Statement for the Record of We Testify
Hearing: “The Impact on Women Seeking an Abortion but are Denied Because of an Inability to Pay”
U.S. House of Representatives Committee on Appropriations Subcommittee on Labor, Health, and Human Services
December 8, 2020
As people who had abortions, we know what it is to make the decision to terminate a pregnancy more intimately than anyone. We know what it is to contemplate what’s next for our futures, we know what it is to make the decision to not grow our family beyond its current size, and we know what it is to go through the experience with and without the support of our government. Together, we’ve experienced financial, logistical, and legal barriers to abortion care, as well as support, compassion, and care from our loved ones, providers, and community. We know what abortion care should look like in the United States, which is why we have joined together to speak out against the Hyde Amendment, a policy that has harmed us and our right to abortion care for too long.
The Hyde Amendment has existed as a discriminatory policy enforcing an economic caste in this nation, ensuring that people with no or low-incomes are unable to afford abortions as soon as we want care. When former Congressman Henry Hyde of Illinois lobbied for the harmful policy that bears his name, he used hurtful and degrading imagery and descriptions about those of us who have abortions, particularly those of us who receive our health insurance through public support systems. This racist and classist language has thrived for too long, keeping those of us who need care from being able to access it safely. The majority of us—people who have abortions—are people of color, so these restrictions harm us the most. It is long past time for the Hyde Amendment to be ended.
As abortion storytellers with We Testify, an organization dedicated to the leadership and representation of people who have abortions—particularly at the intersection of race, class, and gender identity—we are opposed to any bans on insurance coverage for abortion. We know the unnecessary financial struggle and the stigmatizing climate these bans create. We dream of a world where every single person who wants abortions is able to receive care, without stress, worry, or harassment. One of the first critical steps to this liberated world would be to lift all coverage bans on abortion and ensure that we are able to access care, freely. We know the difference that Medicaid coverage of abortion can make for our families.
Everyone loves someone who had an abortion. We had abortions and we deserve to be heard. Thank you for listening to our voices on the impact of the Hyde Amendment.
Denied Medicaid-funded Abortion
HK Gray, 20, Texas
When I was fifteen years old I found out I was pregnant with my daughter. I was ecstatic. I struggled to get on Medicaid since I was a minor and my parents were unable to help; my dad was homeless and my mother was incarcerated. I was unable to go to an Ob/Gyn for almost three months because I had to jump through so many hoops to get my application approved. Once it was approved, I was able to start getting the prenatal care I should’ve had all along. I also had the opportunity to go to the doctor and dentist for the first time in years. Medicaid paid for everything from ultrasounds to the birth of my daughter. This allowed me to spend my money on baby clothes, toys, and nursery supplies.
I was still on Medicaid three months postpartum when I started having what I thought was a very heavy period. I made an appointment with my Ob/Gyn just in case it was anything serious. It was a spontaneous abortion, commonly known as a miscarriage. I didn’t even know I was pregnant before I went in. I was given some medication (the same as a medication abortion) and Medicaid covered it all.
When my daughter was nine months old, I realized I was pregnant again. This time I knew that I was going to have an abortion. I was seventeen, so in Texas, I had to get my parents’ consent, but this was something I couldn’t do because my parents were still homeless and incarcerated. I had to wait to get permission from a judge through a judicial bypass. This entire process made me go to the clinic multiple times, forced me to stay pregnant for an extra 12 weeks, and made my abortion more expensive. I had Medicaid but I couldn’t use it. Luckily, I was supported by Texas Equal Access Fund and Jane’s Due Process through the process. Despite the funding support, I still had to raise $350 and that was difficult. It was unfair that Medicaid covered everything I needed for my daughter’s birth and my miscarriage, but not my abortion.
Makayla Montoya Frazier, 21, Texas
I found out I was pregnant on my 19th birthday while inside of an anti-abortion crisis pregnancy center. I told them I did not want my ex-partner in the room for the ultrasound, but they invited him in any way. I told them I was in constant pain and that I was losing weight. Rather than medical advice, they gave me a blue onesie and a bottle of prenatal vitamins.
