For Low-Income Women, Lack of Coverage Leads to Anxiety, Unnecessary Delays in Terminating Pregnancies

Regardless of the current state of health care insurance in this country, a woman obtaining abortion care can expect to pay for the surgery on her own.

Perhaps, for example, her insurer claims to cover elective abortion services but there are in reality no in-network providers in her region. Or perhaps her insurer fails to reimburse payment for abortions—jeopardizing a clinic’s ability to afford to provide quality care if they are willing to accept her claim.

Her insurer may not cover elective abortion at all or she may be uninsured, a government employee without coverage for abortion care, or a member of the military or undocumented.

Certainly, she is out of luck if her health care coverage is through Medicaid in one of 32 states or Washington, DC , where Medicaid refuses to cover the fees for abortion services unless her life is imminently threatened or she was raped and has filed a police report.

For residents of the District of Columbia, the hope of vital changes to Medicaid coverage of abortion services is on the horizon. As reported by RH Reality Check:

Last week, the House of Representatives passed a spending bill, the Financial Services and General Government Appropriations Act, that included a provision for lifting the ban on Washington, D.C.’s use of local funds to pay for abortion services for low-income women. Efforts to lift the ban now move to the Senate.

In theory, if also approved by the DC council, Medicaid would then cover abortion services for recipients in DC.

Currently, a woman seeking abortion care in DC will need anywhere from $250 to $6,000 to cover the cost of a surgical abortion and the longer the delays in obtaining a procedure—the longer it takes her to confirm her pregnancy, choose the most realistic solution for herself and her family and raise the money to personally afford the health care fees–the more expensive the surgery will be.

For a single, uninsured mother of one child to qualify for Medicaid coverage in DC, her annual income cannot exceed $42,000. The average annual income for a single mother of one child who qualifies for financial assistance from the DC Abortion Fund is approximately $7,000—more than 50 percent less than the federal poverty guideline for a two-person household. As a mother in DC, she is inevitably insured by Medicaid, but because she chooses to terminate an unintended pregnancy in order to continue to provide for her family, she may need to raise up to $6,000 within no more than three weeks—if not sooner—in order to afford to secure an abortion and exercise what is her basic right to safe health care. The greater the obstacles to obtaining an early-term procedure the longer the delays and the more expensive and risky it becomes for the woman. It is that simple.

The DC Abortion Fund (DCAF) is the only local fund in the metropolitan area dedicated to pledging financial support to DC residents who cannot afford the full cost of an abortion. We see first-hand when women choose to have an abortion. They face a multitude of state and national restrictions designed to deny their access to this procedure. These restrictions disproportionately affect low-income women.

On average, a DCAF client is a mother of one to three children, employed part-time—if employed at all—and living with family members or friends. She is the primary provider for her children and needs to afford food, clothing, shelter and utilities, possibly childcare, transportation and education—all on a monthly basis.

A majority of the women we serve have scoured every corner to gather payment for an abortion. They borrow money from several family members and friends, sell their children’s things, delay payment of rent and utilities and appeal to several local and national funds—in addition to DCAF—in order to terminate an unintended, unwanted, and unaffordable pregnancy.
As a local fund, working in partnership with local clinics, and women and families desperately seeking clinical services, we dwell in the cracks of the system where crucial details of real lives go ignored and vital necessities are still denied to our most vulnerable neighbors.

Our volunteer case managers connect with women and girls who are eleven or twelve years old, who are homeless, imprisoned, physically or mentally ill, raped and beaten—women unable to access the comprehensive care they need because they live in a community unwilling to acknowledge and empathize with their condition and unwilling or unable to address the root causes of the circumstances with which they are faced.

Due to the modest capacity of the fund, we are often forced to turn women away unless they are completely destitute. We stare head-on at the tremendous and frightening gap in dignified, health care coverage. We sense the weight of needs unmet. We feel the strong force of our clients’ efforts to overcome the barriers imposed on them.

We assertively welcome the possibility of national recognition and local support of this troubling burden to women’s lives and the health of their families. We diligently look forward to the day when Medicaid covers the cost of an abortion in DC and in every deprived state. We dream of a time when accessing reproductive health care services in this country and all over the world is no longer similar to traversing a rough and tumble landmine laced with quagmires and bombs. We believe the time is ripe for turning the hopes and dreams of the families we serve into reality.

