Last weekend, my friend (one of those types who’s an encyclopedia of random knowledge) dropped an interesting fact on me. She said that women who are on Medicaid, the government-issued insurance plan for people who can’t nearly afford medical care, are not covered if they would like to have an abortion. As someone who’s pro-choice, this kind of shocked me. First, because it feels a little bit Big Brother. And second, because if someone qualifies for the program they almost certainly will have a hard time coming up with the quarter-million dollars it takes to financially support a child through age 17. And they may be looking for other options than having a baby.
I had to get to the bottom of this. So I put in a call to my home county’s Medicaid office and after chit-chatting with some well-versed people on the subject in New York state, I’ve got some deplorable facts to report about abortion coverage. Err, termination coverage. The first thing I learned is that Medicaid workers don’t like the word “abortion.”But before I jump into the nitty gritty, some background on abortion funding. For a three-year period after Roe v. Wade was passed in 1973, Medicaid fully covered abortion care without restriction. Then in ’76, Representative Henry Hyde, a Republican from Illinois, introduced the Hyde Amendment which limits federal spending on abortion services. After a few decades of deliberation, it currently stands that Congress has barred the use of Medicaid funds to pay for abortions unless a woman’s life is endangered, the woman was raped or the woman was subjected to incest. [ProChoice.org]
As far as federal spending is concerned, only low-income women with extremely specified needs for termination can receive the funding. But states can make legislation that expand upon the Hyde Amendment for their district and add more funding for women in both physical and emotional need. This is the case in 17 states—from Hawaii to New York—where coverage is available for practically all medically necessary reasons. To find out if you live in one of these states, visit State Health Facts.org. Thus far, I think most people will agree that everything I’ve said isn’t too surprising due to the religious leanings of the United States. The thing that blows my mind is not how the states decide what reasons make a woman eligible for coverage, but how the states determine who is financially eligible to receive Medicaid coverage and if access would be made available to them if needed.
One Medicaid worker who wished to remain anonymous said, “It pays to be poor if you want to have a termination of pregnancy.” It seems that regardless of your reason for an abortion, the needier you are financially, the easier it is to get the procedure. And when I say needy, I mean you have to have practically nothing to be eligible. The Medicaid worker explained to me that, currently, the Medicaid eligibility level stands at $767 a month for a person living on his or her own. With each additional family member, the poverty level raises a few-hundred dollars. So as of right now, if you’re a single woman making $300 a week, you’re not eligible in the state of New York to be covered for an abortion, even though the average cost of the procedure in the U.S. is $468. [Guttmacher]
So basically, if you’re a lower-income working person with a job, chances are you’re not going to receive funding. Unless, you cheat the system and lie. Since legislation for pregnant women has been put in place to help the unborn and not necessarily assist in terminations, there is a loophole where needy women who aren’t covered can get help, but it’s not really legal.
How the loophole works is that a state arrangement known as Prenatal Care Assistance Programs or PCAP providers, offer pregnant women 45 days of services before they require the women to comply with Medicaid laws. The 45 days exist to grant pregnant women help immediately, without having to worry about paperwork. Since the PCAP program was specifically set up to help those in need, they’re not looking to catch anyone lying. So if a lady seeking an abortion goes to a PCAP provider, reports she has no income and medically requires an abortion, she will be able to access medical services for her termination. A doctor who accepts Medicaid can perform the procedure at no cost to the client and it will be covered without eligibility having to be established. If the client then never establishes Medicaid eligibility within the 45-day period, she will be denied ongoing medial benefits thereafter. However, her needs have already been met for the termination, but at the government’s expense.
While this doesn’t seem kosher, it’s likely one of many loopholes that exists in state legislation. And though the system isn’t perfect, this type of side effect to imperfect legislation truly helps out those in need, but who are not the absolute neediest.
Taxpayers, before you get all up in arms, this loophole is one of the best variables out there for your tax dollars as well. If this legislative side effect didn’t exist, a woman desperate to terminate could be driven to an extreme and might do something much more medically damaging to herself. This alternative would probably end up costing the taxpayer far more in the long run. So for now, it’s much less money than the state would end up spending if an alternative played out. And a much bigger positive to this program is that women who wish to carry their pregnancies to term are provided with prenatal care for their unborns. This is a double-edged sword that’s good on both sides.
But back to those women who need help but don’t have the coverage. Though it totally sucks to have to lie instead of being legally covered by Medicaid, at least the option to fib exists in the state of New York. For women outside of the 17 states with addendums to Hyde’s Amendment, there is little leeway, as access to these services is not provided. The Guttmacher Institute “found that 20-35 percent of Medicaid-eligible women who would choose abortion carry their pregnancies to term when public funds are not available.” So women who would choose abortions but have no option remain pregnant and give birth to unwanted babies due to limited access.
Obviously creating loopholes in all of the states is not the answer. Rather a solution lies in better federal health-care legislation for pregnant women. But sadly, people like Salon.com writer Frances Kissling fear that changes are not coming soon. So for now, we’re creating a never-ending cycle of poverty.
Since this is such a sensitive subject, it’s hard to say what the government will end up doing. But with Obama’s health-care reform plan pending, anything could happen. If you’re interested in learning about the changes that could be made to the Hyde Amendment and how it will affect you, visit The Hyde Campaign.
And I’d like to hear from you. What do you think about all of this? Should the federal government reevaluate what one has to do to access funding for an abortion? Should Medicaid expand income guidelines for different medical situations or should they be standard? Should nothing change? Tell me what you think.