From the Ground Up: Restoring Insurance Coverage for Abortion Care


By now the mantras are familiar: The Hyde Amendment is settled law. Current Hyde Amendment restrictions governing abortion policy will always be the law of the land. No elected official is willing to stick their neck out for this issue.

The Hyde Amendment was first passed in 1976, and with each passing year, as it gets routinely attached to the annual appropriations bill without even a floor vote, the mantras reinforcing the ban on public insurance coverage for abortion care grow more deterministic. 

But what if elected officials strongly and unequivocally spoke out in support of insurance coverage for abortion? What if they went on record declaring that a woman needs access to a range of safe, affordable reproductive health care services throughout her life, including abortion care? And that all women, regardless of income, need insurance coverage to access these services so that economic barriers do not dictate critical health care decisions? What if they called on Congress to stop withholding coverage for abortion care for qualified women?

On January 23, 2013, the New York City Council took this step by adopting Resolution 1635-A, which commemorated the 40th anniversary of Roe v. Wade and called on the United States Congress to support funding for comprehensive reproductive health care.

This resolution is an example of the kind of proactive move that elected officials can take to break the mold of defensive responses that have characterized the movement, especially the attitude toward insurance coverage for abortion.

Back in 2007, the National Institute for Reproductive Health saw that the tendency of Congress and state legislatures to attack access to reproductive health care—especially abortion care—created a real opportunity for cities and municipalities to step in to pick up the slack.

Urban areas are often ground zero for some of our nation’s most pressing reproductive health challenges, including high rates of unintended pregnancy, sexually transmitted infections, and maternal and infant mortality and morbidity. The data is especially stark for particular groups of women who often have the least access to health care, including young women, lower-income women, and women of color. At the same time, city governments and agencies are comprised of people who see firsthand how state or federal policies that restrict reproductive rights can have a devastating effect on the ground. 

The Institute launched the Urban Initiative for Reproductive Health specifically to demonstrate that there is a place and a need for local elected and public health officials to advocate for improved access to reproductive health care. And furthermore, we knew that elected officials working on the local level could advance the kind of proactive policies and programs on reproductive health that might be seen as nonstarters at the state and federal levels.

The Urban Initiative’s city-level strategy has been in play in 30 cities across the country since 2007. From Austin to Baltimore, Denver to Pittsburgh, Memphis to San Francisco, the Urban Initiative has helped local advocates to pass proactive legislation, enact effective and innovative reproductive health programming, and build support for reproductive health, rights, and justice. It has countered the deceptive practices of crisis pregnancy centers, directed teens to youth-friendly reproductive health care, minimized the dangerous effects of environmental toxins on women’s fertility, trained local legislative champions, and more. Most importantly, it has started to create a change in the minds of partners and allies about the meaning of local work—both its importance to the community and its impact on the national conversation.

In 2012, the Urban Initiative aligned our local partnerships to help create a critical mass of public support for abortion coverage from local elected and public health leaders and advocates, all working in tandem to repeal laws that currently withhold this coverage from low-income women. The 40th anniversary of Roe v. Wade was a perfect opportunity to underscore that the legal right to decide to have an abortion means nothing if abortion isn’t accessible. We believed that an elected official at the local level—who feels the immediate ramifications when her constituency’s needs aren’t being met – understands how a longstanding federal policy like the Hyde Amendment leads to fundamental inequities in access to health care, creates confusing and inefficient bureaucracy, and ultimately harms women and families.

On January 18, 2013, the Committee on Women’s Issues of the New York City Council held a hearing on Resolution 1635-A commemorating the 40th anniversary of Roe v. Wade and calling on the United States Congress to support funding for comprehensive reproductive health care. This resolution recognizes that “budgetary actions taken by the federal government have increased barriers to accessing such services by restricting abortion coverage for those enrolled in public insurance programs” and that “when a woman needs to end her pregnancy it is important that she have access to safe medical care, and insurance coverage can help ensure such care is available.” Advocates who testified at this hearing highlighted the importance of insurance coverage for abortion; on January 22, the full Council adopted the resolution.

And New York City is just one example. Urban Initiative partner cities throughout the country are laying the groundwork to take this conversation higher and farther.

For example, in Austin, TX, advocates worked with the Travis County Commissioners Court to adopt a resolution commemorating Roe that speaks to the challenges facing women in Travis County and Texas as a whole and reflects the local political climate. Ultimately, on January 22, the Court adopted a resolution that “affirms the importance of full spectrum women’s reproductive rights” and “urges Congress and the State of Texas to pursue a positive agenda that reaffirms the fundamental right of women to make decisions about their health in concert with their doctor and improves women’s access to safe and comprehensive reproductive health care.” 

As our partners at NARAL Pro-Choice Texas noted, “the Texas Women’s Health Program is in shambles and family planning clinics have closed their doors around the state,” and this resolution represents a step forward for elected officials in publicly recognizing the dire need for funding and coverage for reproductive health care, including abortion care.

This is just the beginning. Throughout 2013, additional cities will take actions to publicly declare that it is unfair for politicians to withhold insurance coverage or try to influence a woman’s decision about whether to end a pregnancy just because of the type of insurance she uses. For a woman to be able to make a real decision based on what’s best for her own circumstances, she needs to be able to afford it. Withholding insurance coverage for abortion to a woman who qualifies for these benefits for political reasons is unconscionable. 

With more actions like these from brave and prominent leaders in our cities, the quiet acquiescence that reinforces the Hyde Amendment’s ban on coverage just might start to disintegrate.

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