Many of us are concerned about how the Trump administration’s efforts to repeal and replace the Affordable Care Act (ACA) will impact access to sexual and reproductive health care, especially for marginalized folks. With Republican leadership drafting their bills in secret, plus attempting to rush votes on them without hearings or much floor debate, it can be difficult to understand what is going on. The numerous moving parts only add to the confusion.
I’m here to break down four ways that any effort to repeal and replace the ACA would spell disaster for full spectrum sexual and reproductive health care access:
It would gut coverage of essential health benefits, many of which include aspects of sexual and reproductive health care
The ACA includes a list of essential health benefits that all insurance plans must cover—in many cases at no cost to the insured individual. This includes FDA-approved forms of birth control and a yearly gynecological visit plus screenings for breast cancer, cervical cancer, mental health, intimate partner violence, and STIs, as well as the Hepatitis B and HPV vaccines. The list also includes pregnancy care, childbirth, and breastfeeding support. Under the new legislation, insurance plans would no longer be required to cover some or all of these services. That means we could be forced to go back to the pre-ACA era where only 12% of individual market plans covered pregnancy care and the cost of needed services such as long-acting reversible contraceptives or early cancer detection were out of reach for many. People would instead be at the mercy of state laws regarding whether or not these services must be covered. For instance, only twenty-eight of the U.S. states have laws which mandate contraception coverage and not all of these laws provide the comprehensive protections under the ACA. Thus, a GOP health care bill threatens contraception coverage under public and private insurance plans alike.
It would defund Planned Parenthood, putting its clinics’ ability to stay open in jeopardy.
When our foes talk about “defunding Planned Parenthood,” they are referring to revoking its clinics’ ability to receive Medicaid reimbursements for the services they provide. Never mind that federal funding for abortion care is already prohibited under the Hyde Amendment (states in which Medicaid does cover the procedure utilize their own funds to so do)and Planned Parenthood also offers other critical components of sexual and reproductive health care. If Planned Parenthoods are unable to receive Medicaid reimbursements for these services, many would be forced to close. We’ve seen how defunding Planned Parenthood on the state level led to higher rates of unplanned pregnancies and already one unprecedented HIV outbreak. We also know that Planned Parenthood clinics are often the only full-service option for millions. This is especially the case for residents in states which did not expand Medicaid, as well as immigrants who are ineligible for coverage because of the clinics’ generous sliding fee scales. Don’t be fooled into believing other clinics would come even close to covering this gap. While the legislation would technically defund Planned Parenthood for one year at baseline, enough damage would be done by that year’s end.
It would leave even more people without abortion care coverage
Certainly, the ACA is a far cry from recognizing abortion as an important part of health care. If someone wants to purchase a plan covering the procedure, they must opt-in to tack the coverage on via a separate rider. Not only is this hardly transparent, but most people obtain abortions precisely because, well, they did not expect to become pregnant in the first place. Yet the new legislation is attempting to completely ban the use of tax credits towards purchasing plans which cover abortion beyond cases of rape, incest, and life endangerment. This strongly disincentivizes insurance companies from offering plans on the individual and small business employer marketplaces that provide comprehensive abortion care coverage. Not to mention that these efforts directly conflict with New York and California laws which mandate all insurance plans to provide such coverage, begging the question as to whether any residents of these states could utilize said tax credits meant to make plans more affordable. Additionally, the new plan would dismantle the ACA’s Medicaid expansion which is terrible in and of itself, though it’s also worth keeping in mind that all fifteen states where Medicaid covers abortion also opted to expand the program.
It would deeply cut Medicaid by introducing disastrous funding mechanisms
The subject of Medicaid funding is complex and occurs through several different avenues, though one important aspect is that states are guaranteed at least $1 in federal funds for each $1 of state spending. Trumpcare would replace this with a combination of funding via block grants and per capita caps. To break it down, block grants consist of a fixed amount that states may choose to allocate as they wish and per capita caps would limit spending to a fixed quantity per enrollee. Of course, neither could be altered in the face of rising health care costs and or unexpected needs like, say, another Hurricane Katrina or the HIV outbreak I mentioned above. It also doesn’t take into account how millions of people with disabilities reply on expensive, extensive, and life sustaining care which would likely be one of the first Medicaid services to be cut. This could force them into institutions, which states are required to cover in their Medicaid programs (unlike home and community-based care, which is optional). To add to the callousness, states which accept Medicaid block grants would no longer be required to cover family planning services and states could impose work requirements on enrollees, including people who have just given birth. Make no mistake, these measures would bring less flexibility to Medicaid, not more.
