Post has been updated since original publication
The Obama administration is poised to extend the reach of federal restrictions on abortion funding to new high-risk insurance pools, a supplementary system for people at risk of being shut out of ordinary private insurance due to preexisting medical conditions. The pools will exist until 2014, when new rules that ban providers from rejecting people based on preexisting conditions begin. This basically means that the spirit of the notorious Stupak amendment, which would have broadly preempted any federally supported insurance program from covering abortion services in the new health care system, has become reality.
For many reform advocates, 2010 will be a banner year for health care, as states begin setting up insurance exchanges and other measures to broaden access for the uninsured. But many in the reproductive rights community fear it could also be the year that an uphill struggle turns into a losing battle. In the states and in Washington, lawmakers are chipping away at abortion rights bit by bit.
Jessica Arons of the Center for American Progress explains that the Obama administration claims the step is simply carrying out the status quo of the Hyde amendment, a longstanding restriction on abortion funding in federal programs like Medicaid. In reality, however, the policy precedent the Obama administration used to justify this new ban, the Federal Employees Health Benefits Plan, is more pernicious because it blocks women from even spending their own money on abortion services within the plan:
The FEHBP, like the Stupak Amendment, imposes a total ban on non-Hyde abortion care, meaning that non-federal money cannot be used to supplement premiums in order to purchase a plan that includes abortion coverage. Thus, without even any political or legislative benefit to receive in exchange, the Obama Administration has imposed a more restrictive abortion funding rule on PCIPs than is required for health insurance exchanges or Medicaid. (Emphasis added.)
And who gets to be the guinea pig for these enhanced restrictions? The women least able to protest, of course:
Women entering these plans are, by definition, those who have experienced serious medical conditions--so serious that insurers are unwilling to sell them insurance. In other words, those who get pregnant are already at a heightened risk for needing an abortion for health reasons when compared to the general population.
The high-risk pools haven't been implemented yet, so we don't know who will be most affected. But because the women who match this profile currently suffer a debilitating health condition, they are also, by definition, far more likely to be of color. The plague of racial health disparities--including both poor health and a lack of insurance--has found a new breeding ground, ironically in a federal program designed to remedy those very inequalities.
But while the Obama administration has meekly rolled over for the GOP and the anti-abortion lobby, it's really the state houses that are doing the heavy lifting. As we pointed out previously, state lawmakers from Oklahoma to Missouri are devising novel ways to strip away a woman's right to choose, like forcing them to undergo ultrasounds before an abortion. By far the most effective anti-abortion tactic, though, is to make sure women are too poor to get one. In Virginia, reports NARAL's Tarina Keene, assembly members have approved a bill that would ban state funds for abortion, even if the woman's health faces substantial endangerment.* Again, the sickest and the poorest women are explicitly targeted by this bill--just to save the state roughly $150,000.
Moreover, it's an open secret in Washington that the abortion rates of Black and Latina women are higher than others due to a variety of often misunderstood, and typically ignored, social factors like poverty and inadequate preventive health care.
And so now we come full circle in the doomed cycle of inadequate care, eroding health, and crisis passed on from generation to generation. 2010 has been a big year for health care reform, but the families on whose backs those legislative victories were won have little to celebrate.
*A previous version of this post incorrectly reported that the Virginia bill would provide funding for abortion when a woman's health is at risk.
Photo: White House