes proof not of the unsoundness of their ideas, but rather that a conspiracy is afoot to silence them.

Instead of presenting this small but vociferous group of discredited activists as outliers—shunned because their theories have no scientific basis, or because they lack any credentials relevant to reproductive or mental health, or because they have repeatedly mischaracterized data—HUSH paints them as whistle-blowing renegades determined to set the truth free.

A tearful Lanfranchi recounts the story of patients who came to her with aggressive breast cancer in their 30s. Lanfranchi says she strove to understand “why this was happening,” and realized that each of these young women had had abortions, which she then concluded had caused their cancer. Lanfranchi said her hopes that the public would learn of this risk were dashed over time.

“Over the years I’ve realized that, no, it didn’t matter how many studies there were,” she tells viewers. “That information was not going to get out.”

Joel Brind says that he has worked with a colleague whom he says he later discovered was pro-choice, but that their views on abortion never came up. “This is about science,” he tells Gill. “This is about the effect on women and whether or not abortion increases the risk of breast cancer. Period.”

Gill asks both Lanfranchi and Brind whether they are trying to “stop abortion,” or whether they “want abortion to go away.” Both answer that all they want is for women to be informed when they exercise their choice.

The film makes no mention of the fact that both have been anti-choice activists for decades; they have each testified in support of anti-choice laws in both legislative and judicial proceedings, and both have participated in the extreme right-wing, anti-choice, anti-LGBTQ World Congress of Families.

To the extent that HUSH acknowledges these activists’ bias, it is couched in a softer light that is linked, implicitly, to their religious views—a reality raised by Grimes in his on-camera interview, in which he notes, accurately, that the anti-choice “intellectuals” often lack the relevant medical or scientific qualifications to do the type of work they purport to do, but that they do tend to share religious convictions that lead them to oppose abortion and contraception.

That allows the producers to imply that the False Witnesses are perhaps victims of discrimination; to suggest that their work is being discounted because of the activists’ religious beliefs, and not because the work itself has been thoroughly debunked. Play the ball, not the man, appears to be the producers’ plea.

It’s a conspiracy theory twilight zone: where medical groups withhold information for reasons so cloudy that they cannot be articulated, but where people who have for years worn their beliefs on their sleeves cannot be evaluated with those political views in mind.

After asserting that she is, herself, pro-choice, Gill says she “finds validity” in the claims of the anti-choice advocates, and that she finds it “sickening” that the “media and health organizations have spent their energies closing the case and vilifying those who advocate in favor of the link, instead of investigating any and all reasons why breast cancer rates among young women have increased and women are dying.”

The producer, Joses Martin, did not answer Rewire’s questions about the experts he and his team had selected, other than to say, “We are very proud of the balanced approach that we’ve taken in this documentary that is neither anti-abortion nor pro-abortion.”

Another Instance of Secret Recordings Made in Abortion Clinics

What troubles Grimes most about the film is not so much that he was cast as the face of an international conspiracy by virtue of being the sole pro-choice physician to appear on camera, but that he may be associated with people who appear to have made secret recordings in at least one abortion clinic.

The footage and audio in question have been heavily edited, and it is difficult to discern what is real from what has been staged or spliced to give certain effects.

Early in the film, Gill is shown standing in the entry path to what the producers identify as a “Seattle abortion clinic.” As she makes her way inside, the footage swaps to guerilla-style, hidden camera shots, which capture wall artwork that appears in some Planned Parenthood clinics. Viewers see Gill’s face in the waiting room, as well as blurs of other people there. The film then swaps to audio recordings without any video footage. Gill can be heard posing as a patient, receiving counseling from a woman who is identified as a “health center manager.” This audio is used twice more during the film.

In Washington state, it is a crime to make audio or video recordings of people without their consent. Similar laws are in place in California, Florida, and Maryland, states where David Daleiden and his co-defendants from the Center for Medical Progress made their surreptitious videos of Planned Parenthood employees and members of the National Abortion Federation.

Grimes asked the producers whether they had obtained permission to make any of those recordings; Rewire asked the producers whether the recordings were in fact made in Seattle.

The producer, Joses Martin, replied to Grimes that he would “not be disclosing the name or location of the clinic or the name of the individual recorded to yourself or anyone else.”

“We have kept this information undisclosed and private both in the film and out of the film to not bring any undue burden on them. We’re certainly not implicating anyone involved of wrong doings, as was the goal in the Center For Medical Progress case,” Martin wrote in an email shared with Rewire.

In an email to Rewire, Martin did not answer our specific questions about the recordings, but asserted, “We did not break any laws in the gathering of our footage.”

