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Forty Years After Roe, “Choice” No Longer Means Much in Michigan

9:43 am in Uncategorized by RH Reality Check

Written by Angi Becker Stevens for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

From my vantage point in Michigan, celebrations of Roe v. Wade‘s 40th anniversary have felt decidedly bittersweet. Earlier this month, Governor Snyder signed HB 5711 into law — Michigan’s anti-abortion super-bill, which will prohibit the telemed prescription of medical abortion, force all women seeking safe abortion care to undergo “coercion screenings,” and enact a number of costly regulations on abortion clinics and providers, inevitably forcing many clinics to close their doors. All of this is in a state that already required a 24-hour waiting period before obtaining an abortion, where minors cannot obtain an abortion without parental consent, and where 87 percent of counties do not have a single abortion provider. The meaning of “choice” here in Michigan — as in many other states in the country — has eroded a great deal since that day 40 years ago when the Roe decision was handed down. How did we end up here? And more importantly, how do we move forward?

Under the language of the Roe v. Wade decision as it was written in 1973, it was extremely difficult for states to pass laws restricting access to abortion care, at least during the first two trimesters of pregnancy. Though the decision fell short of guaranteeing abortion access as a right, it did not allow for state intervention in regulating abortion except in cases where such regulations could be shown to be of clear medical benefit. In 1976, the Hyde amendment dealt a massive blow to abortion access by prohibiting the use of federal Medicaid funds for abortion; in the years between Roe and Hyde, approximately 295,000 abortions annually were paid for with Medicaid funds. With Hyde’s passage, access to abortion instantly became a privilege, out of reach to many who needed it most. But it was not until the early 1990s that state legislatures gained the authority to restrict abortion in the myriad ways that have become so familiar to us today. In the 1992 Supreme Court case Planned Parenthood v. Casey, the court ruled that states were free to place regulations and restrictions on abortion access so long as those restrictions did not impose an “undue burden” on a woman’s ability to choose. State lawmakers were no longer required to argue that abortion restrictions had medical benefits; on the contrary, they became free to openly acknowledge the ideological basis behind their proposed restrictions on abortion access. Suddenly, it was open season for creating barriers between women and abortion. And the murky question of what, precisely, constitutes an “undue burden” remains open to interpretation.

At the same time as states were granted this far-reaching power, a cultural shift surrounding abortion had taken place. Twenty years after Roe, a generation had come of age taking legal abortion for granted. In the days before Roe, it was necessary for abortion-rights activists to speak of abortion in terms that were bold and affirmative. But in the years that followed, as legal abortion became a given rather than something to fight for, even those who identified as pro-choice began to increasingly speak of abortion as a necessary evil rather than celebrating it as an essential ingredient for women’s equality. Bill Clinton was lauded as the first unabashedly pro-choice president, yet he popularized the now oft-heard refrain that abortion should be “safe, legal, and rare.” Legal abortion was defended most often on the grounds that without it, women would simply be endangered by illegal abortions, either self-inflicted at the hands of “butchers.” This notion — that abortion must remain legal only because it will happen anyway, and it’s safer this way — is a far cry from the notion that women have a right to bodily autonomy, and that without access to safe abortion care, women cannot be entirely free in a world where we cannot control our own reproductive lives. Even Planned Parenthood, when threatened, tends to publicly respond by downplaying its abortion services and focusing instead on the other health services the organization provides. And it is this ambivalent treatment of abortion — as an unpleasant, shameful, but necessarily legal thing — which invites support for all manner of restrictions.

Perhaps nowhere is this ambivalence about abortion as evident as a state like Michigan. We are not a Southern state, known for our biblical conservatism — the kind of environment where extreme restrictions on abortion are expected. We are, in many ways, the quintessential Midwest: blue-collar, working-class, and characterized, if anything, by a desire to be polite and reasonable. We are a state that does not want to rock the boat, that does not want to talk about religion and politics at the dinner table. It is precisely the kind of environment where people want abortion to remain legal, but are generally uncomfortable with the topic, and are easily persuaded that abortion restrictions are simply good common sense. Though at this particular moment we are governed by both a predominantly Republican legislature and a Republican Governor, anti-choice Democrats are easily elected here, and those who do claim to be pro-choice are often still supportive of restricting access to safe abortion care. It was a democratic former Governor, James Blanchard, who signed our parental notification requirement into law. And years later, yet another Democrat, Jennifer Granholm, signed off on the “informed consent” legislation mandating 24-hour waiting periods and requiring that any woman in need of an abortion be given state-produced materials detailing the current developmental stage of the embryo or fetus she is carrying. We are a state, in other words, where the dividing line between “pro-choice” and “anti-choice” is often not so clear, and where that divide certainly does not fall neatly along partisan lines.

