Jenny Brown's Blog

The Womxn Project holds panel on state funded healthcare prohibitions against paying for abortion services

By Steve Ahiquist
January 9th, 2020

“The fact that state employees don’t have abortion coverage is actually a relatively well kept secret,” said Rhode Island College professor Mikaila Arthur. “Many of my colleagues don’t know that they don’t have abortion coverage until somebody tells them or until they, or a family member, needs abortion care.”

On Tuesday evening The Womxn Project presented a panel in the State House library about how, despite last year’s passing of the Reproductive Privacy Act, which codified the protection of Roe v Wade into state law, many Rhode Islanders are still denied abortion services though their state healthcare plans. This state ban on abortion coverage forces both state employees and state Medicaid recipients to pay for abortion services out of pocket, except in cases of rape, incest or danger to the life of the pregnant woman.

The panel was moderated by Stephanie Olarte, Principal of Step Forward Strategies and a board member at The Womxn Project.

Participating on the panel were Jenny Brown, author of Without Apology: The Abortion Struggle Now, Daria-Lyric Montaquila, an artist and activist and a volunteer with The Women Project who used the Rhode Island State Medicaid plan for health care coverage, which does not cover abortion care, and Mikaila Arthur, Rhode Island College professor and volunteer with the Women Project who has personal experience using the Rhode Island state employee health plan, which doesn’t cover abortion care.

Here’s the video:

Here are selected transcriptions from the discussion:

Olarte: As most of you know, The Womxn Project worked hard to pass to help pass the Reproductive Privacy Act of 2019. And I know you have been wondering what are we going to be working on next. Over the summer we held a community meeting, surveyed our supporters and worked with our board to craft a legislative agenda. Our supporters spoke loud and clear that they wanted to see us take on abortion bans and close the gap on healthcare coverage for abortion. While we were able to protect the right to abortion last year in Rhode Island, our state Medicaid plan and our state health insurance plans do not provide coverage for abortion, and that leaves many Rhode Islanders with a legal right but a significant barrier to access. So we wanted to bring a panel discussion to highlight the need to take on abortion bans here in Rhode Island and why it is of national importance Today’s panel will provide background on what’s happening nationally while given us the context of local impact.”

Jenny Brown: “I’m an organizer with a group called National Women’s Liberation that has its roots in the 1960s Women’s Liberation movement. I wrote this book, Without Apology: The Abortion Struggle Now, partly from inspiration from the organizing that I and other people did around winning the morning after pill over the counter in the United States. This was a 10 year battle that we started in 2003 and got a favorable decision in 2013. Some of the lessons that we got from that I think can be applied to the other reproductive rights struggles, the reproductive justice and abortion struggles more generally.

“We were counseled, when we started thinking about how to get the morning after pill over the counter, to go for something less ambitious – to try to get it available for rape victims in hospital emergency rooms, for example. We decided that we didn’t want to do that because when we looked at our own experience and consciousness raising, we found that we needed the morning after pill not because we had been raped – usually it was some kind of contraceptive failure or we hadn’t used contraception – but also those of us who had been raped had not gone to the emergency room. So we didn’t think that that program would have helped most of us. And so we created a plan to get it over the counter for all ages, which was kind of controversial because the FDA tried to divide us by age first. They said, ‘If you’re under 18, you have to still get a prescription.’ So one of the lessons that we got from that was to not get divided by age, or whether you have an ID, or all that kind of stuff, but to really be united, and so by 2013, we were able to win that.

“I was also inspired by the experience in Ireland of getting the abortion ban there overturned. They repealed the ban that was in their constitution. A couple of lessons from them, which we should talk about are, first of all, most of the groups had not been using the word abortion until that time, and they were mostly going for incremental changes, like allowing people to have one psychiatrist rather than two saying that they were suicidal in order to allow them to get an abortion. It wasn’t until they started to really demand free, safe, legal abortion for everyone who needed one that the movement grew and became really powerful. And then they were able to win by a lot more than they expected. They thought it was going to be extremely close.

