ibis reproductive healthibis reproductive health

September 2010

In This Issue:

Public Funding for Abortion in Cases of Rape, Incest, and Life Endangerment

New Resource: Public Funding for Abortion in Florida and Pennsylvania

Ibis in the News

Dear Friend,

This month we reach a discouraging milestone. On September 30, 2010, the Hyde Amendment, the federal ban on funding for abortion in the United States, will have been on the books for 34 years.

In this newsletter, we provide an overview of research Ibis has been conducting since 2007 to evaluate the impact of the Hyde Amendment on women and health care providers who seek coverage from the federal Medicaid program for abortions in qualifying cases: when a woman is pregnant as a result of rape or incest, or when her life is endangered. The results of our studies show that women are being denied coverage for services that should be covered based on current law.

We also share a new resource that we have developed in response to requests from advocates working to improve abortion access in various US states. These two summaries provide detailed findings and discussion based on our research in Florida and Pennsylvania. We hope that they will be useful to advocates across the US who can learn from the experiences, both positive and negative, in these states.

On a more positive note, we are very excited that Ibis’s work has been in the news a lot lately; we list some highlights below. 

We are grateful for your continued support and hope you enjoy reading about our latest work.


Kelly Blanchard, President

Public Funding for Abortion in Cases of Rape, Incest, and Life Endangerment

In direct contradiction to both state and federal laws, thousands of women in the United States are denied Medicaid funding each year for abortions that meet the criteria for coverage: rape, incest, or a pregnancy which endangers the life of the woman.

Since 2007, Ibis Reproductive Health has investigated the impact of the Hyde Amendment on women seeking Medicaid coverage for abortion and on health care providers that offer abortion services. Abortion is a legal procedure in the United States, but the Hyde Amendment, a federal law that has been attached annually to appropriations bills and renewed every year since 1976, bans Medicaid from covering the cost of abortion except in cases of rape, incest, or life endangerment.

Medicaid is a public health program for eligible families and individuals with low incomes. Securing Medicaid funding for abortion means interacting with the joint federal and state funding structure that makes up the program. Abortions that meet the Hyde Amendment funding criteria draw from federal funds. Individual states can opt to use their own state Medicaid funds to cover abortions under a broader range of circumstances, though few do. Currently, 32 state Medicaid programs fund abortions only in the cases outlined by the Hyde Amendment, and in South Dakota public funding only covers abortions when a woman’s life is threatened, in defiance of federal law. Funding restrictions on abortion create disparities in access to safe, high‑quality care, and disproportionately affect the poorest women in the US; a first-trimester abortion can cost more than half of what a family at the poverty level lives on in one month.

Ibis has found that even in the extreme cases of rape, incest, and life endangerment, Medicaid is not meeting the needs of low-income women. In three phases, Ibis conducted 66 in-depth interviews with abortion providers recruited from 17 states, including five in which state law mandates that Medicaid cover all or most abortions. The first phase of the research was conducted in six states which limit Medicaid funding to the restrictions imposed by the Hyde Amendment. One of the main findings from these interviews was that the providers were unable to obtain Medicaid coverage for women for abortions in these limited cases due to unclear and complex Medicaid policies and procedures. In all states but one, virtually no abortions that the providers thought should be eligible were funded by Medicaid. Most providers had therefore given up working with Medicaid due to the burdensome claims procedures, excessive staff time required to file for reimbursements, and ill-informed Medicaid staff that hampered their efforts to seek coverage for these abortions.

Our research also found that women are delayed in, and sometimes prevented from, obtaining abortions and accessing treatment for life-threatening conditions by bureaucratic Medicaid policies and procedures. Providers reported that many women who were raped or whose lives were threatened by their pregnancies were delayed in obtaining an abortion due to time spent trying to determine if their insurance would cover the abortion, working through the Medicaid claims process, or searching for other funding for the procedure. These delays pushed some women into obtaining riskier and more expensive second-trimester abortions, and prevented some from obtaining abortions altogether. Women with grave conditions, such as cancer, were forced to delay life-saving treatment until they obtained an abortion because such treatments may have harmed the fetus.

Further, women, providers, and abortion funds are assuming financial responsibility for abortion procedures for which, by law, the federal government should pay. Providers reported that many women had to borrow money from family and friends, delay the payment of critical bills like rent, pawn items of value, sell drugs, or take out small loans to cover the cost of their procedures. Many providers absorbed the partial or full cost of some procedures to compensate for Medicaid’s failure to reimburse for abortions in these cases. Abortion funds—primarily volunteer-led organizations that raise money to directly help women cover the cost of an abortion—are a critical source of financial support for women in need. Many providers called abortion funds a “life-saver” for women.

We have gone on to complete two additional phases of interviews to include providers from additional states, some of which have more expansive state Medicaid laws. The results, which are currently under review, indicate that problems working with Medicaid to secure abortion coverage are widespread, and that even in some states where the law provides for coverage of abortion in most circumstances, obtaining funding is difficult or impossible, revealing a large and concerning gap between the law and its implementation. However, the second and third phases of the study also revealed a number of successful strategies employed by providers to ensure reimbursement for the abortion procedures they performed, and in two study states the Medicaid system was shown to be working efficiently to meet the reproductive health needs of Medicaid clients.

Most recently, we conducted a “mystery caller” review of the Medicaid offices in 15 of the states where we had previously interviewed providers. After calling Medicaid offices directly, we evaluated the information Medicaid representatives provide to women about the availability of abortion funding and the procedures for obtaining such funding. Preliminary analysis of the results of this assessment suggests that the information provided by Medicaid is highly inconsistent, and often does not reflect the current law.

Unfortunately, restrictions on abortion funding through Medicaid are not the only bans which impede women’s access to legal and vital abortion services in the United States. Funding restrictions also affect women in the military and women receiving health care from the Indian Health Service. Ibis has begun work over the past year to explore the experiences of these women. And, new abortion funding restrictions were included in the new national health care law. Ibis is committed to continuing our rigorous research on the impact of funding restrictions on women’s ability to access abortion services. It is our hope that our data can play a critical role in overturning current restrictions and fighting new ones, in order to ensure that all US women have equal access to safe, affordable abortion.


New Resource: Public Funding for Abortion in Florida and Pennsylvania

I am excited to share two new briefs that closely examine the experiences of abortion providers securing Medicaid funding in two US states: Florida and Pennsylvania. We completed these materials at the request of on-the-ground advocates who were interested in the data we had collected from abortion providers in specific states as part of our overall Hyde Amendment study.

The analyses provide details of the lessons learned about the successes and remaining challenges for abortion providers in individual states. Such information can provide important feedback about local and state-level strategies for improving access to abortion funding for women who are legally entitled to it, and can help advocates in other states develop strategies to improve access to federal funding and state funding when available. We aim to utilize them as a jumping off point for developing future research and advocacy activities. If you are interested in having us develop a brief based on one of the other states in our study, or in collaborating to develop advocacy activities using this data, please contact me at adennis@ibisreproductivehealth.org.

- Amanda Dennis, Senior Project Manager

Ibis in the News

We are pleased to share recent news stories which have featured Ibis and our work:

*Note: This article nicely summarizes the issue of moving oral contraceptives over the counter in the Canadian context. Unfortunately, it contains a quote from a physician stating that progestin-only pills (POPs) are not effective contraceptives. Despite common beliefs that they are somewhat less effective, POPs are highly effective and may in fact be equally as effective as combined oral contraceptive pills.