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Time for change.

As they should, our public policies encourage the provision of medical care to poor pregnant women by subsidizing maternity care services under Medicaid. But when it comes to abortion, the reverse is true: Subsidized care is denied to medically indigent women even when they do not wish to bear a child. Both the individuals involved and society as a whole pay a high price for this unequal treatment of pregnancy-related services.

* Poor women are forced either to divert their family's meager resources from basic necessities to pay for an abortion themselves or to continue the pregnancy and give birth to a child they cannot afford to raise on their own-a result that may force the family onto welfare or extend its period of dependency.

* Taxpayers, meanwhile, spend hundreds of millions of dollars annually to support the families of women who were unable to obtain an abortion they would have otherwise freely chosen to have.

Clearly, it is both fairer and economically more sensible to let women make up their own minds about how to deal with an unintended pregnancy, and to facilitate that choice, than it is to coerce them through government policy to bring baby into the world when they themselves conclude that they can-not care for a child, particularly if the government intends to turn wound and penalize them for doing so.

Public Opinion and State Trends

Ostensibly, Congress has restricted abortion funding since 1978 because it believes the public supports limitations on coverage. Recent polls suggest, however, that Americans may be more receptive to public funding of abortions for poor women than they have been in the past. (140) In addition, important changes in abortion funding policies have occurred at the state level.

Public Support. According to a recent poll in the Chicago metropolitan area, two-thirds of adults believe the continuing cycle of welfare dependency is a major cause of many of the serious problems facing the country, and nearly six in 10 think the increase in births to single mothers is an important factor. Unlike the sponsors of the current welfare-reform proposals, however, a majority of those polled support the provision of voluntary abortion services to welfare recipients. Furthermore, support for public funding of abortions increases from 57% to 63% when those surveyed are informed that the state of Illinois pays at least $2,000 for prenatal care and delivery services when a Medicaid-eligible women gives birth, plus welfare costs for the child, but will not pay roughly $300 for an abortion when a welfare recipient wants to terminate her pregnancy. The majority of those who oppose funding acknowledge that it is the baby who suffers most if the woman is forced to give birth and raise an unwanted child; 21 % believe society as a whole is most affected because of additional expenditures for welfare; only 10% think the woman is hurt most. (141)

Meanwhile, a national poll conducted shortly after the November 1994 election found that a majority of Americans oppose "making it more difficult to get an abortion." (142) Clearly, restricting Medicaid coverage of abortion makes it more difficult for a poor woman to terminate her pregnancy.

Expanded Coverage. In 1994, three states--Idaho, Minnesota and New Mexico--began funding most abortions for Medicaid recipients for the first time since the late 1970s, bringing to 16 the number of states that use their own funds, even in the absence of federal reimbursement, to pay for abortions under Medicaid. (143) In addition, states have actually expanded eligibility for subsidized abortions.

Since the late 1980s, the federal government has mandated Medicaid coverage for maternity care services for women with incomes up to 138% of the federal poverty level, (144) and has given states the option to include women with incomes up to 185%. (145) States are applying the same expanded eligibility standards to women seeking abortions as they do to women who want prenatal care and delivery services. Among the states that currently pay for most abortions for Medicaid-eligible women, for example, Minnesota and Vermont have raised their eligibility ceilings to 275% and 200% of poverty, respectively; California, Connecticut, Hawaii, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina and Washington cover women up to 185% of poverty; West Virginia, up to 150%, and Alaska, Idaho and Oregon, up to 133%. (146) New York is the only state currently funding abortions that has decided not to pay for the procedure under the expanded eligibility rules.

The states' decision to use the same income standard to determine eligibility for publicly funded abortion services and maternity care stands in sharp contrast to U.S. Supreme Court rulings that rejected the proposition that once the government decides to pay for pregnancy-related care for poor women, it must treat all options equally. In a series of decisions culminating in its 1980 opinion upholding the Hyde Amendment, (147) the Court held that the government may make "a value judgment favoring childbirth over abortion, and...[implement] that judgment by the allocation of public funds." (148) At least with respect to income eligibility levels, states have rejected that approach.