While efforts to stop such a cruel bill have been working so far, we are hardly out of the woods. Even if the Republicans in Congress don’t have the votes today or tomorrow or even for this go-around, they have made it clear they are dead set on dismantling the progress we have made under the ACA. As individuals who volunteer our time to fund abortions, we have plenty of stories to share — including our own — regarding how important comprehensive, affordable health care really is. Let’s keep up the pressure and keep telling our powerful stories! Have one to share? Email media(at)dcabortionfund.org.
By volunteer Meredith Nicholson
There is no shortage of legislation aimed at eliminating abortion access for people in the United States. In fact, the number is growing. The most discussed in DC, arguably, is the Hyde Amendment—the legislation that bans the use of federal money for abortion except in the cases of rape, incest, or when the pregnant person’s life is in danger. Some states lessen the burden, which falls overwhelmingly on low-income people, by using their local Medicaid dollars to help pay for abortions.
Unfortunately, in DC, we also have the Dornan Amendment.
This month marks the sixth anniversary of the re-instatement of the Dornan Amendment, also known as the DC Medicaid Ban: the law stating that no congressionally-appropriated funds may pay for abortion in the District of Columbia.
Because Congress controls DC’s budget, the city does not have the autonomy to decide whether or not it wants to use its own locally raised Medicaid funds to help pay for abortions. And in a political climate that is increasingly hostile to abortion access, overturning the Dornan or Hyde Amendments seems unlikely.
At the DC Abortion Fund, we help low-income patients, many of whom are directly affected by the Dornan Amendment, pay for their abortions. In Fiscal Year 2016, 71 percent of our DC patients who reported their insurance provider said they were insured under DC Medicaid. This means they are faced with unjust coverage bans simply because their city is not permitted to control over its budget.
In Fiscal Year 2016, DCAF was able to fund over 1,300 patients, giving them the opportunity to access abortion services they may not have been able to afford otherwise. Because the Dornan Amendment affects so many people in DC, we see its toll on our budget. Many of these patients need to find additional funding that they would otherwise have from their Medicaid coverage, and money we give to one patient is money we cannot give to another.
DC may have fewer barriers to abortion than some states, however, even DC residents still face unjust burdens forced upon them by an anti-choice Congress.
Donating to DCAF helps us to alleviate some of the financial burden put upon DC residents by the Dornan Amendment. Your donation goes toward the patients who face an uphill battle when it comes to funding their right to choose.
The last few weeks have seen some surprisingly good news coming out of Virginia. In a win for reproductive justice advocates and patients, Governor Terry McAuliffe has vetoed a bill narrowly passed by the Senate that would have prevented the Virginia Department of Health from funding clinics that provide abortion services that would not be covered by Medicaid. This was the latest effort by Virginia legislators to defund women’s health clinics such as Planned Parenthood.
By vetoing this bill for a second year in a row, Governor McAuliffe is protecting the thousands of people who use Planned Parenthood for preventative health care, STD testing, birth control, breast exams, and a number of other vital health services.
Last week, the Virginia Senate also passed the Birth Control Access Act, which will require health insurance companies to cover a full year supply of birth control, rather than just a few months at a time. This is an enormous victory because barriers to contraception are a major factor in unintended pregnancies.
With a government that is expected to enact anti-choice policies in the coming years, we are happy to see support for reproductive rights coming through on the state level—especially in a state where we work to provide funding for abortion care.
On January 24, the U.S. House passed H.R. 7 to codify — and expand — the Hyde Amendment and related longstanding restrictions on federal funding for abortion. For the last four decades, the Hyde Amendment and other budget riders like it have created financial hurdles for abortion access for DC Abortion Fund’s Medicaid patients. Our patients who live in the District face an additional hurdle because of Congress’ constant meddling in DC’s budget — and sadly, that’s unlikely to change anytime soon.
The Hyde Amendment bans the use of federal money for abortion except in cases of rape, incest, or when the pregnant person’s life is in danger. Some states mitigate the effects of Hyde for their low-income residents by using their own funds to provide abortion access to people enrolled in Medicaid. But almost continuously since 1989, Congress has prohibited the District from using its own locally-raised Medicaid funds to pay for abortions through a rider known as the Dornan Amendment. (The ban was temporarily lifted in 1993, 1994, 2009, and 2010, but otherwise it has been in effect every year since 1989.) H.R. 7 converts these riders, which previously needed to be re-enacted every year, into permanent funding restrictions.
For many politicians and anti-choice advocates, DC residents are just another pawn in an ongoing effort to reverse the constitutional guarantee of abortion rights. It’s an easy “win” for them because the federal government exerts full control over DC’s budget while DC residents have no representation in Congress. Congress could not exert the same control over the residents of any other jurisdiction.
But for DCAF’s patients, this Medicaid ban is not just a move on a political chessboard.
