To many, Roe v. Wade represents the fundamental right of a woman to choose abortion. The 42 years since Roe, however, show how illusory that right is for some and the sharp contrast between the haves and the have-nots.
The 114th Congress, fresh off a series of promises to better the lives of all Americans, made its debut by readying votes on five bills to undermine women's health. The new Republican majority's actions come at a time of significant gains in health care for some, while others continue to experience sobering inequities. The Affordable Care Act has brought coverage to 10 million people, dropping uninsurance levels to near record lows in the past four decades. The 28 states expanding Medicaid have provided a lifeline to millions, offering them coverage they would otherwise never be able to afford.
As the insurer for millions of reproductive-aged women, Medicaid plays a key role in advancing low-income women's health. Every person should be able to expect coverage of health care services that meet evidence-based standards of care. Medicaid does that by providing, among other services, coverage for birth control, well-women's health visits, pregnancy care, prescription drugs and emergency care. Yet, there is one glaring omission from the services needed to meet the standard of care for women.
Medicaid does not cover an abortion in all cases when a woman needs it.
The prohibition, known as the Hyde Amendment, has played politics with women's health since 1977. As Mr. Hyde put it, "I would certainly like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman. Unfortunately, the only vehicle available is the... Medicaid bill."
The amendment bars federal funding for abortion, including in Medicaid, except in the narrowest of circumstances: rape, incest or where a woman risks death if an abortion is not performed. Thanks to Mr. Hyde, poor women must balance their health needs and futures against the weight of their pocketbooks.
It is impossible to divorce dollars from the conversation. The average cost of a first-trimester abortion is $451. The median weekly earnings for women in 2013 was $706. A woman relying on Medicaid for her health care may earn far below poverty wages. Low-income women and women of color experience the highest rates of unintended pregnancy by far, as high as five times that of higher earners. This is why Medicaid is so crucial for caring for millions of women of reproductive age. And why the Hyde amendment so cruelly targets them.
Abortion is part of the full range of reproductive health care that must be available to all women, not just the ones that can afford it. A woman may decide to seek an abortion for a myriad of personal, socio-economic or health reasons. She may not be ready to start a family. She may already have the number of children she can best care and provide for. She may feel too young or too old to become a parent. Or pregnancy may compromise her health. Only a woman knows what is best for herself and her family--not politicians.
A woman who is struggling just to get by and unexpectedly becomes pregnant faces an arduous battle of coming up with the hundreds of dollars for an abortion. By the time she scrapes together the cash, she may have more trouble finding a provider or may run up against state gestational time limits crafted by abortion opponents. A later abortion is thus harder to come by and, while abortion is safer than childbirth, a later abortion can pose more risks to the mother.
Singling out abortion from other forms of health care forces one in four poor women to carry an unintended and unwanted pregnancy. Childbirth is fraught with risk that is particularly unequal for women of color. African American women, for example, are three times more likely than their white counterparts to die from pregnancy-related complications.
Playing politics with Medicaid coverage threatens women's physical health and economic security. The landmark Turnaway Study found that women denied abortion are more likely to live in poverty and rely on the public safety net than women who receive an abortion. The Hyde amendment cements these inequities. As a result, the women most likely to experience an unplanned pregnancy have the least resources for managing in a way that makes sense for their own health and their families.
On yet another anniversary of Roe, women's health opponents in Congress will mark the occasion by voting for a national ban on abortion at 20 weeks -- another attempt to overturn the Supreme Court's decision. Even if the ban fails, the right under Roe will still not be realized for millions of women.
So long as we have the Hyde amendment, we will be a nation of haves and have-nots.