Whether or not some of us are uncomfortable with the word or the current statistic, nearly 1 in 3 American women have an abortion in their lifetime, making the procedure a common secret in the lives of women across this country. Depending on one’s viewpoint, the actual incidence may be more or less common than you believe. What is common is that many people think they don’t know anyone who has had an abortion.
It’s likely we do, but this medical procedure has been so stigmatized and politicized that the people we do know don’t talk about their experience. One reason for this stigma is that abortion is the only medical procedure that is banned from most public insurance funding.
September 30 is the 40th anniversary of the Hyde Amendment, a piece of legislation that is not enshrined law, but rather a federal appropriations “rider” that is voted on annually. This policy bans Medicaid recipients from using their insurance to obtain an abortion, except in very specific instances (rape, incest, threat to the life of the woman). For a simple procedure that can still cost upwards of $500 (if done during the first trimester), lack of insurance coverage can be a huge barrier, especially for the low-income women who typically use Medicaid and are already struggling economically.
Medicaid recipients, however, aren’t the only ones who suffer under this policy. Since it was introduced, the Hyde Amendment ban on government funding for abortion has been extended to, among other places, military personnel, Peace Corps volunteers, federal employees, federal inmates, Native Americans and residents of Washington, DC (without representation, Congress makes these decisions for them). What’s more, as this public funding ban has normalized, the idea that abortions shouldn’t be covered by insurance has spread and private insurers have gotten in on the act.
Congress forced the Affordable Care Act to exclude abortion coverage in its federal marketplaces, and the North Carolina General Assembly bans insurance coverage in our state marketplace (and forbids state employee insurance from covering the procedure). Some private insurers have taken this one step further, by opting out of offering abortion coverage in small group or individual plans, on the premise that it is an “elective” procedure (in much the same way that most every other procedure that is not emergency could be considered “elective”). The stigma perpetuated by the Hyde Amendment of 1976 has a long reach.
In a society in which even those labeled “middle class” have trouble coming up with $400 for an emergency, lack of insurance coverage – public or private – can make the difficult situation of an unintended pregnancy even worse. But while funding bans and unnecessary restrictions that can increase the cost (for things like travel, time away from work, etc.) make abortion care difficult to obtain for many, the burden of these bans falls hardest on those who traditionally have had difficulty accessing any kind health care – poor women, women of color, young women, rural women, immigrant women and queer women. And that, of course, was the intention. When introducing this bill back in 1976, Rep. Henry Hyde indicated that while he couldn’t stop all women from getting abortions, he could at least stop the ones who needed government assistance. Who are also those who traditionally have had less political power and voice in public policy.
In an often racist, sexist and classist system that makes it increasingly difficult to break out of generational cycles of poverty, marginalized women are left with few options to exercise control over their reproductive lives. In a state with higher-than-average uninsured rates, and in a nation where one’s employer can insist on not covering contraception, it’s not as easy as it should be to prevent unintended pregnancies. Abortion is becoming increasingly out-of-reach, and the social safety nets needed to help low-income women raise the children they do have are constantly under threat of additional cuts.
Poor women have a multitude of reasons, many economic, for seeking an abortion, just like wealthier women. But unlike women of means, poor women are subject to political interference and public judgment that richer women do not face. And, sadly, that is the value that is being expressed by these continued funding bans: wealthy women can do what they want, and poor women will have their most personal decisions controlled by others. With recent polling demonstrating majority support for the idea that politicians shouldn’t deny this health care coverage based on income, we know this is not a value shared by most Americans. That’s why it’s well past time to repeal Hyde.
Tara Romano is the Executive Director of NARAL-Pro Choice North Carolina and President of North Carolina Women United.