The Affordable Care Act brought many significant changes to women’s health care in the United States. Before the law passed, women could be and frequently were charged more than men for health insurance, and plans were not required to cover birth control. Insurance companies could refuse to even sell a woman a policy because of “pre-existing conditions,” such as having had a C-section or getting treatment for domestic violence or sexual assault. Health care access, affordability and quality of care have vastly improved nationwide for women since the Affordable Care Act was enacted. Unfortunately, the notable exception to these gains is abortion access.
Community Health Options’ recent decision to drop abortion coverage is a step in the wrong direction. By refusing to cover abortion, the Maine insurance co-op reinforces the expectation that women pay for essential health care completely out of pocket — though we don’t expect the same of men. This kind of gender-based pricing and gender discrimination was supposed to be eliminated by the Affordable Care Act.
Such a decision tells the public and Community Health Options’ policyholders that the insurance co-op does not believe abortion is part of comprehensive reproductive health care. It further stigmatizes a legal and medically-proven procedure that one in three women will have in her lifetime. It also creates additional barriers for women who need to end a pregnancy. It is essential that women receive the care they need when they need it — no matter their insurer or how much money they have in the bank.
The decision to drop coverage was an “economic” one, according to Community Health Options. For many Maine women, the impact also is economic. In addition to the financial burden of paying for abortion out of pocket, limits on the ability to consider all options in pregnancy also limit a woman’s economic security. When women can decide whether, when and how to parent, they are able to better seek education and employment opportunities. It is unconscionable for Community Health Options to balance its books on the backs of women who are already struggling to make ends meet.
When it comes to the most important decisions in life, such as whether and when to become a parent, it is vital that a woman is able to consider all the options available to her, regardless of income. By covering some pregnancy-related care, such as labor and delivery, but excluding abortion, Community Health Options is limiting a woman’s ability to make decisions about her health that are in the best interest of her life and family. Decisions about our families, health and lives — including abortion — should not be dictated by how much money we make.
At Mabel Wadsworth Women’s Health Center in Bangor, we frequently hear from women who must scrape together funds to pay for an abortion, often selling their belongings or skipping or delaying payment of other household bills to do so. The lengths women must go to in order to raise funds often forces women to delay care. Denying coverage for abortion care is incredibly harmful, and it disproportionately affects women with low incomes, immigrants, young women and women of color. This is 2016, and women’s health care services must include abortion care. I expect Community Health Options to make decisions in the best interests of its members, which includes many Mainers struggling to make ends meet.
While it may be too late for Community Health Options to reverse its decision this filing year, I urge them to reinstate coverage for 2018. In addition, I urge Mainers and employers to carefully consider a health plan’s coverage and make sure it covers basic health care for everyone, including comprehensive reproductive health care.
Andrea Irwin is executive director of the Mabel Wadsworth Women’s Health Center in Bangor.