On Thursday, President Barack Obama signed a bill that will allow the District of Columbia to once again use its own local tax dollars to pay for abortion services for low-income women. The 2010 omnibus appropriations bill lifted a restriction on the nation's capital using local funds for abortion care that has been imposed by Congress every year since 1988. (The bill also lifted restrictions on funding potential medical marijuana and needle exchange programs.)
"This is really something to be celebrated from the point of view of women who live in D.C. who are low-income," said Heather Boonstra, senior public policy associate at the Guttmacher Institute.
At its core, lifting the restrictions gives D.C. "home rule" like other states and allows autonomy over its own funding. Now, D.C. can once again put local funding toward Medicaid that would pay for abortion services and care. Medicaid is paid for through a combination of federal and state funds. Federal funding can't be used for abortion because of the Hyde Amendment, but states have autonomy to fund abortion services with their own dollars. But D.C., because it isn't a state and technically falls under Congress' rule, has faced additional restrictions.
"When I moved here eight years ago, I was shocked that D.C. Medicaid didn't pay for abortions," said Tiffany Reed, president of the D.C. Abortion Fund, an all-volunteer organization that raises money for small loans and grants to low-income women for abortion care. "Shocked, because I thought that if there was one place in the country where that would happen, I thought it would be here."
In the past three decades, low-income women in D.C., as well as women from Maryland and Virginia, have been left with few options. Reed's organization works to help such women, but with an annual budget of just over $46,000 a year, the number of women they can serve is limited. "If we want to spend our money on that, I don't think a legislator in Utah should be able to stop us from doing that," Reed said.
Such a sentiment is likely why this abortion restriction was lifted in an era when other anti-choice restrictions are threatening to tighten. In fact, the same omnibus bill that lifts the ban on D.C. funding also reinforces a restriction on paying for abortion services for federal employees enrolled in the Federal Employees Health Benefits Program. Dana Weinstein wrote in the Baltimore Sun that, although she was insured by the Federal Employees Health Benefits Program, she had to travel to Ohio and pay $17,500 for an abortion out of pocket when she learned at 28 weeks that her fetus had severe brain abnormalities and would be born brain dead. "To be forced to carry to term because of lack of financial coverage is beyond cruel," Weinstein wrote. But because Weinstein's health care is paid for by federal dollars, she is subject to federal funding restrictions. Now, it is up to the D.C. Council to fund the program that would pay for abortion services. Reed hopes that D.C.'s tradition as a progressive, pro-choice city will mean the Council will fund abortion coverage for Medicaid-eligible women.
Last year, the D.C. Abortion Fund received nearly 1,000 calls for financial assistance -- its highest call volume to date and likely the result of an economic crunch where employment numbers are high. "What we do is we only cover usually about half, sometimes less than half of the total cost. When a woman has to raise $250 or $300 on her own, that can be a big deal," Reed said. "If you're getting $300 in unemployment and you're a single woman with three children, it's going to be impossible."
If D.C. pays for abortions through its Medicaid program, it will become just one more place in a sparse patchwork of states that allow public funding for abortion. Currently, 17 states allow state funding to pay for abortions for low-income women. (The debate over Nelson and Stupak amendments, the abortion amendments currently in the health-care reform bills in Congress, concern federal funding of health insurance. Although such amendments, if passed in the final bill, could drastically reduce access to abortion under private insurance coverage, D.C. could still choose to fund abortion through its local tax dollars thanks to the lift of the ban.)
In July, the Guttmacher Institute released a study that examined state Medicaid funding for abortion. The study found that such restrictions can cause delays in women obtaining an abortion, and, about a quarter of the time, women said they would otherwise get Medicaid-funded abortion but ultimately carried the fetus to term. The study also indicated that Medicaid restrictions are also often associated with a higher teen birthrate.
"We talk to thousands of women from D.C., but we talk to hundreds of thousands of women all around the country and who oftentimes resort to selling their possessions and even their blood in order to afford care," says Vicki Saporta, president of the National Abortion Federation, which operates a toll-free hotline to give women information about abortion services. "They forgo rent; they risk eviction; they have their electricity turned off because they're unable to pay for the abortion care they need otherwise."
And though 17 states legally allow for state funding to be used for abortion services, these states don't always pay for abortions in practice. In fact, in Maryland, state Medicare reimbursements for abortion have been denied so often that many abortion clinics have simply stopped accepting Medicaid patients.
"The claims are often delayed or questioned, so they eventually just give up because they feel like it's futile," says Jessica Arons, director of the Women's Health and Rights Program at the Center for American Progress. (Arons is my colleague at CAP, though we don't work directly together.) This might be surprising to some activists, considering that Maryland is one of the few states that implemented a Freedom of Choice Act, which codified Roe v. Wade. "Laws are really important and they're all well and good, but they're really just a first step," Arons said. In the end, it's important to ensure that state funding is dispersed.
At the D.C. Abortion Fund, Reed has encountered women who couldn't obtain abortions in Maryland. "We are really scared that that's going to happen in D.C. I think moving forward our biggest piece is having a role in making sure this is implemented properly, making sure that the clinics do get paid if this does end up passing," Reed says.
The lifting of the ban on local funding of abortions in D.C. is a small but important victory for pro-choice activists. If the D.C. council decides to fund abortion services for low-income women, it will alleviate real suffering among its residents. But like all D.C. laws, the District ban could be implemented again by an anti-choice Congress in the future. As many pro-choice activists have seen in the health-care reform debate, ensuring access to abortion -- especially for poor women -- is a constant battle, even in a pro-choice city like Washington, D.C.
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