(WOMENSENEWS)--The Obama administration's stringent ban on abortion coverage in the new high-risk pools for people with pre-existing conditions who have been denied coverage in the individual market has spurred criticism among pro-choice organizations.
They say the ban harms the vulnerable women that the historic health care reform legislation was supposed to protect.
"This ban is blatantly unfair to the thousands of women who have heart disease, diabetes and other serious health conditions and who have been unable to afford and obtain the health care they need," said Donna Crane, policy director of NARAL Pro-Choice America. "Without access to abortion, these women will suffer lifelong complications for their health."
NARAL Pro-Choice America, the Washington, D.C., group that has advocated for pro-choice for more than 40 years, submitted a petition signed by more than 25,000 people to Health and Human Services Secretary Kathleen Sebelius Aug. 6. The petition objected to limiting coverage of abortion in state high-risk pools to cases of rape, incest or probable death of the mother if the pregnancy continued.
On July 1 states began enrolling the first of the estimated 200,000 to 400,000 people in high-risk pools, which provide physicians' services, medications and home health care for individuals who have been uninsured for at least six months. Expenses not covered by the participants' premiums, deductibles and co-payments are covered by the $5 billion subsidy Congress allocated to make the insurance affordable.
Initially, New Mexico, Maryland and Pennsylvania seemed inclined to include elective abortion as a benefit, but backed off after they came under fire by Washington, D.C.-based National Right to Life. The organization claimed that states are prohibited from covering abortion in the temporary pools because of the Nelson amendment to the Patient Protection and Affordable Care Act, which stipulated that no federal funds be used to pay for abortion. The high-risk pools are being entirely financed with federal funds.
July 29 Directive
The Department of Health and Human Services, known as HHS, agreed and issued a directive July 29 restricting abortion coverage to the exceptions traditionally allowed under federal law: rape, incest and the life of the mother.
Nancy-Ann DeParle, White House health care advisor, said in a blog that HHS's policy was in keeping with the "spirit of the health reform law, which neither expanded nor scaled back current restrictions on abortion."
"Not so," said Vania Leveille, legislative counsel in the Washington office of the American Civil Liberties Union, which has also lobbied the White House to reverse the ban. "The Obama administration's ban goes further than the health care reform act. Although the current program for the high-risk uninsured was authorized by the health care reform law, it is a temporary measure for vulnerable people until 2014, when it will be replaced with the state health exchanges where women will be able to choose insurance plans that cover abortion."
Under the state exchanges that become available in 2014, women--including some in the temporary program that began enrollments this month--may choose plans that include abortion coverage as well as those that don't. If a woman chooses a plan that offers abortion, she must pay the premium for the abortion coverage with her own funds and write a separate check.
"The Obama administration could have followed this model in the high-risk pools, which would have given women the same options that they will have in the exchanges," said Leveille. "But the anti-choice movement made the high-risk pools a controversial issue and created such a toxic environment that the pro-choice Obama administration was forced to take this position. As a result, women with serious health problems will be making decisions about treatments based on insurance coverage, not what is best for them and their families."
Pro-choice organizations are waiting for a response from the Obama administration before deciding on their next move.
Some observers believe that lawsuits might be filed to clarify the respective roles of the states and federal government in administering the high-risk pools since the Patient Protection and Affordable Care Act passed by Congress in March did not mention the high-risk pools.
Energized by the HHS ban, Republican Sen. Tom Coburn of Oklahoma and Sen. Orrin Hatch of Utah introduced legislation Aug. 12 that would ban federal subsidies in any plan that covers abortion services under the Patient Protection and Affordable Care Act.
National Right to Life is expected to campaign hard for the bill because it would extend the Hyde Amendment--a 24-year-old law that bars taxpayer subsidies of abortion under Medicaid and other federal health programs--to health care reform.
Dr. Douglas Laube, board chair of Physicians for Reproductive Choice and Health, a New York-based organization of 10,000 obstetricians-gynecologists, family practitioners, emergency room physicians and other doctors, predicts that the states will become the next battlefield over abortion benefits for women in the high-risk pools.
"Opponents of pro-choice have been successful in getting states to pass restrictive laws over the years," said Laube. "However, they may have a very difficult time getting states to restrict abortion coverage for women with serious health conditions whose birth control fails or have an unintended pregnancy because an increasing number of women are finding themselves in this position."
Health Conditions More Common
Conditions such as diabetes, heart disease and hypertension are becoming common, he said. More women are waiting until their late 30s and 40s to become pregnant, which also increases the risk of serious complications for women with underlying health problems.
Although cancer is rare during pregnancy--occurring in about one out of every 1,000 pregnancies--it has a tremendous impact on women's treatment options, said Laube. Pregnancy symptoms such as abdominal bloating, rectal bleeding and breast enlargement are common during pregnancy, which can delay a cancer diagnosis.
"Women who are in the midst of chemotherapy or radiation treatments for cancer also need to have abortion available," he said. "They may survive if they continue the pregnancy, but be left with serious health problems that affect their ability to care for themselves and their children."
The ban on abortion coverage in the high-risk pools is expected to affect low-income women disproportionately. A study by the New York-based Guttmacher Institute found that 58 percent of the 1.2 million women who had abortions in 2005 had incomes of 200 percent or less of the poverty level ($9,570 for an individual and $19,350 for a family of four).
"New Mexico and other poor states that have large uninsured populations will be the most affected by this ban," said Joan Lamunyon-Sanford, executive director of the New Mexico Religious Coalition for Reproductive Choice, an Albuquerque-based organization that provides escorts, transportation and home stays for women who have abortions. "But our members are deeply committed to doing all we can to help these women during this difficult period until 2014, when they will be able to obtain abortion coverage through the state exchanges."
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Sharon Johnson is a New York-based freelance writer.
For more information:
NARAL Pro-Choice America:
ACLU's Reproductive Freedom Project:
Physicians for Reproductive choice and Health:
The New Mexico Religious Coalition for Reproductive Choice: