An examination room at Whole Woman’s Health, an abortion clinic in McAllen, Texas, March 4, 2014. The clinic would possibly be the only open abortion facility outside of a major Texas city under restrictions upheld by a federal appellate court Tuesday. (Jennifer Whitney/The New York Times)
A desperate pregnant woman emailed my office recently. She was in a tough spot: She had enough money to buy diapers for her baby, or food for herself, but not both. She wanted help to pay for an abortion. She faced a pregnancy she could neither afford to continue nor afford to terminate.
This is typical of the stories I hear in my job as executive director of the Texas Equal Access Fund, which serves the northern half of Texas. Even sadder than her predicament was the fact that our organization only has enough money to support fewer than half of the thousands of people who call us asking for help.
An abortion typically costs anywhere from $450 to $3,000, depending on factors including number of gestational weeks. The per capita household income for Texas is $26,327. This is why those who seek to undermine access to abortion have had the most success doing so by going after people’s ability to afford the procedure. The Hyde amendment, for example, added to the federal budget in 1976, placed a restriction on Medicaid funds for abortion, and abortion remains the only procedure ever banned from Medicaid.
During the Texas legislative session that just ended, the Senate considered bill SB575, a measure that would restrict private health insurance plans and those offered on the federal exchange through the Affordable Care Act from covering abortion unless the abortion was medically necessitated due to threat of death or irreversible physical damage to a major bodily function. However, if the damage were to be psychological or emotional, or even if the threat of physical danger didn’t meet the exceedingly high threshold set by the law, the procedure would not be covered. The law would also not include coverage for people who’ve become pregnant through rape or incest, or cases of severe fetal abnormality.
This is just one more way that numerous states have tried to limit access to abortion. While the measure eventually failed in Texas, 28 states have enacted similar laws that prohibit either private insurance or insurance purchased through exchanges, or both, to cover abortion, requiring people to purchase a specific rider to their policies if they would like abortion coverage.
Banning abortion from private insurance plans is an extension of policies like the Hyde Amendment and the Helms Amendment, which ban the use of federal funds to pay for abortion, both domestically and abroad. In 2011, there were 13.5 million women of reproductive age with full Medicaid benefits in the United States, and all of these women are possibly impacted by the lack of coverage for abortion. While Texas leads the nation in uninsured, barring coverage from including abortion puts as many as 3,656,772 women of reproductive age without coverage for abortion.
These policies not only make it hard for many to access an abortion, but they reinforce the idea that abortion is not simply a medical procedure that is part of a full spectrum of reproductive healthcare, but instead that it is a shameful and immoral act.
But what is shameful and immoral is denying access to women who need it. Through my work, I hear stories from people who will see their education derailed by carrying a pregnancy to term, victims of sexual assault and domestic violence who are pregnant against their will, and people who are struggling to feed and care for themselves and the children they already have. When we say it is okay for them to be denied access to abortion simply because some people would not like to pay for it, we’re saying that they do not deserve to have a full range of options to make determinations for their own futures. Isn’t the ability to make determinations for oneself and one’s future at the very heart of the American ideal? I believe so.
But those who support these types of policies often justify their stance by saying no one should ever be required to pay for something that they find morally problematic, even if they’re paying for it indirectly through taxes or premiums. In a representative democracy like ours, it would be impossible to avoid this though. Nationally, Americans have varied views on military spending, but our government has decided that national security is more important than individual opinion.
In Texas, state funding is used to pay for the Alternatives to Abortion program. This program consists of crisis pregnancy centers across the state that offer to help pregnant women, but do not offer medical services other than sonograms, will not refer clients to abortion providers even if requested and provide factually incorrect information about the risks of abortion in an effort to persuade them against the procedure. Plenty of people find this program morally reprehensible. And yet taxpayer dollars are used to support it.
When we look at abortion, on the other hand, 70 percent of registered voters in the United States polled in 2014 responded that they believe the government should not place restrictions on access to abortion. While many people have mixed or uncomfortable feelings about abortion personally, the majority of people support a legal right and access to abortion. But if they cannot afford to pay for the procedure, it is inaccessible. Thus, policies like SB 575 and similar policies in other states, Hyde, and Helms are in direct opposition to the idea that government should not restrict access.
By pushing back on policies specifically targeted at restricting low-income people’s access to abortion, we’re expanding the right to include everyone. No one should be denied healthcare simply because of economic circumstance.
If you care about reproductive freedom and people’s access to abortion, I challenge you to contact your legislators, both on the state and federal level, and let them know that you oppose discriminatory policies that ban funding for abortions for those who cannot otherwise afford them.
For the people I serve and others like them, that is the only path to a real choice.