Reproductive Health Services and Health Care Reform

Congress failed to pass health care reform in 1994, but it may take up the issue again in some form in 1995. In addition, pressures to control rising costs and to extend health insurance to uninsured and underinsured individuals and families are likely to keep state and local policy makers focused on health care reform for the next few years. Health care reform efforts present a unique opportunity to ensure that poor women, as well as women on the edge of poverty, have equal access to the comprehensive reproductive health services--specifically including family planning and abortion services-that enable them to prevent unintended pregnancies and to avoid unplanned births. Poor women's need for these services should be considered first, not last, in any health care reform effort.

Reproductive Health Services and Welfare Reform

As this report has shown, access to family planning and abortion services is equally salient in the context of welfare reform. The ultimate goal of welfare reform should be to enable individuals and families to move out of poverty--not simply to force them off the welfare rolls--through job training, employment opportunities, reliable child care and necessary medical care. In this context, ready availability of services that give women the ability to control their childbearing is crucial to helping women take charge of their lives. Yet, none of the current proposals to reform the welfare system addresses this need: They would deny benefits for out-of-wedlock births, promote adoption, support group homes for unwed mothers and finance orphanages for the children of destitute women who are denied welfare, but they would do nothing to ensure access to family planning and abortion services; some would even deny poor women information about abortion. (149) What is more, they would impose harsh penalties for childbe aring despite the fact the government explicitly--and intentionally--encourages poor pregnant women to have babies by paying for prenatal care and delivery services, but not for abortion.

Supporters of these welfare-reform proposals contend that they will discourage out-of-wedlock births and prevent long-term welfare dependency. (150) There is widespread disagreement, however, as to whether such proposals would accomplish those objectives. Opponents point out, for example, that the increase in benefits upon the birth of another child--less than $75 a month, on average (151)--does not cover the family's additional expenses, and therefore a cap on benefits would not be an incentive for welfare recipients to avoid additional childbearing. Others note that the current proposals ignore the fact that the overwhelming majority of unmarried teenagers who become mothers come from economically and socially disadvantaged backgrounds, and that early childbearing is as much a reflection as it is a cause of the entrenched poverty in which these young women live. (152)

If the intent of welfare reform is to help poor people-primarily poor women-take hold of their lives and become employed and eventually self-sufficient, then more attention needs to be paid to ensuring that these women have the same freedom and ability as all other Americans to exercise their right to prevent unintended pregnancies and, if they wish and need to, avoid an unwanted birth by having an abortion. Failure to ensure that poor women have these options not only condemns them to continued second-class status; for practical purposes, it also sabotages society's efforts to discourage out-of-wedlock births and long-term dependency.

(140.) Harris, 1991, p.16; Richard Day Research, Inc., 1994.

In 1991, 55% of adults opposed Medicaid coverage of abortions for poor women, 42% supported coverage and 3% were undecided. In 1994, 57% supported Medicaid coverage of abortions, 37% were opposed and 6% were undecided.

(141.) Richard Day Research, Inc., 1994.

(142.) CNN/USA Today/Gallup Poll, 1994.

Forty-four percent favor making it more difficult for a woman to get an abortion and 3% have no opinion on the subject.

(143.) American Political Network, 1994; Kolbert, 1994.

(144.) OBRA, 1989.

(145.) OBRA, 1987.

(146.) Crepps, 1994; National Governors' Association, 1994, Table 1; American Political Network, 1994. Minnesota and Vermont have taken advantage of flexibility afforded by section 1902(r)(2) of the Social Security Act to expand Medicaid coverage above that authorized by OBRA, 1987 and OBRA, 1989.

(147.) Harris v. McRae, 1980.

(148.) Maher v. Roe, 1977.

(149.) Congressional Quarterly, 1994, pp. 3371-3372.

(150.) Bennett, 1994, p. A9; Murray, 1993, p. A14.

(151.) New York Times, 1994, p. A24.

(152.) AGI, 1994i, pp. 61-62, 70-71.


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Article Details
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Title Annotation:Medicaid should fund prenatal care services and abortion
Publication:The Politics of Blame: Family Planning, Abortion and the Poor
Article Type:Topic Overview
Geographic Code:1USA
Date:Jan 1, 1995
Previous Article:Financial implications of restoring medicaid coverage.
Next Article:Living on welfare in one state: Minnesota.

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