Planned Parenthood had no comment on whether the crew had obtained consent to film inside its clinics, or whether Gill had misrepresented herself throughout her conversation with the counselor. Nor did the organization comment on the increasing use of secret recordings by anti-choice activists within its clinics. In a federal suit, Planned Parenthood has sued Daleiden for breaches of similar laws in California, Florida, and Maryland.

The branch of the Canadian government that the producers credited with supporting the film was less sanguine when informed about the apparent use of secret recordings made in American abortion clinics.

The film’s credits say that it was produced “with the assistance of the Government of Alberta, Alberta Media Fund,” but when Rewire contacted that Canadian province to learn why it had funded a piece of anti-choice propaganda, a spokesperson distanced the fund from the film.

“We have entered into conversations with the production company but we do not at this point have a formal agreement in place, and we were not aware that the production had been completed,” the spokesperson said. “We’re not able to comment on any funding because to date we have not funded the project. Thank you for bringing the use of our logo to our attention and we’ll be in touch with the producers to discuss.” The producers did not reply to Rewire’s question about their use of the logo.

Ironically, while the producer, Martin, did reply to emails from both Grimes and Rewire (albeit without answering specific questions), the reporter, Gill, remained silent. She never answered questions about what she knew about the backgrounds of the False Witnesses to whose work she lent such credence. She didn’t respond to our questions about whether she obtained permission to record video or audio within abortion clinics, or where those clinics were located. And she didn’t reply to our questions about the nature of her relationship with the extreme anti-choice group Live Action, who also received a credit at the end of the film.

To a reporter such as Gill, such silence would surely have been deeply suspicious.

Rewire Investigative Reporter, Amy Littlefield, contributed to this report. 

Commentary Abortion

Latinx Must Use Votes to Fight Hyde Amendment

Cristina Aguilar, Jessica González-Rojas, Laura Jimenez & Maria Teresa Kumar

More than 27 million Latinx are now eligible to vote, and that number can help determine who takes office and what abortion policies they enact.

The first woman known to die of an unsafe illegal abortion after the Hyde Amendment was a Latina. A struggling 27-year-old college student with a young daughter, Rosie Jimenez died from septic shock in October 1977—with a scholarship check earmarked for school in her purse. Jimenez had been refused coverage because, just months before, Congress had enacted the Hyde Amendment banning use of federal Medicaid funds for abortion except in cases of rape, incest, or life endangerment.

As we enter this Latina Week of Action for Reproductive Justice (today through August 7), the Hyde Amendment continues to deny pregnant people the chance to make the best decision for themselves and their families. And because our communities are hard-hit by abortion restrictions, Latinx must play a role in our electoral process to repeal Hyde and replace other anti-abortion measures with policies that truly support all families.

A 2011 study found that more than 70 percent of Latino registered voters believe that we should not judge someone who feels they’re not ready to be a parent. Unfortunately, this sentiment is not echoed by many legislators in Congress and throughout the country, who too often design policies precisely to put abortion care out of reach.

While the recent Whole Woman’s Health v. Hellerstedt Supreme Court struck down medically unnecessary restrictions in Texas, abortion access remains a challenge for many Latinx across the country. The Hyde Amendment has a disproportionate impact on low-income people of color who already face numerous health-care disparities and often do not have the money to compensate for insurance gaps.

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Withholding Medicaid coverage for abortion has an especially devastating effect in our communities, where enrollment is high; in 2012, 29 percent of Latinx adults and children nationwide received benefits from the program, and in some states such as Texas, more than half of Medicaid participants were Latinx.

Whether it’s public or private, health insurance must cover the services we need. When it doesn’t, the scramble to pay for an abortion has the potential to push families further into poverty. Already, too many of us are just scraping by while living with the stresses of a broken immigration system that divides families, structural racism, and lack of educational and employment opportunities.

Our communities need laws to ensure that health plans provide abortion coverage—not the Hyde Amendment nor legislation that claims to protect women while closing clinics or shaming those who provide and seek abortions.

Abortion is health care. And the ability to obtain health care should not be predicated on what type of insurance benefits you have, how much money you make, or whether you live in a state that allows public funds to pay for abortions.

It is time that we push back. Together, we can harness our power to advance positive policies that will make a difference. Latinx comprise a critical voting bloc that can significantly influence electoral outcomes; according to the Pew Research Center, an unprecedented number—27.3 million—of Latinx will be eligible to vote in the upcoming election.

But this only matters if we show up at the ballot boxes. We need to hold our elected officials accountable when they don’t consider the needs of our families. By lifting our collective voices and our votes, we can sway who holds office and makes policies.

This election, the health, rights, and dignity of our families are at stake. We cannot afford to sit out voting. It is an opportunity to make sure that those who are charged with representing us stand with our families. We owe it to Rosie Jimenez and the daughter she left behind. We owe it to ourselves.

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