For many years now, even many who identify as “pro-choice” have been all too willing to accept any and all abortion restrictions so long as abortion remains at least officially legal. But what does it mean for abortion to be technically legal if it is inaccessible to the majority of women who need it? Many people today don’t realize that legal abortion did take place in America before Roe v. Wade. But obtaining one required the often traumatic and dehumanizing process of going before a hospital “abortion board” to request permission for a legal abortion. Or, alternatively, in the late sixties and early seventies, women with the resources to do so could travel to one of the states where abortion had been legalized pre-Roe. The majority of Americans do not wish to see Roe v. Wade overturned. But the restrictions we are living with today have, in essence, already returned us to a pre-Roe era: one in which legal abortion exists, but is extremely difficult to come by. The purpose of the fight for Roe was not simply to make some abortions available for some women in positions of privilege. The purpose was to make abortion equally available to all women who need them. And the state of Michigan today — along with many other states in the country — falls extremely short of this ideal.

If we are to truly defend abortion rights — not simply preserve legal abortion in an empty sense — we need to reclaim the urgency of those before us who fought to legalize it in the first place. We need to stop treating abortion as a dirty word, but instead be willing to positively affirm it as a vital component of reproductive health care. We need to stop taking abortion access for granted, and to stop living with the illusion that so long as Roe has not been overturned, abortion is available for the women who need it. And we need, finally, to reclaim the dialogue surrounding reproductive rights. Abortion access always has been, and always will be, a key component to women’s equality. And it’s time we get back to speaking boldly about abortion in terms of women’s liberation, not fetal personhood.

If there were actual, serious talk of outright banning abortion in America, I believe there would be a massive outcry of resistance. But we need to realize that, at least in many states, the situation is just this dire. If we are to build the kind of social movement that’s strong enough to fight back against these attacks on reproductive freedom, we must begin by fully recognizing just how serious the consequences of these restrictions are. If we want to honor the legacy of Roe, let’s do so by remembering the spirit and the intent of those who fought for it. Let’s not continue to believe we are honoring Roe by sitting by and allowing it to be stripped of all real meaning. “Choice” means nothing in a world where there is no access. As Michigan faces a future with few remaining clinics, higher abortion costs, and a rapidly increasing list of obstacles women must pass through before being permitted to obtain an abortion, that world without choice is not some far off, conservative dystopia. It is here now. And we must first recognize the severity of the situation we’re in if we are to find a way out.

The Public Funding Debate: If We Don’t Fight the Hyde Amendment, We Will Lose Everything

11:01 am in Uncategorized by RH Reality Check

We have him to thank.

Written by Miriam Pérez for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Sunday was the kind of anniversary you wish you didn’t have to celebrate: specifically, the 36th anniversary of the Hyde Amendment, one of the most restrictive reproductive rights laws in recent history. It restricts the use of federal funds for abortion services, meaning that people on publicly-funded insurance programs like Medicaid and Medicare (the low-income and the disabled) have to pay for abortion services out of pocket. The vast majority of the women affected by this ban are low-income, and if you are poor enough to qualify for Medicaid, you aren’t likely to be able to shell out anywhere from $300 to $3000 for an abortion procedure.

But, of course, that was exactly the point of the Hyde Amendment. “I would certainly like to prevent, if I could legally, anybody having an abortion: a rich woman, a middle class woman, or a poor woman. Unfortunately, the only vehicle available is the [Medicaid] bill,” said Henry Hyde, author of the amendment.

Unfortunately, though, it seems that we often forget this intention, and somehow decide that it’s okay to equivocate on this issue. Efforts to repeal the Hyde amendment are more often than not seen as unrealistic, and advocates work instead to maintain the status quo — low-income women denied access to abortion. Often the argument is that if we try and fight the public funding battle, we might lose ground in overall access to abortion. But I think that the exact opposite is true. If we don’t fight the public funding debate, we’re going to lose altogether.

The reason is that the public funding debate is simply a slippery slope toward outlawing abortion (and now even birth control) altogether. Take, for example, the 2011 move by Ohio legislators to slip an anti-choice amendment into the state budget. Their new restriction? Extending the public funding ban by banning abortion procedures in public hospitals and facilities in the state. Now, remember, state-funded insurance programs (Medicaid, Medicare) already don’t cover abortions, so if a woman on Medicaid walks into an Ohio hospital, her insurance isn’t going to cover the procedure. Taxpayers literally aren’t going to pay for the procedure — she’s going to, out of pocket, if the abortion is considered “non-therapeutic,” for reasons other than her life and health.

So why the redundant amendment? Because while her procedure won’t be paid for by taxpayer dollars, the facility itself, a public hospital, is supported by taxpayer dollars. This may seem like a huge leap to make, but this amendment passed (along with the budget), and became the rule of law in Ohio. This is the natural extension of the Hyde Amendment, and every day anti-choice advocates go a little further. Under the logic of the Ohio bill, even privately-run clinics and hospitals could be subject to abortion bans. They too are serviced by public roads and sidewalks, their water and electricity provided by public utilities. Even police and fire departments are supported by taxpayer dollars. Under the logical end of this rationale, only abortions provided on private islands, with private security, that were off the grid, could conceivably be done without being considered “publicly-funded.” Obviously this is absurd, but we shouldn’t have to wait until the public funding debate goes all the way to its logical extremity before we realize we can’t afford to leave this battle alone.

