The U.S. Senate is poised to vote on confirmation of Judge Brett Kavanaugh for the U.S. Supreme Court. Despite vague assurances during his confirmation hearing that he considers legal abortion through Roe v Wade to be settled precedent, many have legitimate concerns based on his record serving in George W. Bush’s White House and as a U.S. appellate judge.
What many people may not realize is the damage that can be done to abortion rights and access, even without overturning Roe v. Wade. Despite legal access to abortion, pregnant people in North Carolina already face significant barriers, both legal and financial, to getting the care they need.
As an obstetrician and gynecologist, I care for people with pregnancies in a variety of circumstances. One of the privileges of my job is caring for individuals with planned and desired pregnancies to help them prepare for birth. Helping people in situations where the pregnancy is unintended and undesired is less talked about, but is equally important. So is caring for those with pregnancies that are desired but dangerous to the pregnant person’s health, or pregnancies with genetic conditions or other fetal anomalies that lead to the decision to terminate.
In North Carolina, around half of pregnancies are unintended. Moreover, low-income women, people of color and young women are at higher risk. Unintended pregnancy is exactly the sort of health risk that health insurance should be designed to address. But here and in other restrictive states, abortion often falls in the no-coverage zone.
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This is partly a result of a conservative legislature bent on curbing abortion rights, and partly a ripple effect of federal funding restrictions. The Hyde Amendment, first passed in 1976, sets the policy on federal funding toward abortion care. It prohibits Medicaid from covering the cost, except in cases of rape, incest and life endangerment. Practically, this means that most state Medicaid programs, like North Carolina, only cover abortion in these extreme cases.
Almost half of pregnancy coverage in the U.S. and in North Carolina is through Medicaid. But the Hyde Amendment has even farther-reaching effects. No federal employee health insurance plan can cover the cost of an abortion, and military plans do not cover abortion. In North Carolina, no state, county or city employees can obtain insurance coverage including the cost of an abortion. Finally, no North Carolina plans offered through the health insurance exchange established through the Affordable Care Act include abortion coverage.
Even Americans with good health insurance know that some services fall outside the bounds of their coverage. But I expect when I get appendicitis and need surgery, that my insurance will cover the surgery and hospitalization. Likewise, for a minor with a pregnancy resulting from rape or incest, abortion care constitutes the type of medical emergency that should always be covered. I recently found out that several private insurers in North Carolina, including Blue Cross Blue Shield of North Carolina (BCBSNC) and United Healthcare, disagree.
Those are just the prohibitions. Many employer-sponsored or private insurance plans through companies like BCBSNC may also exclude abortion coverage. Anecdotally, in fact, in North Carolina, this seems to be the norm.
This is despite the fact that 76 percent of North Carolinians think decisions about reproductive healthcare should be made by individuals, not politicians, and that nationally, 7 out of 10 people support Roe v. Wade. In a recent Gallup poll, 76 percent of Americans favored the legality of abortion in cases of rape or incest.
If Judge Kavanaugh were confirmed, it would shift the balance of the Supreme Court to a 5-4 conservative majority. While cases since Roe v. Wade have affirmed abortion rights, they have also allowed for proliferation of the types of regulations that make abortion difficult and expensive to attain. In May, Iowa banned abortions after a fetal heartbeat can be detected. That is around six weeks, before many people even realize they are pregnant.
As conservative states continue to test extreme limits on abortion regulation, we cannot risk a Supreme Court justice like Judge Kavanaugh who has an anti-abortion agenda that is out of line with the majority of Americans. While it may feel too late to stop this confirmation, it is not. It is still worth calling Senators Burr and Tillis to let them know how you think they should vote and remind them (in light of their abysmal records on abortion rights) how you plan to in the future.
Jonas Swartz, MD, MPH, is an OB/GYN in Chapel Hill.