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Without a right to healthcare, how could there be a right to abortion?
A quick thought on the end of Roe.
This post originally ran on iNews.com. I’m republishing it here with their permission.
Abortion is healthcare, advocates remind us. No wonder, then, that Americans have no right to it.
Though the leaked decision to strike down Roe v. Wade won’t become law until the court officially publishes it, triggering immediate abortion bans in 13 states, the procedure is already all but banned in many states. Texas passed a notorious law in 2021 that banned abortion after six weeks, well before many women know they’re pregnant. In 2021, 39 per cent of reproductive-age women lived in counties with no abortion providers, and several states had only one clinic to serve millions of women.
Like so many supposed rights in America, the “right” to abortion is mediated by income, by geography, by chance. If you have to drive hundreds of miles, cross state lines, risk prosecution, and beg a charity for funding to get an abortion, you don’t have a right to it. This is already the case for millions of Americans, and has been for years.
As with the rest of American healthcare, the consequences of restricted access to abortion are more widespread and more dire for poor people and people of colour. The United States guarantees no right to healthcare. An emergency room has to treat you if you show up bleeding, but they can still send you an astronomical bill and take money directly from your wages, or even have you arrested, if you don’t pay. There is no right to chemotherapy or insulin; no right to see a primary care doctor, let alone an oncologist. Abortion is no different.
This is compounded by the absurd bureaucratic and financial hurdles that stand between Americans and healthcare, which plague even the well-off but are far more severe and consequential for the poor. Poor women already face a cost barrier to abortion, including restrictions on coverage of abortion under Medicaid, the joint federal-state health insurance program for low-income people.
To qualify for this program in most states, recipients must earn less than 138 per cent of the federal poverty level, which is $18,754 (£14,943) for a single person. In 12 states, Medicaid is still not available on the basis of income alone—to qualify, recipients must also be disabled, pregnant, elderly, or a parent/caretaker. States also conduct routine re-evaluations of income that result in coverage losses, even for eligible people.
A little over half of women live in states that do not cover abortion under Medicaid using state funding—federal abortion funding is already banned by the Hyde amendment, except in cases of rape and incest—and more than half of states ban abortion coverage for Marketplace plans, which are available with income-based subsidies to people who make too much for Medicaid but don’t have employer-provided insurance. Even now, with Roe in place, most people end up paying for abortion out-of-pocket, with the most commonly-cited reason being lack of insurance coverage.
After Roe falls, the number of self-managed abortions will grow. If we’re lucky, these will continue to be driven by safe abortion-by-mail, using the drug mifepristone. Charities like Just the Pill and telehealth companies like Choix, which charges $289, provide solutions for many. (That’s more than the monthly income limit for a single mother to access Medicaid in Texas.) But there are already severe restrictions on access to mifepristone. In 19 states, the law requires a physician to be physically present when the pill is taken, even though it’s safer than paracetamol.
A majority of states require at least one in-person visit to receive the pill, in a country where 25 per cent of the population has no primary care physician and 31 million people lack insurance. Without insurance, even a simple primary care visit costs hundreds of dollars. Lab tests and drugs cost extra. In a 2021 study, one in five women choosing to self-manage abortion cited the lack of access to a clinic—but a higher proportion, one in four, said it was too expensive to visit a clinic. Half of all OB-GYN medical students will be banned from learning how to perform abortion, setting up future generations for even more limited availability.
Women of all income levels will suffer from the end of Roe, but it will be felt hardest by women whose access to healthcare is already limited or nonexistent. The war on abortion is an imposition of backwards religious views, the result of a minoritarian government and an erosion of democracy. It’s also perfectly fitting for a country that doesn’t guarantee healthcare, where diabetics cross the border to Canada just to purchase insulin and where uninsured people die every day of preventable, treatable illness. Why would abortion be any different?