Addressing the Elephant in the Room: Ensuring Abortion Coverage in Universal Health Care

By Myra Batchelder

Imagine you are a 17-year-old girl who has been in and out of foster care, with no friends or family to turn to when you discover that you’re pregnant as a result of a rape. I spoke with a young woman in this situation several months ago, while on phone duty for the New York Abortion Access Fund, an all-volunteer non-profit that helps women cover the cost of their abortions. The young woman was desperate to get the money she needed for her abortion and kept calling to double-check that we’d be able to help her pay for her procedure and to seek reassurance it was all going to be okay. This young woman should not have had to depend on a grassroots organization for her health care coverage. We need a universal health care system in this country that can provide help for women in such tragic situations.

With Americans’ increasing frustration with the current health care system and the Democratic presidential candidates outlining comprehensive health care reform plans in their campaigns, it appears our country may be on the brink of accomplishing this goal. As the U.S. looks to creating a universal health care system, it is important that reproductive health advocates play an active role and ensure that comprehensive reproductive health care, including abortion, will be covered.

Unfortunately, the issue of whether abortion will be included in universal health care plans is still being discussed or, more accurately, is still lurking in the background like an elephant in the room. The truth is, many health advocates don’t want to talk about it. Many may hope that, if we remain quiet about abortion, it will be lumped into a universal health care plan without much debate or public attention. Unfortunately, that seems unlikely. Conservative organizations and media outlets are already criticizing political candidates’ plans to provide comprehensive reproductive health care. This issue is already on the agenda of the religious and conservative right, and they’re organizing their opposition.

The debate over whether abortion should be funded in a Federal health care system is not new. Since the initial passage of the Hyde Amendment in 1976, Federal health care plans have failed to provide women (particularly low-income Medicaid beneficiaries) access to abortion, currently with exceptions if a woman’s life is endangered or she was the victim of rape or incest. Many advocates have pushed to repeal this language but, 30 years later, the Hyde Amendment is still included in Congressional funding bills for health care. (For more information on this effort, see the Hyde — 30 Years is Enough! Campaign website at: http://www.hyde30years.nnaf.org.) Federal legislation also often restricts abortion services for other women, such as those who serve in the military or the Peace Corps, or who are incarcerated in Federal prisons. Even more unfortunate, many of today’s mainstream reproductive health organizations have not prioritized either Hyde’s repeal or other policy issues primarily affecting poor women and women of color.

Millions of women in this country who are uninsured, underinsured, or in Federal health care plans are currently unable to access the full range of reproductive health care they need, including safe abortion, affordable contraception, testing and treatment for sexually transmitted infections (STIs). As we move towards the possibility of instituting a universal health care system we, as advocates, must unite to guarantee that this plan will include the full array of comprehensive reproductive health services. Abortion is an essential component alongside family planning, pregnancy and postpartum care, prevention and treatment of STIs (including HIV/AIDS), cancer screening, infertility counseling, and other services.

Abortion is prohibitively expensive for women without health insurance, with the average cost ranging from $523 at 10 weeks, to $1,339 at 20 weeks gestation.¹ For context, a single mother with one child living at the Federal poverty level only makes $1,166 a month! Without public assistance for abortion services, women on fixed incomes are forced to spend money intended for rent, heat, car payments, or other bills. The majority of women who have abortions in this country already have children, and out-of-pocket spending for medical procedures takes money directly away from helping their families. The procedure itself is not the only emergency expense, as the shortage of U.S. abortion providers means that, for many women, getting an abortion means traveling out of their town or state. Additional costs include missing time from work and paying for childcare.

In the absence of public funding for abortion services, concerned individuals have created grassroots organizations to help women pay for their abortion procedures. Organized by the National Network of Abortion Funds, over 100 abortion funds gave out a total of $2 million last year to help women cover the cost of their procedures.² The Funds are largely staffed by volunteers and are often organized out of people’s living rooms, church basements, or local coffee shops. I co-direct the New York State abortion fund and, over the past three years, have seen first-hand the dire need for abortion coverage in this country.

Hearing the stories of women in New York who need money to cover an abortion can be heartbreaking. Several months ago, a clinic called about a young woman who had been raped by her brother and had been both impregnated and infected with an STD as a result. Treatment for the STD had to occur first and, as a result, the young woman had to delay getting needed care until several weeks later, which raised the abortion’s price. Later that same day, I got an email from a friend writing about a woman who was coming to New York City for an abortion because the procedure cost less here than in her home state. This woman had nowhere to stay while she was receiving services, and people all across the city were trying to find a place for her to stay and to connect her with the Haven Coalition that helps women find short-term housing.

It was painful to hear what these women went through and, at the same time, so amazing to have this underground network of people working to help make sure women had the health care they need. Luckily, both of these women got the care they needed, thanks to private individuals who stepped forward. It is ridiculous and horrific, however, that women have to go to such lengths to access needed health coverage! These stories and millions more are the reason we as advocates must push for abortion services to be included in universal health care coverage. The leading Democratic presidential candidates have suggested that comprehensive reproductive health care would be included in their health care reform plans; however, as the policy discussions advance, it will be important to stay involved and ensure that all needed services, including abortion, will actually be included.

To be sure, it’s going to be a hard battle and it may be impossible to win, but I ask that, as advocates, we don’t give up without a fight and we continue to strategize so that women can access the care they desperately need. Start talking with your colleagues and friends about this issue, and get involved in state and national efforts to expand health care. We need more reproductive health advocates at these tables! Write your Members of Congress and the presidential candidates and demand that comprehensive reproductive health care be included in their universal health care proposals — and keep track of their efforts. Join Raising Women’s Voices, an effort to create responsive health care reform (see page 5). Last, but not least, VOTE on November 4th! We must address the elephant in the room and work together to make sure that broad reproductive health care, including abortion services, will be included when a universal health care system is ultimately created.

Myra Batchelder is the Director of the Low-Income Access Program at the National Institute for Reproductive Health and the Co-Director of the New York Abortion Access Fund. She lives in Brooklyn, NY.

REFERENCES

1. Jones, R et. al., “Abortion in the United States: Incidence and Access to Services, 2005,” Perspectives on Sexual and Reproductive Health, March 2008, page 14.

2. National Network of Abortion Funds, website: http://www.nnaf.org, accessed February 17, 2008.