The simple fact of the injustice of this law should be enough to have the entire reproductive rights community up in arms, but unfortunately, that has not been the case. Maybe it’s because the people in power have private health insurance that keeps them covered, or because abortion funds around the country have cropped up to fill some of the gaps. But we’re at a critical moment where we have to redouble our efforts and claim the ground we’ve conceded these past almost 40 years — otherwise we might find the ground we’re protecting quickly disappearing beneath our feet.

Evidence-Based Advocacy: What Do Low-Income Women Think about Public Funding for Abortion?

10:18 am in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Evidence-Based Advocacy is a bi-monthly column seeking to bridge the gap between the research and activist communities. It will profile provocative new abortion research activists may not otherwise be able to access. 

September 30th marks the anniversary of the Hyde Amendment, which prevents Medicaid coverage of abortion in most circumstances. When activists and advocates talk about Hyde, we discuss the injustice of health care denial, the importance of grassroots abortion funds, and the stories of people who’ve sacrificed rent, food, and monthly bills in order to pay for an abortion their insurance won’t cover. And rightly so—there’s no denying that the more we talk about the horrific ramifications of the Hyde Amendment and the more awareness we raise, the better. We know what we think about Hyde. But what do women who are on Medicaid, the very people who are most affected by Hyde, think about the restrictions it places on their insurance coverage?

Amanda Dennis of Ibis Reproductive Health interviewed 71 low-income women who had  abortions while living in Arizona, Florida, New York, and Oregon, states that represent those operating under Hyde’s restrictions and those that have pro-actively provided Medicaid coverage for abortion. These women ranged from 18 to 35 years old, most reported having some college education, and a majority of them had surgical, first trimester abortions within the past two years. All of them met their state’s Medicaid income qualifications.

Most of the women supported government funding for abortion care; in fact, 82 percent said that they support Medicaid coverage of abortion. When asked about whether funding should be available in specific circumstances, however, they wavered. The interviewees didn’t think abortion should be covered if a woman could not afford another child. Similarly, they didn’t think Medicaid should cover abortion if a woman was not in a relationship with the person with whom she had sex. These views held constant even for women who were themselves in these same circumstances when they had their abortions. For example, a majority of the women cited financial instability as the most salient factor in their personal abortion decision, yet when specifically asked if Medicaid should cover abortion as a result of not being able to afford another child, 40 percent said no. Similarly, women often used disparaging language to talk about people who seek abortions for reasons they don’t approve of, again, even if they themselves had abortions in those circumstances.

This seems contradictory: why would women who have abortions for financial reasons disapprove of Medicaid coverage of abortion for the exact same reason? Dennis and her colleagues points to abortion stigma, explaining:

“Women said that they did not support coverage in these circumstances because they felt coverage would promote ‘irresponsible’ behavior…these circumstances conjured images of irresponsible, promiscuous, and callous women, which participants sought to distance themselves from in order to view their own abortion decision as consistent with their moral values.”

Dennis and colleagues propose that abortion stigma operates differently for low-income women, as they are battling both abortion stigma and welfare stereotypes. The researchers note that the overlap between stereotypes of women who have abortions and women on welfare are notable—they’re both thought of as irresponsible, lazy, and promiscuous, the exact qualities from which the women in this study were trying to distance themselves. Indeed, the shame associated with welfare reflects an American view that holds individuals accountable for their own poverty rather than recognizing the systemic determinants of poverty and health.

The point of this research is not to suggest that we should keep Hyde in place because low-income women themselves don’t believe that Medicaid should cover abortion in every circumstance. A person’s character, whether upstanding or “irresponsible,” should not determine whether or not they receive insurance coverage. This particular study uncovers just how pervasive abortion stigma is, so much so that even women who need Medicaid to cover abortion because they can’t afford another child don’t believe women like them deserve to have this coverage. 

The Hyde Amendment has made it acceptable to debate whether different pregnancy circumstances merit abortion coverage. As we see in this particular study, parsing out who does and doesn’t deserve abortion coverage based on the circumstances of a pregnancy only further embeds stereotypes about people who seek abortions, especially among those who need access to these services (in this case, low-income women). Research like this demonstrates that our work on the Hyde amendment can’t just be at the policy level. Repealing Hyde is not enough—it does not undo the damage of stereotypes associated with people who have abortions. We must advocate for policy change coupled with culture change, in which we both repeal Hyde and challenge the multiple stigmas and stereotypes associated with those who need Medicaid coverage of abortion.