I had an extremely difficult few weeks after that. Gestational diabetes made my blood sugar low every few hours leaving me in cold sweats and vomiting all day. My body continued to struggle heavily and I knew that I could not continue my pregnancy while keeping myself healthy. I called my CHIP case manager and was told that I couldn’t be helped because Texas bans insurance coverage of abortion. I was told that I wasn’t going to die; I only felt like I was.
I was then forced to resume my job as an erotic dancer while 14 weeks pregnant in order to pay for the abortion care I needed. I wasn’t able to raise the full $700 within the time crunch I was on, so a few friends pitched in what they could to help me. I owe them everything and more. I feel like they saved my life. Sex work and solidarity did more for me than the State ever could. Every person should have unrestricted access to medical care, regardless of circumstance.
Brittany Mostiller, 35, Illinois
When I was 22, I was a mama to three daughters and holding down a part-time job at a grocery store, and I realized I was pregnant again. I couldn’t afford another child then — physically, emotionally, or financially. The decision to have an abortion was the easy part — but I couldn’t afford it.
When I gave birth to my three daughters, Medicaid covered every aspect of my pregnancy and the delivery of my daughters. So I assumed it would cover my abortion, but because of the Hyde Amendment, it didn’t. I had to figure out how to pay $900 for the abortion out-of-pocket. That was more money than I made in a month. It took me several weeks to save up, which meant that while I tried to get my abortion during the first trimester, I was pushed to later in my pregnancy before I could finally afford the procedure. This was a really challenging and disheartening experience.
Thankfully, the law has changed in Illinois and people enrolled in Medicaid now have abortion coverage. Unfortunately, that is not the case in more than half of the states, and it is doubly difficult when combined with the thousands of abortion restrictions. Millions of people live in states that are hostile to abortion. I experienced first hand the panic and worry of not being sure of whether I’d be able to get the abortions I wanted because I couldn’t afford them. Medicaid insurance has been a healthcare lifeline for me and my family—including when I chose to become a parent. We need to make sure that everyone on Medicaid is able to decide if, when, and how to grow their families without fear of that decision being taken away from them simply because insurance won’t cover it.
Angel Kai, 22, Texas
At the time of my abortion, I was 20 years old and I had Texas Medicaid for my health insurance. In Texas, Medicaid will not cover abortions unless it is a medical emergency, which was not the case for me. I ended up traveling to New Mexico because it was closest, and in Texas, there is a 24-hour waiting period. I had a strict time limit to get the abortion done.
Since abortions are not covered by Medicaid you must either pay out of pocket and or find funding, if you’re lucky some people may be able to get their full procedure covered, but it’s very rare. Thankfully, in my case, I was able to get my full procedure covered, fuel, and lodging between two abortion funding organizations. It would have been easier if my insurance could have covered it, so I could have had the procedure in my home city or at least within the state of Texas.
Medicaid does not cover abortions, but they do cover alternative services such as prenatal medical care and adoption. Texas Medicaid prenatal assistance includes counseling, mentoring, informational brochures about pregnancy, and a family nurse program. They give information on adoption and how it works, but they do not give any information, counseling for services for abortion. I have had Medicaid for all of my pregnancies, including the last two I carried to term and it was so important to me. When I see how much my medical bill actually is, there is no way I could even come close to affording to have my children. I am so thankful that I was able to go see a doctor and not be forced to go through my pregnancy without it because I can’t afford to pay. There is so much medication that I have to have, like lab work, sonograms, and weekly injections due to my anemia. Even the nausea medication is too expensive for me to afford on my own. I am thankful that Medicaid does cover a lot of it because there is just no way that I could have prepared for a baby and pay the medical bills at the same time. It is just impossible. What I wish, however, is that Texas would support me in my decision to not have another child, too. I wish all of my pregnancy healthcare was covered—including my abortion.
CoWanda Rusk, 21, Texas
When I needed an abortion, like a lot of young people, I experienced a lot of barriers, including a Medicaid coverage ban and parental involvement law. I lived independent of my parents but was receiving Medicaid tied to my parents’ state benefits. Because I was under 18, I needed my parents’ permission to get an abortion, but I couldn’t go to them for support and instead had to ask a judge for permission. The way Medicaid was set up it wouldn’t have allowed me to navigate health care systems using pubic assistance (Medicaid) until I became 18 and could apply for services on my own.