As a grassroots fund, we exist because we understand that neither national nor local health care systems currently fulfill every individual’s unalienable rights. We also provide assistance to women who live in the state of Maryland where Medicaid voluntarily claims to cover abortion services. However, not one DCAF partner clinic in MD currently accepts Medicaid due to a dismal history of reimbursement failures. We consider Maryland Medicaid recipients our most underserved clientele due to the grave misconception that there are policies in place to cover their health care needs.

Because of similar obstacles, Women’s Choice of Oakland, California closed this spring due to California’s chronic low and slow reimbursements for MediCal services. In theory, California also voluntarily claims to cover abortion services for Medicaid recipients but in practice there are many roadblocks to accessing services.

If DC Medicaid does eventually cover abortion services for low-income women in the district, we must be vigilant to ensure accountability and that the local government complies with the law and genuinely fulfills its obligations.

We see the availability of quality abortion care services and family planning resources for every human being as the baseline for a healthy and progressive society and we will continue to subsidize the cost of abortion care until we have no more cases to address.
Our hope for a brighter day is unwavering and our dedication to our neighbors is steadfast.

In direct support of the women we serve and our local abortion providers, we will know when to stop relentlessly pleading for your donation because we will truly see that a woman’s right to safe health care no longer depends on what’s in her wallet.

Donations to the DC Abortion Fund can be made through this link.

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  • invalid-0

    Dear Elisabeth,

    Well-written with passion and belief that there might be hope in the future for women and their health care rights. I am proud of your stance and all that you do for women and their families. You are their true advocate.


  • invalid-0

    Well done! The deadbeat tactics of states that claim to voluntarily pay for abortion is something I have been concerned with for a while – particularly in the state of Maryland, coincidentally. So, while I dearly hope that the DC government will finally be allowed again to use its own funds in a manner consistent with the fiscal rights of the 50 sovereign states, I’m also hoping it doesn’t result in a premature abandonment of private efforts to support and advocate for the women of the District. So basically, what you just said. Thank you for writing this and thank you for the work you do. I’ll be donating to DCAF and sharing this link with my friends.

  • invalid-0

    Thank you Elisabeth for making these important points known about the realities of abortion funding!! This is a wonderful birthday present for me!! Well done!!

  • invalid-0

    Thank you! And fabulous!

  • invalid-0

    This *is* brilliant and should be required reading for all politicians who call themselves pro-choice (or, more likely these days, “against making abortion illegal”). A while back, a woman who was helped to pay for an abortion by a collection of private donations from people who never met her told the clinic staff that the financial help for her abortion was the “kindest thing anyone has done for [her] in a long time.” Women who are poor and parenting often feel isolated and alone. You are doing amazing work to help them not only with money but with those feelings of isolation.

    Peace to you always, Elisabeth.

  • invalid-0

    Seriously, I knew the situation was grave – but this beautifully written piece is bringing a lot of emotion to me right now. Women deserve better – in DC – and around the country.

  • invalid-0

    And it is mighty! I love you Elisabeth. This was a wonderful, painful read. I like my pain to be education, ya know. Please write your way to the Times and the Post!!

  • invalid-0

    A woman deciding to have an abortion should have the same opportunity to seek the best medical care possible and have the prodedure covered the same as any medical procedure. Lacking that basic freedom of choice is a shame and there is no justification or rationalization. In fact it should be illegal to refuse a woman the right to choose how to deal with an unwanted pregnancy! The pen is a mighty weapon in the hands of passionate young writers like Elisabeth!!

  • invalid-0

    Thanks, Beth, for exposing how misleading our abortion rights are. I am proud of our young generation of women, like yourself, who are still working on this sad, sad issue that we thought in the 70’s was finally resolved. It would be interesting to know if the special health insurance that our House and Senate members refuse to give up covers abortions.

    Keep up the fight!

  • independentminded

    because it’s clearly a loophole in the Roe v. Wade ruling that would set the stage for gradual (or perhaps not so gradual) undermining  of and eventual overturning of the Roe v. Wade ruling altogether.  Rather scary, imho.