When the Medicaid ban, also known as the Dornan Amendment, was suddenly reinstated in April 2011, DCAF saw “an immediate spike in need within our community,” and that need continues today, as DCAF board member Emily discussed on a recent episode of the Kojo Nnamdi Show.
In Fiscal Year 2016, 72 percent of our DC patients who reported their insurance type said they were insured under DC’s Medicaid program. The DC Medicaid ban stretches DCAF’s budget and forces many of our patients to scramble for funds that wouldn’t be needed if Medicaid covered abortion just like other medical procedures.
A first-trimester abortion can cost between $300 and $950. By comparison, the monthly income limit for an individual to be eligible for DC Medicaid is $2,128 — and that’s the upper limit, the maximum that a person can make and still be eligible for Medicaid. Many people make less than that, and when they can’t use their Medicaid coverage to pay for abortion, they often have to turn to family and friends who may also have a low income, pawn their belongings, consider which bills they can delay, or make other difficult choices.
In spite of all of this, we have a history in DCAF of turning rage into resilience. Our volunteers continue to take calls seven days a week, 52 weeks a year. In an ideal world, the Hyde Amendment — and all of its spinoff restrictions like the Dornan Amendment and H.R. 7 — would be history. We stand with our allies every day to try to make that world. And in the meantime, we keep answering the phone. Always.
By volunteer Deborah S.
Letter to U.S. State and Federal Legislators,
Thank you for the opportunity to speak with you today on this most personal issue.
Let me be clear. Only I Know when the time is right for me to bring a new life into this world. Only I Know when my partner and I want to keep our family at four. Only I Know that I don’t have the resources to raise a child. Only I Know that raising a child by myself is not an option. Only I Know that bearing a child and giving it up for adoption is not an option. Only I Know that I’m working two jobs just to support myself. Only I Know when my health is poor and my stamina weak. Only I Know what I need to do to care for my existing children. Only I Know that my contraception failed. Only I Know that I am too young and immature to have a baby. Only I Know that I have no job and lots of debt. Only I Know what I need to do to finish school and find meaningful work. Only I Know that my relationship is new and waiting is best. Only I Know that I have a plan for my life and it doesn’t include an unplanned pregnancy. Only I Know that my children are nearly grown and my childbearing years are behind me. Only I Know that I’ve become pregnant from a sexual assault. Only I Know when the time is right for me to bring a new life into this world.
Only I Know these things. You don’t Know.
It’s that simple.
Thank you for your attention and for backing-the-hell-off this most personal issue.
By volunteer Lynda D.
Members of Kentucky’s legislature recently voted 92-3 in favor of a new law mandating counseling for women seeking an abortion. The state already requires parental consent for minors and limits public funding of abortions to life endangerment, rape, and incest. Rep. Mary Lou Marzian, a Democrat from Louisville, was one of three women who voted against the new law. And she had had enough of government intrusion into women’s private health care decisions.
So, Marzian turned the tables and introduced a bill that would intrude into men’s private health care decisions. Enter House Bill 396, legislation that would require any man seeking Viagra, or other erectile dysfunction drug, to have two office visits with his doctor, a signed-and-dated letter from his spouse providing consent, and a sworn statement that he would use the drugs only to have sex with his spouse.
Oh, and only married men would be eligible for the drugs. (It is a Family Values issue, after all.)
Since the Supreme Court legalized abortion in 1973, states have found ways to limit women’s access — and abortion clinics are closing in record numbers. In fact, five states — Mississippi, Missouri, North Dakota, South Dakota, and Wyoming — have just one clinic each.
Every week it seems, male-dominated legislatures are creating more abortion hoops to jump through. Kentucky joined 16 other states when it passed the mandatory counseling law for women. Twenty-eight states require a woman to wait a specified period of time, usually 24 hours, between the counseling and her abortion, which effectively requires her to make two separate trips to the clinic. Twenty-two states have burdensome licensing standards that for example, specify the size of procedure rooms and corridor width at clinics.
What does all this mean? It means that access to safe and legal abortion is diminishing. And as this happens, more and more women will be driven to dangerous and illegal means to terminate pregnancies.
If it wasn’t so serious, Marzian’s bold bill would be hilarious. As it turns out, similar legislation has been introduced in Iowa, Missouri, Tennessee, and South Carolina. Female legislators are making the point simply and brilliantly: Don’t infringe on personal decisions between a person and her or his health care provider.
By volunteer Lynda D.
I became a DCAF case manager this past July because I wanted to be directly involved in the fight for access to abortion services. Reading countless articles and sending angry tweets was no longer enough for me. Now, when I am answering calls from women through DCAF, I can see the immediate impact that I (and abortion funds like DCAF) am having on people’s lives.