“The third reason that I wrote the book is that I think that feminists today are kind of missing one of the reasons we are having such a struggle around abortion rates right now, which is that the birth rate is the lowest it’s ever been in the United States. When we won Roe v Wade, the birth rate was extremely high. Now it’s [undergone] a sea change and we’re starting to see right wing think tanks openly talk about how we have to get the birth rate up because we don’t want to have to spend money for childcare and healthcare and paid leave. We want to make sure the birth rate is raised by other means, meaning coercion… I think looking at this as a fight over women’s reproductive labor and how important it is for our whole society and it’s been devalued and not counted and all this stuff. But if we start to think of the abortion story in that light, I think we will be able to convince a lot more people that this is something that they really need to get involved in and struggle on.”

Arthur: “I’m going to be talking today from the perspective of a state employee about what it means to work for an employer who is forbidden by law, from providing appropriate health insurance coverage to a large number of employees.

Montaquila: “Recently I just lost my healthcare coverage from the state. I used to be blessed enough to have dual coverage, both Blue cross and Medicaid, but now I am down to just my Blue Cross, which is only through my father and since he’s pretty absent in my life, it’s going to go away once I hit the [age of] 26.. So that’s something I’ve been worrying about because while I’ve had dual coverage, I was able to get birth control pretty easily. I didn’t have to pay any copays. But now that I only have one insurer, I am paying copays and I have to choose between paying copays for the medication I need to keep me mentally stable or if I want to have birth control. Right now I’m kind of at the point where I need to just pay for the medication to cover my depression and my anxiety because I can’t necessarily afford to pay copays for both of those things.

“And I just now realized I’m not going to have a lot of money to pay my copays for my gynecologist appointments. Cause now I have to pay copays for my therapist and my psychiatrist… When I tried to get my healthcare reinstated, they told me I made too much. I’m living paycheck to paycheck. I make about $14k a year right now. And that is apparently too much to have healthcare coverage. So now I’m just kind of living in fear all the time. And I’m having to choose between ‘Do I want to protect my body and my reproductive organs, or do I want to protect my brain?’ And that’s really scary to deal with, especially since I’ve recently moved in with my boyfriend and I’m 23 and I’d like to live the life of a 23 year old. I’m definitely walking on eggshells more than I was before. And yeah, just getting broker every day…”

Arthur: “The fact that state employees don’t have abortion coverage is actually a relatively well kept secret. Many of my colleagues don’t know that they don’t have abortion coverage until somebody tells them or until they, or a family member, needs abortion care. Now, technically there are three circumstances under which abortion coverage is provided. According to the website that I looked at for my health insurer, rape, incest or ‘where the life of a woman would be endangered.’ Note, this language does not provide abortion coverage for men whose lives are in danger by pregnancy, which as surprising as it may be to some people is a real circumstance that does occur. And imagine having to prove to your health insurer that you were raped in order to get your abortion covered. So what this means is that in the midst of some of the most difficult moments of their lives, my colleagues discover that they’re on their own.

“I personally am privileged enough that I have the financial ability to cover the cost of an abortion if I had to. But many state employees don’t have that privilege. Many of them are among the 39 percent of Americans who would not be able to handle an unexpected $400 expense without facing significant difficulty. And they have no idea that this is situation that they could end up in. In terms of my personal situation, I was born with a genetic condition called Stickler syndrome. This condition is a deficiency in connective tissue that affects my entire body causing progressive deterioration in joints, hearing, and vision. Some people believe that it is one of the leading causes of inherited blindness. It’s transmitted in what’s called an autosomal dominant pattern, which means that 50 percent of the offspring of any person with Stickler syndrome will be a born with that condition.

“What that means is that I would not bear children without pre-implantation genetic diagnosis to ensure that I did not pass on this condition to any child that I had.Were I had to become pregnant without pre-implantation genetic diagnosis, I could not bear the thought of having passed on that legacy to another generation And of course a pregnancy could be dangerous to my own health for various reasons, causing risks I wouldn’t want to undertake. So far in my life, I’ve been lucky enough to avoid unintended pregnancy, but I know that’s just luck, and none of us should have to live a life in which every time we have sex we have fear – whether that’s fear of the financial consequences, whether that’s fear of the physical consequences to our own bodies or whether that’s feat that we would be forced to bring into being a life that we know we don’t want to bring into being.

Montaquila: “Since I found out that my healthcare is not going to be reinstated, and that I don’t have dental coverage, which I found out about on the same month as I like cracked a molar… I’ve started to really think about my career choices. I’ve been interviewing with different places, hopefully to hear back soon, but it’s unfortunate because I love the place where I work right now. I’m a theater major. I graduated as a theater major, so they were really flexible with their hours. They allowed me to do what I’m passionate about. But in my interview I had a couple of weeks ago, I literally told the person, because she knew about my theater background, I told her I was willing to put theater on the back burner even though this is what I spent thousands of dollars on, what my passion is, what I’ve dreamt about my entire life – I was going to have to not do that because I really need to get serious about a job that’s going to offer me more.”