If you are interested in having your research profiled, leave your contact information in the comments section. 

The Hyde Amendment at 35: How One Law Continues to Divide a Movement

8:53 am in Uncategorized by RH Reality Check

Written by Marlene G. Fried for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Photobucket

Rep. Henry Hyde

This article is cross-posted from the National Network of Abortion Funds.

The Hyde Amendment turns 35 this month. This provision, prohibiting federal Medicaid coverage of abortion in almost all circumstances, was the beginning of the anti-abortion movement’s post-Roe, all-out effort to ban abortion. It was a gateway bill, opening the door to the flood of restrictions that today constrict a woman’s ability to obtain an abortion, forcing women to “choose” between paying for other basic necessities and having an abortion, and, in too many cases, making abortion impossible. It became the precedent for all other denials of abortion funding, and reinforces our discriminatory, two-tier health care system in which people without financial resources cannot get the care they need.

The persistence of the Hyde Amendment also created a series of disastrous roadblocks to inclusive reproductive health coverage in other legislation. For example, Congress banned abortion coverage in “The Affordable Care Act” in 2010. Compounding this specific policy loss was the profound ideological loss of normalizing the exclusion of abortion from health insurance. During the battle over health care reform, President Obama reassured those who feared that there might be an end run around Hyde by saying, “I’m pro-choice, but I think we also have the tradition in this town, historically, of not financing abortions as part of government-funded health care.”

As we mark this anniversary with our continued activism, I draw several political lessons to inform our advocacy going forward.

Understand the fight we are in:  The agenda is anti-woman, especially poor women

Paradoxically, the debate over abortion is not primarily about abortion itself. Rather, as Dr. George Tiller so eloquently put it, “This battle is about the self-determination of women over the direction and course of their lives. Abortion is about women’s hopes and dreams. Abortion is a matter of survival.”

Over time the anti-abortion movement has gotten more sophisticated in its approach, arguing in recent years it opposes abortion because of the harm it does to women’s health. False claims that abortion is linked to breast cancer and causes women to suffer from post-abortion syndrome are intended to show that the anti-abortion movement cares as much about women as it does about fetuses. However, the theme of contempt and distrust for women, so clearly articulated during the original debate on the Hyde Amendment, recurs.  A recent attempt by Republicans to restrict government funding of abortion to cases of “forced” rape echoes the earlier debate where opponents claimed that “any woman who wants an abortion under Medicaid could go in and say” she has been raped, in order to get Medicaid to pay for her abortion.

Fight for what you really want

At the time the Hyde Amendment was passed, just three years after Roe v. Wade, its sponsors never thought they would succeed. The original Hyde Amendment proposal was unabashedly extreme, with no exceptions whatsoever, not even to save a woman’s life. Its sponsors were completely transparent about their goals. In 1976, Rep. Henry Hyde (R-IL) said:

“I certainly would like to prevent, if I could legally, anybody from having an abortion, a rich woman, a middle-class woman, or a poor woman. Unfortunately, the only vehicle available is the [Medicaid] bill.”

In 1977, Rep. Hyde and other House members held out for six months, orchestrating 25 roll call votes and delaying passage of a $60 million appropriations bill, before finally accepting a few exceptions in order to get the Amendment passed. But they kept pushing for what they really wanted until they successfully eliminated all but the exception for life endangerment in 1981. Up until 1993, Congress refused Medicaid funding to women who had been raped; only women whose lives were endangered by their pregnancy had any hope of receiving financial support for an abortion through Medicaid.

This tenacity became a signature characteristic of the anti-abortion movement: the ban on so-called “partial birth abortion,” the many state-level challenges to Roe itself, and egg-as-person amendments are just a few examples of this approach. The anti-abortion movement never takes no for an answer. By drawing lines in the sand and refusing to compromise, they have successfully restricted access to abortion, mobilized their base and made significant inroads into mainstream attitudes about abortion.

Do not allow the opposition to exploit divisions

By attacking abortion access, rather than legality, the Hyde Amendment divided the abortion rights movement along lines of race and class. It provided the possibility of being “pro-choice” without supporting real access, thereby trading away the needs of low-income women and women of color. When asked why women of color were not more visible in the pro-choice movement, longtime activist and former clinic director Brenda Joyner reframed the question to ask:

“[W]here is the primarily white middle-class movement in our struggles for freedom? Where was a white middle-class movement when the Hyde Amendment took away Medicaid funding of abortions for poor women?”

These divisions have continually arisen. Sometimes, as with the Hyde Amendment, women of different economic classes are pitted against each other. And sometimes, as in the argument over whether to support a health reform bill without abortion coverage, women are in the position of having their basic needs pitted against each other – trading reproductive health care for other health coverage. Here, too, President Obama actively contributed to this conflict, saying, “My main focus is making sure that people have options of high quality care at the lowest possible price” – as if abortion isn’t part of “high-quality care” for women.