In September, I was accepted into the third annual class of Planned Parenthood of Metropolitan Washington’s Developing Leaders Program (PPMW DLP). This experience has been the perfect opportunity for me to learn more about reproductive health and justice, and to get further involved in the movement in new and different ways. There has been some clear intersection between my volunteer work with DCAF and my involvement with PPMW DLP.
I’ve learned that Virginia residents who call DCAF are often bound by restrictive state legislation, such as Targeted Regulation of Abortion Providers (TRAP) laws that were enacted in 2011. Requirements of such legislation include that all abortion clinics in the state must comply with hospital-based standards, that mandate dimensions for procedure rooms and corridors, and include requirements for ventilation systems, parking lots, and entrances. These laws make it difficult for clinics to remain open.
In addition, Virginia passed legislation in 2012 that requires a doctor to perform a mandatory ultrasound on a woman before she has an abortion, along with Virginia’s law of the 24-hour waiting period between the ultrasound and the abortion, placing another barrier in front of women. Not to mention that patients often have to pay out of pocket. An ultrasound can cost anywhere between $200 and $1,200, and many insurance companies won’t cover the costs. This makes this type of law both medically unnecessary and an additional financial burden.
Last month, I was fortunate enough to canvass with PPMW and NARAL Pro-Choice Virginia on behalf of pro-choice politicians running for Virginia state legislator positions. As it was just weeks away from the November election, a group of us went door to door to remind supporters to get out and vote. Knowing that this election could possibly overturn Virginia’s unfair abortion restrictions someday motivated me as I knocked on doors and talked to dozens of strangers about personal voting decisions.
My experience with both organizations shows me how direct service to individuals and advocacy at the local, state, and federal levels are equally important. We need to be active on both sides. While we pressure politicians to respect and protect choice, there are still many people who need our help right now. I am proud to be part of that.
By volunteer Maggie G.
Beal v. Doe involved a Pennsylvania law that restricted state Medicaid funding of abortions to physician verified, medically necessary abortion procedures. The question that faced the Supreme Court in Beal was whether Title XIX of the Social Security Act required states to fund “nontherapeutic” abortions. In a six to three decision, the Court ruled that states were not required to fund “nontherapeutic” abortions and could limit abortion coverage in their Medicaid programs.
The majority limited their opinion to statutory interpretation — that is, they considered the text of Title XIX and Congress’ intentions when drafting the law. They did not address the constitutional questions of equal protection and due process raised in the challenge. This provoked a blistering dissent from Justice Thurgood Marshall and a skeptical one from Justice Harry Blackmun, the author of the Roe decision.
The consequences of Beal
The Beal decision was issued on June 20, 1977, on the heels of the Hyde Amendment. Federal funds were already limited to pregnant women who were seeking abortion care because of rape, incest or health. Now, states could add similar restrictions.
The impact of this case has been enormous. Today, 33 states have rape/incest/health restrictions in their Medicaid programs. As a result, people enrolled in Medicaid must seek alternate means in order to pay for an abortion. Depending on the cost of the procedure and the financial resources of the patient, this may mean dipping into hard-earned savings, selling family heirlooms or skipping a utility payment to cover the cost. Many people also turn to abortion funds. Nearly half of the callers who contacted DCAF last fiscal year were on Medicaid or a similar government health insurance plan.
The governmental benefits at issue here, while perhaps not representing large amounts of money for any individual, are nevertheless of absolutely vital importance in the lives of the recipients. The right of every woman to choose whether to bear a child is, as Roe v. Wade held, of fundamental importance. An unwanted child may be disruptive and destructive of the life of any woman, but the impact is felt most by those too poor to ameliorate those effects. If funds for an abortion are unavailable, a poor woman may feel that she is forced to obtain an illegal abortion that poses a serious threat to her health and even her life. If she refuses to take this risk, and undergoes the pain and danger of state-financed pregnancy and childbirth, she may well give up all chance of escaping the cycle of poverty. Absent day-care facilities, she will be forced into full-time child care for years to come; she will be unable to work so that her family can break out of the welfare system or the lowest income brackets. If she already has children, another infant to feed and clothe may well stretch the budget past the breaking point. All chance to control the direction of her own life will have been lost.
— Justice Thurgood Marshall’s dissent
The Court concedes the existence of a constitutional right, but denies the realization and enjoyment of that right on the ground that existence and realization are separate and distinct. For the individual woman concerned, indigent and financially helpless…the result is punitive and tragic. Implicit in the Court’s holdings is the condescension that she may go elsewhere for her abortion. I find that disingenuous and alarming, almost reminiscent of: “Let them eat cake.”
— Justice Harry Blackmun’s dissent
By volunteer Carolyn B.