Arthur: “From my experience as an academic, it’s somewhat unusual in terms of our profession. Academics have very little say in where we end up living if we want to be employed in our profession… We don’t have the professional option to therefore say, ‘This employer isn’t giving me the benefits I want. Let me find another one.’ The calculus may be slightly different for other state employees who could go off and find a job somewhere else. But because of the structure of retirement benefits and seniority and various things that are built into state employment contracts for most rank and file state workers, their choice to take another job means actually foregoing substantial benefits, including what they’ve taken on as part of their compensation for the years that they’ve worked. Those are of course, enormous privileges that state workers have, but nobody should be having to give up things in order to get access to health insurance coverage. None of us should have to forego abortion coverage simply because of where we work and because of the ways that our careers have unfolded.

“One of the things that’s really interesting about both the campaign last year and the work that we’re going to be doing this year is how much of a surprise it is to so many people that in this state that they think of as blue, that they think of as liberal, that they think of as progressive, that these rights aren’t protected. It’s been really interesting to me to have those conversations with people, including members of my own faculty union and say ‘No, we don’t have that protection. We don’t have that coverage. Look in your insurance documents.’ People are really surprised. Having the opportunity to get the word out to help people start to understand the situation that we are living in and to build power towards making a difference so that nobody in the state is in that position, which of course is much broader than just this issue, right? We can’t stop with just changing health insurance coverage for people who have Medicaid and for state employees because there are still lots of people who don’t have health insurance coverage at all, because just insurance coverage isn’t enough to make sure that people have the autonomy to make choices about pregnancy and parenting. But at least we can work this year on making that first step to reduce the number of people who are faced with this fear that they aren’t going to be able to have the coverage that they need.”

Olarte: “You both did something really hard. There’s a lot of stigma around Medicaid. There’s a lot of fears when talking about the issue. So I want to thank both of you for being fearless and having that conversation and telling your story.”

Brown: “There are studies that show that in states where there’s more reproductive rights access, women are paid higher. Of course, there are a lot of other compounding factors, so we don’t necessarily know, but we do know from our own lives, as Daria just testified so beautifully, that healthcare in general and reproductive rights in particular, if we have those under control, that means we can take a leap, do other things, maybe be not afraid to change jobs. These decisions around jobs and even around marriage and around health care are definitely constraining our ability to change jobs, leave a marriage, get married, retire. All of these things which should be human rights that we decide on based on other factors than whether or not we have health insurance. My experience was that when Obamacare passed, it allowed me to leave a job that had health insurance and get one that didn’t have health insurance, but the deductibles were very high.

“That was fine as long as I was healthy but when I was diagnosed with breast cancer… I seriously looked at maybe I need to marry the boyfriend that I’ve been living with for several years because I could get health coverage that would be more comprehensive, because I ended up $7,000 out of pocket for two years running at first with the breast cancer surgery and then with the followup treatments. I’m sure all of you have family members, or you yourself can think of ways in which our healthcare system and the reproductive rights part of it have distorted what we wanted to do and with our lives. I’m a big advocate for Medicare for All.

“I think it would be a giant feminist advance not to have to worry about healthcare when we think about jobs and marriage. The whole idea that we would be pressured into marrying to get healthcare as I was. I feel very happy to be married, but I would probably not have taken that step without the requirement of healthcare. It would be a great feminist advance if we could get the same kind of healthcare that people all over the advanced world have and people in very poor countries have because their governments have made it a priority to make that everybody in their society has healthcare.”

Arthur: “Telling these stories is hard, but it shouldn’t be, right? Our society continues to stigmatize not only people who’ve had abortions, but people who use public health insurance and people who experience disabilities and chronic illness. We’re currently in the midst of federal litigation over the provisions of the affordable care act that ensure that those of us with preexisting conditions can access health insurance. So when I share my story, I’m conscious of the fact that telling it could change the way I’m treated personally and professionally, and that makes doing so hard, but it’s also what makes doing so really important. Being willing to have these conversations and tell our stories is part of the way that we work towards de-stigmatization. It’s the fact that so many of us are so reluctant to tell our story that enables people to wear blinders about how common the experiences are.