As we look towards the future, it is my hope that we will resist the fragmentation that has weakened all of our struggles for social justice. The work of the abortion Funds reminds us daily that, as Audre Lorde told us, “There is no such thing as a single issue struggle, because we do not live single issue lives.” Overturning the Hyde Amendment is just one part of our goal of achieving reproductive justice for all women. It is important that we pursue a bold vision, especially in challenging times. We need this vision to mobilize our movement because, as we have seen, the arc of history does not bend towards justice all by itself – it takes all of our hands.

Beyond Federal Funding for Contraception: Taking a Firm Stance on the Hyde Amendment

7:19 am in Uncategorized by RH Reality Check

Written by Angi Becker Stevens for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Over the past few months, in discussing the attack on Planned Parenthood’s federal funding, I—along with probably just about every other feminist and pro-choice activist in the country—found myself repeating “but they already don’t get federal funding for abortion!” so many times I felt like a broken record. It has been necessary, thanks to a proliferation of misleading articles and statements on the subject, to offer that kind of clarification. At the same time, however, I’ve been increasingly concerned that in our haste to remind everyone that this particular political battle is not about funding for abortion, we’ve given the impression that it’s perfectly valid and acceptable that abortion remain ineligible for federal funding. It feels almost as if we’re saying: “oh no, no, we would never ask for taxpayer money for that! We’re talking about breast exams!” And while clarity is absolutely important, and people do need to understand exactly what’s at stake in the current budget wars and what isn’t, I would argue that it’s equally vital that we not throw abortion rights under the bus in an effort to protect other family planning and health services.

Amanda Marcotte eloquently addressed some of the misgivings I’ve been feeling here recently. But I would like to add to the dialogue some thoughts not just on abortion access in general, but specifically on the topic of federal funding for abortion. When worded that way, it’s already something of a misnomer—“federal funding for abortion” calls to mind some kind of specific U.S. abortion fund for anyone who wants it. What we’re really talking about here is whether tax dollars can be used for abortion in the same way they’re used for countless other medical procedures via Medicaid and other government-funded health and welfare programs. … Read more

All Those Alternatives to Planned Parenthood? In Texas, At Least, They Don’t Exist

7:47 am in Uncategorized by RH Reality Check

Written by Andrea Grimes for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Before I met with Texas State Representative Dan Flynn last month during Texas’ pro-choice lobby day, I truly believed that even the most passionate anti-choice conservative couldn’t look me in the face and tell me they didn’t really care whether I got the reproductive health care I needed. Who would seriously tell me their religious beliefs are more important than making sure hundreds of thousands of women just like me—women with high-risk HPV–don’t develop cervical cancer?

But like I said, that was before I sat in front of Rep. Flynn, in his Austin office next to his model airplanes and elect-Dan-Flynn gum, and told him how I’d lost my job and my health insurance and needed regular, affordable pap smears to keep an eye on my pre-cancerous cervical dysplasia. I told him Planned Parenthood could provide low-cost paps, breast exams and contraceptives to keep me healthy despite my lack of insurance, and I believed they should continue to be funded by government family planning dollars. He scoffed, waving around a handful of papers—spreadsheets and maps, it looked like—and told me that Planned Parenthood was nothing but a tax-evading abortion machine (he knew because he used to be a bank examiner and had heard some things from some people) and there were so many other options besides Planned Parenthood in Texas. I should and could go to one of those, he told me, so we could spread some of the wealth around to these smaller providers. It would be very easy, he said.

I asked him if he could give me that list he had in his hand, the long list of places I could get low-cost reproductive health care without insurance near my home in Dallas. He glanced at the list and rattled off some names, something about Dallas Emergency Services and Dallas County Hospital District. He didn’t exactly wait for me to get out my pen and pad. I filed out of Flynn’s office with the rest of the women I’d teamed up with for lobby day feeling surprised and disappointed. But I still wanted (needed!) to know where those low-cost health centers were that Flynn had referenced, because I knew the Texas Legislature to be hell-bent on cutting the family planning funds that keep Planned Parenthood and clinics like it afloat.

Planned Parenthood or not, I’d still need well-woman exams, birth control pills and suchlike, and I wanted to know where I could get these things if I had to spend weeks or months scraping by on a freelancer’s salary without health insurance. So here’s what I did: I spent my own time, money and energy trying to find a health care clinic that anti-choice conservatives, legislators and organizations would approve of—namely, to find a Federally Qualified Health Center or “look-alike” center that, by virtue of federal grant funding, cannot provide abortion services except in cases of rape, incest or threat to a mother’s life, as dictated by the 36-year-old Hyde Amendment. … Read more

Why Did They Seek Abortions There? How Abortion Bans Threaten Women’s Lives

8:23 am in Uncategorized by RH Reality Check

Written by Patty Skuster and Susan Schewel for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

It became tragically clear this week that hurdles to safe, legal abortion can prove life threatening. In West Philadelphia, Karnamaya Mongar lost her life in the horrific facility where Dr. Kermit Gosnell killed and maimed immigrant women and women of color seeking to end unwanted pregnancies. She is one of tens of thousands of poor women who die every year at the hands of butchers and quacks. We sometimes comfort ourselves with the thought that those deaths don’t happen here. But clearly they can.

