The right to an abortion evokes strong emotions among its opponents and its supporters. What should not be tolerable to either is an unequal health care system that denies services to those who cannot pay for them.
But that is the system we have with abortion. It is one of only a few procedures that is highly restricted by MaineCare, the state’s insurance program for the poor. Regardless of one’s opinion on abortion, it is legal and the U.S. Supreme Court ruled in 1973 that women have a constitutional right to obtain an abortion. Extending that right only to women with money is wrong. It may also be unconstitutional, which is the crux of a case currently pending before the Maine Supreme Judicial Court.
Maine lawmakers can end this two-tiered system by passing LD 820. The bill, which has been endorsed by the Legislature’s Health and Human Services Committee, would require MaineCare, the state’s Medicaid program, to cover abortion services, just as it covers pregnancy as well as maternal and infant care.
A 1981 state rul e, updated in 2010, prohibits the use of state funds for abortion, except in cases of rape, incest or if the life of the mother is in danger. A similar federal prohibition, the Hyde Amendment, bars the use of federal funds for abortions except in these instances. Most states have similar restrictions, though they have been overturned in 15 states, including Massachusetts and Connecticut, by lawsuits similar to the one filed in Maine. Five states cover abortion voluntarily.
Maine should as well.
Along with requring MaineCare to cover abortion using state funds, LD 820 extends the requirement to private insurers participating in the Affordable Care Act if they also cover maternity care — with an exemption for religious employers. This is necessary because the Trump administration is in the process of finalizing a new rule for insurance providers that sell health insurance through the Affordable Care Act marketplace.
The rule would require these insurance providers to send two separate premium payment bills to every customer: one for their general health coverage and one for abortion services. Every customer would be sent a separate bill for the small portion of their insurance premium that covers abortion services — about $1 a month — although many would never use these services.
No other health service — such as cancer treatment, pregnancy care or impotence treatment — is subject to billing like this because health insurance policies cover hundreds of procedures for their pool of subscribers, most of which an individual subscriber will never use. The intent of the rule is to stir up anger about abortion, not to ensure comprehneisve health care.
LD 820 would ensure that Maine women with private health insurance through the ACA would continue to have access to abortion services when the new Trump administration rule goes into effect.
“Access to the full spectrum of reproductive health care is integral to a person’s physical, mental, and economic well-being,” Molly Bogart, director of Government Relations for the Maine Department of Health and Human Services, told members of the Health and Human Services Committee in March. “We believe that every person in Maine has the right to make their own personal medical decisions and access sexual and reproductive health care when and where they need it. It is critical that everyone in this state has access to affordable, high-quality health care, including reproductive services, and that they can obtain them free from harassment, intimidation, and undue barriers to services.”
Opponents of the bill argue that they don’t want their tax dollars or insurance premiums to pay for a procedure they find abhorrent. We understand their passion, but taxpayers don’t get to pick and choose where their money goes. Many people object to war and don’t want to fund the Pentagon with their tax dollars. Others don’t want their money to support the IRS or federal arts programs.
Restrictions don’t reduce the number of abortions. Rather, they put women, especially poor women, at risk of complications from delayed abortions and unintended pregnancies.
In Maine, more than a third of all pregnancies are unintended. The rate of unintended pregnancies is significantly higher among women who are low income or unmarried, part because of the inequality in access to health care, contraception and family planning education.
Children born from these unintended pregnancies are at greater risk of negative physical- and mental-health outcomes and are more likely to drop out of high school and engage in delinquent behavior as teenagers, the Brookings Institution reported in 2011.
In addition, unintended pregnancies in Maine cost the federal and state governments $58.2 million in 2010, the Guttmacher Institute found.
Even those who strongly oppose abortion should agree that legally guaranteed, comprehensive health care should be available to all women, regardless of what insurance plan they have.