House Republicans are currently advancing the “No Taxpayer Funding For Abortion Act,” or HR 7, a measure that would impose sweeping restrictions on abortion coverage that could make the procedure less affordable for Americans across the country. In addition to preventing low-income women from using their Medicaid coverage to access abortion, HR 7 could also have dramatic implications for the tax code and the private insurance market. One of its most controversial provisions could actually require the Internal Revenue Service to conduct audits of rape victims.
Why? Because HR 7 eliminates medical-expense deductions for abortion care, essentially raising taxes on the women who opt to have an abortion. Like many abortion restrictions, this provision includes an exemption for victims of rape and incest, as well as women who encounter life-threatening complications from their pregnancies. But in order to enforce those exceptions, the IRS would have to verify that the women who are claiming a medical-expense deduction for an abortion fall into one of those three categories, to ensure they’re not committing tax fraud.
Essentially, that would empower the government agency to have the final say over what “counts” as a sexual assault or a life-threatening situation. And that, in turn, would force victims to prove their case.
“Imagine having to recount a sexual assault — a horrifyingly painful, personal experience — to a tax collector,” NARAL Pro-Choice America says in an action alert to its members to encourage them to mobilize against HR 7. “An anti-choice bill in Congress would do just that. It could force sexual assault survivors who access abortion care to prove the assault occurred.”
That certainly sounds horrific. However, it’s important to remember that HR 7 is hardly the only piece of anti-choice legislation that sets up this dynamic.
The biggest political controversies over abortion policies throughout the past year have centered on rape victims, highlighting the anti-abortion laws that don’t extend any exceptions to them. It’s easy to see why the pro-choice community focuses on leveraging the outrage surrounding rape and abortion. Voters overwhelmingly favor legal abortion access for individuals who have become pregnant from rape, and policies that don’t fall in line with that seem especially callous.
But even when abortion restrictions do include some kind rape exception, as HR 7 does, the issues don’t end there. Exceptions for rape victims have some unintended consequences. They require some kind of system to separate the women who have become pregnant from sexual assault from the other women who want to end a pregnancy for a different reason. They essentially necessitate “rape audits.”
And in states across the country, that’s exactly what’s already occurring. The audits aren’t being conducted by the IRS, but they are being conducted by state officials.
Medicaid coverage for abortion services provides the best example of this. The Hyde Amendment, the policy that currently forbids low-income women from using their Medicaid coverage to help pay for abortion services, includes the same exceptions as HR 7 does. Thirty two states and the District of Columbia follow that federal standard for their local Medicaid funds — so, if the women who live there want to claim one of those exemptions, they already need to sufficiently prove why they deserve it. Some states require more proof than others. In 22 states, low-income rape victims who want to use their Medicaid coverage to pay for their abortion need to present a doctor’s note. Eleven other states require them to file a report with law enforcement or a social services agency. Last year, Iowa approved a law that requires the governor to personally approve each woman who’s seeking an exception to the Medicaid coverage ban.
Studies have found that these exceptions don’t operate as intended. Most rape victims who rely on Medicaid don’t actually end up getting reimbursed for the procedure, largely because of all the red tape. “Basically these exceptions don’t work. It’s really a myth that there is coverage that is still provided,” Stephanie Poggi, the executive director of the National Network of Abortion Funds, told the Washington Post.
Nonetheless, that hasn’t stopped state legislatures from moving forward with similar restrictions in other areas of the insurance industry. Outside of Medicaid, several states have already imposed abortion restrictions on the private insurance market that are similar to HR 7. And the health reform law has given states an opportunity to impose coverage bans on the procedure in their new insurance marketplaces.
We already live in a world in which navigating insurance coverage for abortion is so complicated that many women simply assume their insurer won’t pay for it, and end up financing the entire cost out-of-pocket. And we already live in a world in which victims of sexual assault are forced to prove the validity of their experiences to a skeptical society that doubts they’re telling the truth. We certainly live in a world that’s enacted nearly as many barriers to abortion access as humanly possible. Abortion restrictions that assume that some women’s reasons for terminating a pregnancy are somehow more valid than others exploits all of these dynamics. HR 7 fits neatly into this worldview — but it’s a continuation of a trend, rather than a brand-new outrage.