Around the world — even here in Pennsylvania — women face obstacles to legitimate medical care, including preventive services like contraception, prenatal care and safe abortion care. However, such obstacles — legal and financial barriers, social stigma or language barriers — do not affect all women equally. 

It is poor women, young women, women of color and immigrant women who bear the burden of these restrictions, particularly federal bans on funding for abortion care. These bans – such as the Hyde Amendment that affects Medicaid and the international Helms Amendment that affects our foreign aid – exacerbate the circumstances that lead women to facilities like the West Philadelphia clinic in the first place. Read more

The Hyde Amendment: Denying Women’s Civil Rights

8:55 am in Uncategorized by RH Reality Check

Written by Jessica Arons and Shira Saperstein for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

As we honor Dr. Martin Luther King, Jr., we are reminded of his poignant words that a “right delayed is a right denied.” This is as true for reproductive rights as it is for other civil and human rights. And nowhere is it more true than with regard to a policy known as the Hyde Amendment, which delays and sometimes entirely denies poor women, especially women of color, access to abortion.

Abortion policy in this country does not treat all women equally. Even before Roe v. Wade was decided in 1973, affluent women were usually able to access abortion safely through a network of private doctors or by traveling to other states or countries where it was legal. Meanwhile, poor women risked their health, fertility, and often their lives to end a pregnancy. Unfortunately, because of the Hyde Amendment, similar inequalities exist today — nearly 40 years after the Supreme Court declared that all women have a constitutional right to abortion.

The Hyde Amendment prohibits Medicaid, the joint federal-state health care program for the indigent, from covering abortion care in almost all circumstances. Most people think of this as a “woman’s issue,” which of course it is. But the Hyde Amendment intentionally discriminates against poor women and has a disparate impact on women of color. In this way, the Hyde Amendment is a civil rights issue as well.

The Hyde Amendment is especially harmful to women of color. According to the most recent Census data, 25.8 percent of African Americans and 25.3 percent of Hispanics are poor, compared to 12.3 percent of whites and 12.5 percent of Asians. As a result, women of color are more likely to rely on government health programs. And due to socioeconomic factors, women of color disproportionately experience a range of reproductive and other health disparities, including higher rates of infant mortality, HIV/AIDS, STIs, unintended pregnancy, and abortion.

The upshot: women of color are more likely to be directly affected by the Hyde Amendment and other abortion funding restrictions. Read more

Twelve Things You Can Do To Help Increase Abortion Access

9:16 am in Government, Health care by RH Reality Check

Written by Frances Kissling for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

The end of the year is a special time. Some of us make a slew of year-end contributions; others make New Year’s resolutions. We think back and we think forward. My thoughts as the year ends turn to the greatest challenge facing abortion-rights supporters: the absence of adequate federal, state and personal financial support for women who have chosen to have abortions and simply don’t have the money. I am struck by the almost absolute apathy of most of the movement when it comes to this pressing concern.

When we look back, we are critical of the movement of the mid-seventies which chose to focus its attention on rallying the troops about a less-than-real challenge to Roe’s constitutionality rather than on the first and most significant blow to Roe: the 1980 Harris v. McRae Supreme Court decision which ruled that neither the states nor the federal government were obliged to pay for abortions through various funding mechanisms.

Efforts to overturn the Hyde Amendment as well as state laws prohibiting the use of state money for abortions have consistently taken a back seat to efforts designed to secure adolescent access to abortion services and fight waiting periods, phony informed consent laws and restrictions on later term abortions and on specific types of medical procedures.  . . . Read the rest of this entry →

“Third Way” Goes the Wrong Way on Abortion Restrictions in Health Reform

9:20 am in Uncategorized by RH Reality Check

Written by Jodi Jacobson for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

At this point it’s not news to anyone that our ostensibly pro-choice President has presided, through a combination of silence and pre-emptive capitulation, over some of the greatest setbacks to women’s reproductive rights in more than a generation, culminating with the recent ban on coverage of abortion care for women entering high-risk insurance pools because they have high-risk health conditions that may be complicated or exacerbated by pregnancy.

In a mid-July article on the abortion coverage ban published by RH Reality Check, Jessica Arons, Director of the Women’s Health and Rights Program at the Center for American Progress wrote:

a commotion arose over the question of whether Pre-existing Condition Insurance Plans, also known as high risk pools, can include abortion coverage.  The Obama Administration responded immediately by imposing a total ban on abortion coverage in the pools that echoes the Stupak Amendment, even though nothing in the law requires such action.

