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Of course, in practice, obtaining Medicaid coverage even in the very limited circumstances allowed under the Hyde Amendment is often difficult or impossible . Unreasonable and confusing claims procedures, combined with inaccurate information suggesting that extensive documentation is required for reimbursement in cases of rape, can delay or even prevent reimbursement altogether . As a result, some abortion providers have stopped seeking reimbursement for services or refuse to accept patients on Medicaid, which further limits access to reproductive health services for low-income women .22
As women of color are more likely to experience unintended pregnancy and more likely to seek abortion care—while also being more likely to qualify for public insurance—they are especially impacted by unjust bans on abortion coverage . Additionally, immigrant women are more likely to be born into poverty than women born in the U .S .; immigrant women who otherwise qualify for Medicaid cannot receive federal Medicaid benefits for their initial five years of residence, nor can they purchase health insurance coverage in their state marketplaces at full price .23 Women of color and immigrant women are bearing disproportionate burdens of this short-sighted policy, threatening their health and that of their families .
In addition to the Medicaid restrictions, 21 states have restricted or banned abortion coverage in insurance plans for public employees, whose ranks may include teachers, firefighters, and other government employees .24 And many states also have banned coverage in private insurance plans, including plans offered through state health care exchanges under the Affordable Care Act .25 In fact, in the five years since the passage of the Affordable Care Act, half of all states have restricted insurance coverage of abortion in plans sold in state health insurance marketplaces or exchanges .26 It is unconscionable that politicians are holding back coverage for essential health care from a woman just because they disagree with her decision to have an abortion .
The impact of these restrictions are real . Poor women who seek abortions are often delayed up to three weeks in receiving the procedure while they raise the necessary funds, delays that can drive up the cost and may increase the risk of the procedure .27 For many low-income women, trying to raise the necessary funds means forgoing basic necessities such as food, rent, or utilities .28 For some women, the lack of coverage makes accessing abortion impossible . Research demonstrates that due to funding restrictions, approximately one in four women who would have obtained an abortion if Medicaid funding was available instead carry an unwanted pregnancy to term .29 While researchers continue to study the effects of carrying an unwanted pregnancy to term on a family’s economic status, it is unconscionable that politicians can make it harder for low-income women to get abortion care just because of where they get their insurance .
22 The High Cost of State Bans on Abortion Coverage, cenTer for reproducTive righTs 2, http://www.reproductiverights. org/sites/crr.civicactions.net/files/documents/The%20High%20Cost%20of%20State%20Bans%20on%20 Abortion%20Coverage.pdf.
23 Id. at 3- 4.
24 Id. at 2.
25 Id. at 3.
26 Id.
27 Heather Boonstra & Adam Sonfield Boonstra, Rights without Access: Revisiting Public Funding of Abortion for Poor Women, 3 The guTTmacher reporT on puBlic policy n.2, 10 (April 2000), http://www.guttmacher.org/pubs/tgr/03/2/ gr030208.html.
28 Id.
29 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.
Impact: Collected Essays on the Threat of Economic Inequality