Page 83 - Impact: Collected Essays on the Threat of Economic Inequality

health insurance plans under the Affordable Care Act means that millions of women can now access contraception without the barrier of a co-pay, a stunning public health and public policy achievement with a proven economic benefit for women; however, fully funding family planning programs continues to be essential to ensuring contraceptive access for everyone .
Further, expanding the joint federal-state Medicaid program improves family planning access, as Medicaid accounts for the vast majority of public funds expended on family planning .15 So far, only 28 states and the District of Columbia have expanded Medicaid coverage as allowed under the Affordable Care Act, thereby rejecting an opportunity to improve access to family planning for low-income women, largely on political grounds .16 Politicians cannot honestly claim to be slashing family planning budgets in order to be fiscally responsible, as investing in public family planning services consistently yields net savings for governments .
Access to Abortion Care
The disparities that exist in rates of unintended pregnancies understandably translate into disparities in rates of abortion . Despite an overall 11 percent decrease in the abortion rate between 1994 and 2000, low-income women saw their abortion rate rise 25 percent .17 Women living below the poverty line have an abortion rate of 52 per 1,000 women of reproductive age, while higher-income women (with family incomes at or above 200% of the poverty line) have a rate of nine abortions per 1,000 .18
Meanwhile, there has been an explosion of bills in state legislatures aimed at restricting access to abortion . The resulting laws, passed under the guise of protecting women’s health and safety, actually undermine women’s health by reducing access to services . State-enacted barriers to safe abortion care can be difficult for anyone to navigate, but they are especially burdensome for low- income women, as such legislative barriers often raise the cost of abortions, increase the time it takes to receive the procedure, and increase the distance women must travel . These laws contribute to abortion stigma and undermine women’s lived experiences and decision-making capabilities .
One of the most obvious examples of how public policy decisions make it more difficult for low- income women to access abortion care is the exclusion of coverage for abortion care for women who qualify for public health insurance, through the Medicaid program . Since 1976, the so-called Hyde Amendment has banned federal Medicaid coverage for abortion except in the most narrow of circumstances .19 Currently, abortion coverage using federal Medicaid dollars is available only if the woman’s life is endangered by continuing the pregnancy or if the pregnancy is the result of rape or incest .20 Medicaid-eligible women in 32 states and the District of Columbia suffer under these unfair restrictions .21
15 Adam Sonfield et al., The Social and Economic Benefits of Women’s Ability to Determine Whether and When to Have Children, guTTmacher insTiTuTe 4 (Mar. 2013), http://www.guttmacher.org/pubs/social-economic-benefits.pdf.
16 Where the States Stand on Medicaid Expansion, The advisory Board company (Feb. 11, 2015), http://www.advisory. com/daily-briefing/resources/primers/medicaidmap.
17 Rachel K. Jones & Megan L. Kavanaugh, Changes In Abortion Rates between 2000 and 2008 and Lifetime Incidence of Abortion, 117 OBSTETRICS & GYNECOLOGY 1358 (June 2011), http://journals.lww.com/greenjournal/ Fulltext/2011/06000/Changes_in_Abortion_Rates_Betweeen_2000_and_2008.14.aspx.
18 Id.
19 Stanley K. Henshaw et al., Restrictions on Medicaid Funding for Abortions: A Literature Review, guTTmacher
insTiTuTe 1 (June 2009), https://www.guttmacher.org/pubs/MedicaidLitReview.pdf.
20 Id.
21 Id.
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