Unfortunately, even if Texas’ Medicaid covered abortions, I still would’ve been pushed out of accessing care because of my age. It’s so complicated. Eventually, I had to see a judge to get permission for my abortion, which was granted. Ending Hyde is a necessary step to expanding Medicaid and abortion access. What I imagine is a process that works to include young peoples access and ability to navigate their healthcare independent from stagnant age and parental involvement regulations that only exploit their bodies and freedoms, including and independent from the lack of insurances like Medicaid and that only exacerbates financial barriers to the health needs of young people.
Kay Winston, 26, Ohio
I have had Medicaid health insurance throughout all of my pregnancies, but was only able to use it for the pregnancies I wanted to continue when I had my two children. I didn’t even try to use my Medicaid because I was told early on that it doesn’t cover abortion services before I even got my abortion. It was crystal clear. That makes the barrier just that much more of a barrier. People are on Medicaid because they qualify for it because they can’t afford private insurance. It just creates another barrier. I had Medicaid during my first and second abortion. I also had private insurance through my job, but the deductible on abortion is so high I had no option other than to pay for it out of pocket. It’s extremely unfortunate. They don’t even acknowledge that abortion services are even part of healthcare and that the same Black folks who need abortion care are also on Medicaid. It’s unfortunate that you can use Medicaid to have a baby but not any form of abortion services. That’s astounding. It’s unfair, just like the fifty thousand other issues we fight for so our families can be healthy. It keeps us unable to have the services that we need. We get judged for having children and having food stamps, but then government assistance doesn’t allow you to have abortions you need to decide if you want another child. It’s hypocritical.
I have Medicaid for both of my children and it’s like night and day when it comes to Medicaid supporting doctors appointments, prescriptions, surgeries, having the baby, and everything when it comes to healthcare. It covers so much that sometimes when I go into the pharmacy and get a prescription for my kids, Medicaid covers more than my private insurance through my job so I use it more. It’s wild how Medicaid supports any other healthcare procedure but treats abortion so differently.
Esmarie, 19, Texas
The day I found out I was pregnant, I saw all over Facebook that Texas was going to be shutting down the clinics. I thought ‘I’m not going to be able to have this abortion.’ I thought that I didn’t have a choice—I was going to have to just live with it. It was very scary because I couldn’t tell anybody. I was trying to get as many hours of work as I could. It was also scary because of everything going on. Everything was closed. I wasn’t making enough money. The restaurants were giving me only 10 hours a week, so I couldn’t make enough to support myself. I was scared I would get COVID-19 because I was pregnant. I didn’t have a car, so I had to walk in the heat. No transportation, no work—I couldn’t meet my basic needs.
The abortion clinics were closed at that time, but the CPCs, the crisis pregnancy centers, were open. When I was making phone calls, trying to see which clinics were open for abortion, they were the only ones who answered. They said, “We don’t do abortions, but you can get an ultrasound and we can talk to you about your choices.” But they really only give you two choices—adoption or parenting. I was definitely not going to do adoption because I was adopted and it just didn’t go well. But I knew I couldn’t raise my child at this time.
The first time I had an abortion, I was eight weeks along. I had Medicaid and was under 18, so I had to get help from an organization to get a judicial bypass and pay for my abortion. The first time, it was not that bad—I was able to handle the pain, I guess. But the second time, it was so bad. I couldn’t move, I had chills, and my stomach was hurting. It was so bad I brought my blanket into the restroom just so I could be next to the tub, be next to the toilet. I feel like this wouldn’t have happened if I could have just gotten the help earlier.
I had forgotten my mask—that was not on my mind at all. I was nervous. I didn’t want to touch anything. I think I was having a panic attack because I couldn’t tell them I was having a miscarriage. They were asking me what was wrong and what I needed, but I couldn’t breathe because I was in shock. I just remember holding my stomach because it was hurting and I was crying because I was scared. I told them, “I’m bleeding and I was pregnant.” I told them I was having a miscarriage because I was scared that I could get arrested for doing my own abortion and because Medicaid insurance pays for miscarriage care.