Repeat: "…nothing in the [health care reform] law requires such action."

How we got here under President Obama is the focus of another and forthcoming analysis.

For now, it’s worth examining the claims being made about the abortion coverage ban by the self-proclaimed "progressive" group that appeared at the front of the line last week to apologize for this newest setback.

Enter Third Way.

Third Way is one of those groups that has pushed hard for so-called common ground on abortion issues. You know, the "common ground" on which the most fundamental rights of individual women to decide whether, when, and with whom to bear children–and to act in accordance with their own consciences, morals, and religious traditions in the best interests of their own and their family’s health and well-being–would be subject to a modern-day sacrifice to salve the qualms of religious fundamentalists and political opportunists for whom huge gaps in access to contraception, comprehensive sexual and reproductive health education, child care, economic support for poor women, aid to communities beset by environmental toxins, school lunch programs, Head Start and all else that is "life-affirming" never seem to rise to quite the red-level-threat of urgency as does the reality of women having control over their own bodies.

The abortion coverage ban was bad, and the Administration knew it. And if you are going to break a huge promise to a huge constituency that worked incredibly hard to get you elected for no reason other than you can’t stand up to the bullies, than it’s always convenient to have a group or two that will help with CYA on even the most onerous or heinous policies. So when the regulations were put out there, and health and human rights groups cried foul, Third Way, purportedly at the request of some "progressive policymakers," stepped right in with an analysis intended it seems to pat all us womenz on the head and assure us that these regulations are really in sync with the "spirit and the letter" of the health care reform law. Don’t worry your pretty little head, darlin’.

Except they are wrong on both the spirit and the letter of the law as well as the spirit of the President’s repeated, repeated promises that no one would lose current coverage under health reform, and his later "promise" (after breaking the first one) that the so-called status quo in federal funding for abortion care would be preserved.

Third Way makes the following claims to support the coverage ban:

1) Federal funds cannot be used for non-Hyde abortions

2) High-risk pools are not like Medicaid

3) High-risk pools more closely parallel the Federal Employees Health Benefits Program (FEHBP)

4) The ban does nothing to change the rules for private insurance.

Let’s take these claims one by one:

Claim 1: Federal funds cannot be used for non-Hyde abortions

Third Way argues that because the Hyde Amendment forbids federal funding for abortions, and because the high-risk pools are federally funded, it is "fundamentally consistent…to apply to the pools the same limitations that accompany federal funds in other areas of the health care law" even though, as they clearly state, "there is no specific legislative provision limiting coverage of abortion in the pools."

There are a number of things that make this analysis particularly shallow.

First, as Arons points out:

There is not one, over-arching law that restricts abortion funding for all sources of federal funds.  Rather, abortion opponents have had to fight to obtain funding restrictions for each separate source. Moreover, those restrictions are not permanent; they must be re-approved each year through the annual appropriations process and their contours have changed over time.

What, in effect, the Administration has begun to do in its expansive interpretation of existing law is to create a larger umbrella banning abortion coverage than exists in written law, thereby further (and further) eroding already-existing access to abortion care. This is neither the spirit of the health care law as the Administration publicly and consistently described it nor as the majority of Democrats in Congress intended it. In fact, as Arons further points out, the compromise that finally resulted in passage of the Patient Protection and Affordable Care Act (PPACA) was to preserve the "status quo" of Hyde, not expand it.

[T]he whole point of the compromise was to preserve the status quo, which included both restricted and unrestricted spheres of abortion funding.  Moreover, the terms of the agreement were carefully negotiated.  Abortion opponents who participated in the bargaining did not raise concerns about high risk pools or other specific potential sources of federal funding, and they should be able to live with the deal they made.

Second, the compromise was based on the fact that while federal funds would be prohibited from being used to pay for abortion, the law would maintain the availability of abortion coverage in health insurance plans by preserving the rights of women to use private funds to pay for that coverage. The high-risk pools are not "completely federally funded" (as Third Way asserts) because they in fact require participating individuals to use their own private funds to pay for their premiums. While the federal government is providing funding to offset the extremely high costs of providing insurance to those with pre-existing conditions, it is incorrect to say that this insurance will be paid for entirely with federal funds. That is yet another aspect of the "status quo" obliterated and an affront to the rights of all women to purchase and pay for the health care insurance they need.

Finally, the restriction on high-risk pools is not, as Third Way states, the same limitation placed on health care plans in the exchange. Subsidized individuals enrolled in a plan a state exchange will be able to purchase health insurance that includes abortion coverage as long as the health insurance company segregates the federal from private dollars to ensure that federal funds are not used for abortion. Participants in the high-risk pool, on the other hand, will be completely prohibited from purchasing health coverage that includes abortion coverage.