“In fact, the history tells us that stigmatization has in some ways been more powerful than criminalization in deterring people from access to abortion. So we need to return to a framework of liberation that helps us get beyond that. We need to do it better than prior generations did so that we can care more about reproductive justice more broadly. In this conversation, we’re not just talking about access to abortion, we’re talking about access to healthcare of all kinds. We’re talking about access to autonomy and making decisions that are about our bodies and our childbearing, which are rights that people with disabilities often don’t have. So there’s so much more there and it’s not until we, all of us, can start to share our stories without so much fear that we can really make some of the progress that we need to make.”

Olarte: “I’m really glad that you spoke on disability because true. We have a lot to say on that issue, but because that’s probably another panel, we can talk about that another time.

“White women in general have an easier time speaking about these things than women of color. Sometimes women of color are stigmatized a lot more than white women when we’re sharing stories.”

Brown: “I start the book with the breakup of a reform hearing by the Women’s Liberation Movement. And then this group called Redstockings conducted the first ever abortion speak out where women got up and talked about their illegal abortions at a time when it was still illegal, so presumably you could be arrested and asked to reveal who was your doctor and so forth. 20 years later they did a speak out in 1989 and it was very interesting. One of the testifiers said it was easier to speak out in 1969 than in 1989 because she felt that she had the movement around her, she felt she had movement sisters who would be there. In 89, she felt much more isolated. The movement had dissipated and it was much harder to speak out.

“I think this is a lesson for all of us. For people to be able to get up and speak out as they did in 1969, we need to have a strong movement. We need to be there for our sisters and siblings. We need to think about how we can support people. For example, Amelia Bonow, who inadvertently started the Shout Your Abortion movement with her abortion testimony had to basically go into hiding because she was attacked so viciously online and had so many death threats. But it’s not just horrible strangers. It’s also your own family, extended family, people in your church, folks in your community when they hear you had an abortion, it’s like, you know, will the stigma hurt your kids? Will it hurt your family? You can be stigmatized very easily.

“We need to be a support system for folks who do speak out, who feel the strength to speak out. And that makes it easier for everybody else to speak out. And more and more until we can break through that stigma. It definitely hits women of color more because there are all these horrible stereotypes that women of color are sluts or women of color are having too many babies or whatever, all of these things that we’re familiar with. So for women of color, we need to be even more, supportive and make sure that those folks are safe when they’re speaking out.

“The first step that caused the Women’s Liberation Movement to take on abortion was really talking, not publicly, but speaking to each other, speaking among ourselves about abortion and discovering that so many people had had abortions and had never told anybody, right? So you don’t have to get up in a big crowd. You can just share it among your friends and talk to women that you know are going to be supportive. That’s the first step. And then they get strength from your testimony. You get strength from their testimony and you really get more of an assessment of the condition of women, which is the idea with consciousness raising – you would take all of those specific experiences and generalize it into what we need and want for our political program and what we need to demand in the public arena.

“So even if you don’t feel quite ready to speak out to strangers it’s important to talk to your friends. And this was one of the really powerful things in the campaign in Ireland where people talked, went door to door and talked, about their experiences with abortion and asked each other about their experiences with abortion and so many people had had abortions but they hadn’t told anybody because it’s illegal in Ireland… That was, extremely powerful. And when the vote happened, they asked people who voted, what was influential to you in your vote and hearing people’s stories was one of the big factors. And those people were much more likely to vote for repeal.

“When Roe was decided, for the following three or four years, Medicaid covered abortions nationally, all abortions were covered. That was ended with the Hyde Amendment. Which is very interesting when we think about the Democrats and Republicans and how they’re divided now. [President Gerald] Ford said he would not sign it. [President Jimmy] Carter staked out a position that he would sign this ban on abortions through Medicaid. And then he did. And he even said, well, there are some things that aren’t fair in life when asked about it by a feminist journalist.

“The Hyde amendment is always attached every year to the budget and it restricts all federal funding to abortions. That’s the Indian health service. That’s the military, military hospitals, federal prisons and people who get their healthcare, through Medicaid… We campaigned in various States and won Medicaid coverage for abortion in various places. So California and New York, for example, cover it. Then some States covered abortion in certain circumstances and whatnot. So that’s the history of how it happened.”

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