Iowa Gov. Terry Branstad (R) has approved a measure to expand his state’s Medicaid program under Obamacare, which will extend health coverage to tens of thousands of his poor residents. But there’s a catch buried in the Medicaid expansion legislation that the governor signed last week. Now, when low-income women on Medicaid seek insurance coverage for medically-necessary abortions, they’ll have to get approval from Branstad himself.
State-level Medicaid programs often exclude abortion from the health services they will cover for low-income beneficiaries. Just like the Hyde Amendment prevents federal money from directly funding abortion care, over 35 states have decided they don’t want state dollars to pay for abortion, either. Just 17 states allow low-income women on Medicaid to receive insurance coverage for most abortion services — the others, like Iowa, will only permit those women to be reimbursed for the cost of their abortion in cases of rape, incest, and life endangerment.
But now Iowa is going a step further. If a woman who gets her health care through Medicaid has an abortion that falls under one of the exceptions in the state’s abortion coverage ban — if she has been a victim of rape or incest, if her fetus has fatal abnormalities that won’t allow it to survive outside the womb, or if her life will be put in danger unless she ends the pregnancy — she’ll need to have her case approved by the governor’s office. Presumably, Branstad will choose whether to approve or deny each woman’s request for insurance coverage for her abortion. It’s the first law of its kind in any state.
“This bill — now law — is outrageous on many different levels,” Ilyse Hogue, the president of NARAL Pro-Choice America, said in a recent statement. “Women in Iowa already face so many barriers in trying to get safe, legal abortion care. Now their governor will be deciding personally on a case-by-case basis, whether a woman’s doctor will be paid for providing a legal, medically appropriate, and constitutionally guaranteed procedure.”
Under Iowa’s current policy, a state agency already reviews claims for Medicaid funding of abortion services to make sure the billing is adhering to the law and doesn’t fall outside of the approved exceptions. As the Des Moines Register reports, that process will likely continue under the new law. But there’s a notable difference: “instead of the final call being rendered by the Medicaid medical director, the democratically elected and politically accountable governor will decide.”
Low-income women are unlikely to be able to afford bills for abortion care, which can exceed $1,000 dollars. If the governor decides that Medicaid won’t cover the cost of an abortion procedure, the medical providers will likely be forced to absorb the cost.
Ultimately, denying low-income women access to affordable abortion services simply exacerbates the economic divides that lead some desperate women to seek out illegal abortion providers. By passing a mounting number of state laws that prevent women from using their insurance coverage to pay for reproductive care — as well as by forcing abortion clinics out of business and driving up the cost of the abortion pill — lawmakers are essentially making abortion too expensive for low-income women to access at all.