Claim 2: The high-risk pools are not like Medicaid

Third Way argues that the Administration "will apply the same rules to federal contributions in the high-risk pools as currently apply to federal contributions to Medicaid."

This is a misleading analogy. First, the Hyde Amendment does not apply to the high-risk pools because the funding does not go through the Labor-HHS Appropriations Act to which Hyde applies, but is appropriated directly from the Affordable Care Act. 

Even in making an analogy to the Hyde Amendment and the Medicaid program however, this analysis falls short. Third Way distinguishes the availability of abortion coverage in the Medicaid program versus the high-risk pools based on the ability of states to use their own funds to pay for abortion services under the Medicaid program.  While it is true that the newly created high-risk pools will not include state funding, the Hyde Amendment explicitly allows the use of both state and private funds for abortion coverage. If the high-risk pools did fall under the Hyde restriction like the Medicaid program, states could allow the coverage of abortion in their high-risk pools by using private funds to pay for the coverage.

Claim 3: The high-risk pools more closely parallel the Federal Employee Health Benefits Program (FEHBP)

Third Way next likens the high-risk pools to the FEHBP.

But these pools do not closely parallel the FEHB program. The FEHB is employer-based health insurance that provides health insurance benefits exclusively for federal employees, while the high-risk pools will provide coverage for individuals who cannot find insurance elsewhere due to a serious pre-existing condition, and as the Administration stated in the proposed rule, is a “temporary Federal insurance program in which the risk is borne by the Federal government up to a fixed appropriation.”  The fact that both FEHB and the high risk pools will be administered by the Office of Personnel Management (OPM), another assertion made by Third Way, also does not mean that the programs are similar.  In fact, OPM will also administer the multi-state plans established under the Affordable Care Act, which are not only separate and distinct from FEHBP, but will be allowed to cover abortion.

Again, Third Way persistently states that the high-risk pools are run with federal money by federal rules. The high-risk pools however, will actually include a substantial amount of private funds due to premium contributions from participating individuals. According to the federal government’s own health care reform website, the premium for an individual in New York state’s high-risk insurance pool will range to $400 to $600 per month. And while the federal government will administer some of the plans, 28 states will administer their own plans. 

Claim 4: This action does nothing to change the rules for private insurance plans.  

Third Way argues that the rules issued by the Administration do nothing to change the law for private insurance companies.

It is technically true that the Administration’s new restrictions don’t change those on health care plans in the exchanges under the Affordable Care Act.

However, Third Way incorrectly distinguishes the Stupak Amendment from the restriction on high-risk pools. In fact, like the Stupak Amendment, the restrictions prohibit those enrolled in the program from purchasing coverage that includes abortion with their own private money, which is the exact principle that was rejected when the Stupak Amendment failed to be included in the law. 

Third Way states that the restriction on the high-risk pools does not prohibit consumers from purchasing private insurance plans that include abortion coverage as long as they use their own money. However, the individuals who will qualify for coverage under the high-risk pools are by definition unable to purchase health insurance elsewhere on the private market.  Since there is no other way for these individuals to purchase health coverage, they are in fact prohibited from purchasing health insurance coverage that includes abortion with their own private money.

Third Way concludes that the Administration has applied “existing federal law and precedent.”

As Jessica Arons pointed out in her original piece, there is no existing federal law that requires this restriction for the newly-created high-risk pools. And the Congressional Research Service confirmed in a July 23rd 2010 memo to the Senate Committee on Health, Education, Labor and Pensions that the Hyde Amendment does not apply to the high-risk pools and that there is no other federal law or regulation, including the Affordable Care Act and the subsequent Executive Order, that requires this result.  

What Third Way’s analysis further neglects is the reality of abortion politics today, in which far right politicians, bereft of any ideas whatsoever to address profound economic, environmental and social challenges instead spend entire legislative sessions thinking up ways to make it increasingly difficult for women to prevent unintended pregnancies in the first place, or secure terminations of a pregnancy even when their lives are at imminent risk.

On all of these counts, Third Way’s analysis is a completely indefensible effort to excuse  a completely indefensible policy.

Let’s just call it what it is: This is a new restriction on coverage of abortion care for those who are most in need of comprehensive coverage, imposed by an Administration capitulating–yet again–to pressure from anti-choice groups. Last I remember, those groups did not vote for the President, contribute money to his campaign or campaign for him. Quite the contrary.

Still, Third Way for some reason sought to excuse it.  But the shallow nature of the analysis suggests that either Third Way didn’t read the laws involved, or doesn’t quite understand them, or both. Or perhaps the group is so enamored of its own limited analyses of the abortion debate that it completely misses or disregards what really motivates debates around sex and reproduction in this country–race, class, control of women, and craven power grabs by fundamentalist religious figures and politically opportunistic politicians.

The President broke a fundamental and profound promise by reaching outside an already-restricted law to further undermine women’s fundamental rights. There is no "third way" or other way to slice it.