Then I lost so much iron from bleeding that I passed out on the floor. I’m 4’11” and I weigh about 98 pounds. I later found out that I have an iron deficiency and was able to get medication for it. I remember a receptionist told me to go put hand sanitizer on. I walked to go get hand sanitizer and I woke up on the floor. They put me in a wheelchair. It was kind of embarrassing—I was bleeding all over the wheelchair, all over the floor and the restroom.
They gave me morphine for pain through an IV. I was on anesthesia because I guess they had to finish taking out whatever was left, so I was asleep. When I woke up, I felt better and everything was fine. The pregnancy was over, and honestly, they did the same procedure, but Medicaid covered it because it was considered a miscarriage and not an abortion. I should have been able to have it covered without going through this.
Received Medicaid-funded Abortion
Sally Alves, 35, Massachusetts
At the age of 24, I found myself unemployed, struggling with an active addiction, and in poor mental health. It was at this time that I discovered that I was six-weeks pregnant. I knew growing my family was not in my best interest, so I wanted an abortion without hesitation. However, I was extremely scared and unsure of my options as someone with limited income. The silver lining during this very scary moment in my life was that I was on Medicaid and living in the state of Massachusetts. My state—unlike so many others—makes it possible for many on Medicaid to access abortion services without financial barriers. If it were not for Medicaid, I do not know how I would have saved up over $500 to afford the medication abortion. Perhaps, if I sold some of my things, I would have needed four or more weeks to raise it all, but honestly, I do not think I would have been able to raise it in time. I didn’t have anyone to turn to because everyone around me either didn’t support my decision or—like me—also had limited income and didn’t have the cash to spare.
I do not hesitate to say that my abortion saved my life. It was truly the access to comprehensive healthcare that provided me a second chance. My abortion allowed me the opportunity to re-direct my life towards stability, and thankfully I can say that I am ten years sober today. I do not doubt my trajectory would have been much different if I had not had my abortion. What I wish to stress is that I am privileged to live in a part of the country where my abortion experience was possible without financial stress, especially when Medicaid abortion coverage is not an option for many people across this country.
It’s shameful to think that a legal right to an abortion is continuously hindered because one has limited income and/or lives in a region that makes it logistically impossible to access one. Medicaid is a viable and appropriate route for many who wish to seek an abortion, and if we’re truly serious about upholding abortion rights in this country, then we must secure all resources for the 1 and 4 who will choose to rightfully have one.
Lexis Dotson-Dufault, 22, Ohio (via Massachusetts)
Nearly every factor surrounding my abortion experience was traumatizing– except the fact that I was no longer pregnant, which was made possible only because my insurance covered my abortion care in its entirety. Growing up poor and part of the foster care system, I had been a MassHealth (the Massachusetts state Medicaid plan) member my whole life until I graduated college. As a full-time student at the time, I was not working as many hours as I needed already. Then once I became pregnant, I quickly became sick to the point of being bedridden, and could no longer work at all. I barely had enough money to put gas in my car to make it to the clinic. If MassHealth had not covered my abortion care entirely, I would have had no choice but to unwillingly continue my pregnancy due to my financial status. I can’t imagine how long it’d have taken me to raise the funds to pay for my abortion. I wasn’t in a safe position to tell anyone who had the means to help and I was too sick to work. I probably would have had to wait at least an additional two months until my school refund check came through.
Massachusetts has a long way to go in terms of reproductive justice, specifically abortion access, but just allowing state dollars to be used to pay for abortions elevates a number of barriers for specifically for low-income individuals trying to make personal reproductive decisions. By banning Medicaid dollars from covering abortion care, America continues to perpetuate reproductive coercion, specifically targeted against poor people, Black people, people of color, and young people. It will never be enough to just make abortion legal, unless this country switches its focus to accessibility, abortion might as well be illegal to people with marginalized identities and from disadvantaged backgrounds.