Women enrolled in Maine’s Medicaid program, known as MaineCare, are assured that nearly all pregnancy-related care — including prenatal care, delivery and miscarriage management — will be covered. Abortion care, however, is not covered.
Mabel Wadsworth Center joined the ACLU of Maine, Maine Family Planning and Planned Parenthood in 2015 to sue the Maine Department of Health and Human Services to change that. If successful, a serious injustice would be reversed, as MaineCare beneficiaries would — for the first time since 1981 — have true options when facing a pregnancy.
Covering most but not all pregnancy care is coercive and discriminatory. In our view, it’s also unconstitutional and violates Maine law. Last month, the Maine Superior Court decided to uphold MaineCare’s practice of refusing to cover abortion. We filed an appeal to the Law Court on Nov. 8 and expect a favorable outcome. Failing to overturn this policy, however, could be disastrous for Maine women.
As a provider of comprehensive pregnancy care — including abortion care and prenatal care — this distinction feels particularly onerous. MaineCare beneficiaries are poor by definition. The fact that the program will cover all pregnancy-related care through labor and delivery and then cover health care for her child but won’t cover an abortion is highly coercive.
While the majority of women are confident about their decision to have an abortion, it isn’t unusual for a client to arrive at her first appointment with uncertainty about an unintended pregnancy. When that happens, we provide options counseling and encourage her to take some time to make her decision. But when one option is funded and the other is out of reach financially, a woman may as well have no options at all.
When insurance covers the cost of carrying a pregnancy to term but won’t cover abortion, we are punishing poor women. Just as some men control women’s bodies through sexual assault, abuse and sexual harassment, this policy controls and coerces poor women. And it’s important to note that these women already have the fewest resources — they are also more likely to be women of color, immigrant women and young women.
Nearly 60 percent of our clients need financial aid to help cover the cost of an abortion at our clinic. Nationally, nearly one in four women enrolled in Medicaid who seeks an abortion is forced to carry her pregnancy to term because she cannot afford the care she needs. And it’s important to understand that things don’t improve after that. Studies also show that a woman who seeks an abortion but is unable to access one is more likely to fall into poverty than one who is able to get an abortion.
There are already too many barriers for women seeking abortion, especially those living in rural communities. Every day, we see the many hurdles women must clear just to reach us: among these, having to miss work, arrange childcare, find transportation and manage other health issues. This harmful coverage ban places an additional roadblock by forcing women to scrape together funds, often resulting in a delay in getting the health care they need. A woman’s right to decide to have an abortion shouldn’t depend on how much money she makes or where she lives.
At issue is power. Restricting access to abortion is one of the most insidious ways that patriarchal, misogynist and racist politicians exert such power. By controlling women’s bodies, politicians restrain women from exercising their constitutional and human rights and achieving their full potential.
This has to end. We can no longer abide by an antiquated policy that treats women and their health care as other at best and shameful at worst. Instead, let’s trust women to know what’s best for their lives.
As a health care provider committed to protecting and advancing meaningful access to abortion care, Mabel Wadsworth Center will continue to raise funds to help our clients access abortion no matter what. We will also continue to work to dismantle the systems and structures that keep women and other vulnerable people down — poverty, racism, misogyny, homophobia and xenophobia — and artificially inflate the power and privilege of others.
Andrea L. Irwin is executive director of Mabel Wadsworth Center in Bangor.
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