47 Years After “Roe v. Wade,” Theoretical Abortion Rights Are Not Enough

As we mark the 47th anniversary of Roe v. Wade, the landmark decision that legalized abortion in the United States, we need only look to a recent sneak attack by the Trump administration as a reminder that even with the ruling in place, anti-abortion politicians are hellbent on passing policies that keep the true promise of Roe from being realized for many.

As 2019 drew to a close and the holiday season kicked off in full force, the Trump administration quietly finalized a rule that will require private health insurers to send separate bills for abortion coverage, doubling down on its agenda to make abortion unaffordable and unavailable. The timing of the policy rollout, at the end of a decade marked by a landslide of attacks on reproductive health care, was nothing if not deliberate. This administration knows how unpopular restrictions on abortion coverage are and purposefully chose to finalize this regulation thinking no one would notice, hoping to bury it amid the chaos of travel and other end-of-year business.

But they were wrong: We know exactly what this administration is trying to do. In requiring two separate bills and two separate payments for abortion coverage, the new Department of Health and Human Services (HHS) rule is meant to discourage insurance plans from covering abortion care at all, while also confusing consumers and stigmatizing abortion by needlessly separating it from all other health services.

If private insurers opt to stop covering abortion as a result of this rule, people seeking abortion could be forced to delay care or could be denied care altogether, imposing onerous financial burdens, especially on women of color and families with lower incomes. Too many people are already denied abortion coverage based on how much money they make because of the decades-old Hyde Amendment, which prohibits federal health care programs from covering abortion. This discriminatory new rule put forth by the Trump administration pushes abortion care out of reach for even more people.

Whether someone has private or government-funded health insurance, each of us should have coverage for a full range of pregnancy-related care, including abortion. We pay for health insurance so we can be covered if we have an unexpected medical expense, which could certainly include abortion care. Under the Affordable Care Act, insurance plans can cover abortion in case we need it — but now, the Trump administration is deliberately discouraging insurers from covering the care we need and creating unnecessary confusion.

January 22 marks the 47th anniversary of Roe v. Wade, but Roe and policies like this latest rule still limit meaningful access and remind us abortion rights in theory are not enough. We must also fight to ensure that we all have equitable access to the resources and care we need to make safe, healthy and autonomous decisions about our lives, bodies and futures. The Trump administration’s new rule — a deliberate effort to make insurance plans stop covering abortion — poses a direct threat to the fight for dignity and equity.

Already, with policies like the Hyde Amendment, we know who suffers the most: people and families with lower incomes, who are disproportionately women of color. Hyde forces an estimated one in four women enrolled in Medicaid who seek abortions to carry an unwanted pregnancy to term. Additional research has shown that someone who wants an abortion but is denied, compared with being able to obtain abortion care, leads to a significant increase in household poverty.

And we know policies like Hyde — which can pose insurmountable barriers to abortion access for communities already marginalized by our health system, as well as state-level abortion coverage bans — are deeply unpopular. In fact, this year, research showed 75 percent of national voters believe every woman should be able to get the full range of reproductive health care, including abortion, regardless of whether she has private or government-funded health insurance.

Let’s be clear: Any health insurance that respects our decisions and upholds our health must cover abortion. Each of us should be able to make our own decisions about our bodies, our lives and our families. We won’t stand by while anti-abortion politicians erect more and more barriers that stop women and people with lower incomes from getting the care they need. When we can make decisions that are best for our lives, we empower families to thrive, and we create communities where each of us can participate with dignity and equity.

Policies like this new HHS rule show how precarious meaningful abortion access truly is, in the face of so many cultural, political and economic barriers. Just as we continue our fight to protect and expand the promise of Roe, now in its 47th year, we must also fight to ensure abortion is affordable and accessible for all of us, however much money we have and whatever our source of insurance.