Rep Cassar: Bans on abortion coverage are not good economic policy, not good health policy, and not good for Rhode Island
“…it is unacceptable for the legislature to control the reproductive lives of individuals on Medicaid and state plans, just because we can, and because a small number of legislators think we should.”
When Representative Liana Cassar (Democrat, District 66, Barrington, East Providence) introduced the Equality in Abortion Coverage Act, her legislation to remove the bans on abortion coverage that currently exist in Rhode Island’s Medicaid and state health insurance plans, she made a powerful and profound case. Here are her words, in their entirety.
“I’m here to introduce H7442, the Equality in Abortion Coverage Act, which would remove the bans on abortion coverage that currently exist in Rhode Island’s Medicaid and state health insurance plans. It is an invasion of privacy and an infringement on personal liberty for government to decide if and when an individual is pregnant, gives birth and parents.
“Removing bans on abortion in our state assures that necessary healthcare can be delivered when patients need it, regardless of how they pay for their care. Pregnancy is not a benign condition and it is not a health neutral event. It can be and often is a physical and financial hardship to be pregnant. It can be and often is a physical and financial hardship to give birth. It can be and often is a physical hardship. It is always a long term financial commitment and for some, a hardship to parent in Rhode Island.
“We do not have adequate supports for parents, pregnant and parenting people. We do not have adequate paid parental leave nor adequate sick leave. We do not have adequate mental health services for people experiencing postpartum depression and we do not have adequate early intervention services. We do not have adequate supports for parents with disabilities, nor for parents raising children with disabilities. We do not have adequate affordable childcare services, and we do not have adequate affordable housing. We lack the social service infrastructure to help families succeed, especially our families with the lowest household incomes.
“We do, however, have a growing number of families experiencing hunger and homelessness. A lack of abortion access pushes people already marginalized by our struggling healthcare and social service systems a whole lot closer to the edge. Pregnancy, labor, delivery and parenting are a potential life sentence for individuals who are stuck in households where there’s domestic violence. Even in the best of healthcare circumstances, there are immediate physical impacts of pregnancy, labor, delivery, and the postpartum period. Birthing and adoption are not reasonable alternatives to abortion access.
“There are long term adverse health effects of pregnancy, and all too often, there is a risk to the life and wellbeing of the pregnant person. The maternal mortality rate in the United States and in Rhode Island has been rising for the past 20 years with the highest rates among Black, brown and poor individuals. The data shows Black and Hispanic women are multiple times as likely to die in childbirth as their white peers in public health circles. Maternal mortality is an indicator of overall population health. For this rate to be rising at a time in history, when we have access to high quality healthcare, should be alarming to all of us and a call to action across the country and here in Rhode Island.
“Also, there’s a high rate of maternal morbidity, the short and long term complications from giving birth. Black, brown and poor individuals in Rhode Island have a higher level of maternal morbidity and are more likely to be readmitted to the hospital for pregnancy related complications in the postpartum period. Since more than 60% of individuals who have abortions are parents, we can imagine the strain on a family, not to mention the cost of childcare, when a person needs to be readmitted to the hospital after a birth where if they’re experiencing physical limitations from childbirth that impedes their ability to care for their families or even return to work.
“This is one of the many reasons why it should be up to the individual, and not us legislators, whether or not they give birth. Receiving one’s health insurance through Medicaid or state health insurance plans is not a choice, but a condition of an individual’s economic reality that is beyond their control – the inability to access abortion through Medicaid or state health insurance plans.
“The inability to access abortion is not a result of market forces. It is a result of a small number of legislators who have decided their beliefs should control the life and healthcare choices of individuals who are on Medicaid and state plans. Aside from removing an individual’s agency over their own body, the limits on access to abortion coverage impact our healthcare provider’s ability to deliver quality care.
“The obstetricians and gynecologists in our state are among the best healthcare providers in the country. They’re highly trained, board certified clinicians who work tirelessly to assure the health and wellbeing of their patients. They’re dedicated to the advancement of women’s healthcare through continuing medical education and through practice, research and advocacy for their patients. They work to assure the best health outcomes, and they understand that there are instances due to personal economic and medical reasons that a patient will not be able to continue a pregnancy.
“Abortion bans, like the ones we currently have, tie the hands of these medical professionals in an instance where there is a fetal demise or loss or a miscarriage, where an abortion would be medically indicated. If a patient is covered by Medicaid or a state health plan, that provider is limited in the services that they can provide or access on behalf of their patient.
“In those situations, the beliefs of total strangers, in this case a small number of legislators in this building who oppose abortion with no insight into or consideration of the medical reality facing a doctor and patient, enter into the exam room and limit the options. When this is the case care is often delayed in order to determine how to pay for services that insurance won’t cover. And in the case of a pregnancy complication, any delay creates an increased health risk. This is the reality for Rhode Islanders who receive their health coverage through Medicaid. Those who are, by definition, poor – as well as for the 33,000 individuals, like those of us who work in this building and our family members, who are covered by the state health insurance plans.
“I urge my colleagues to resist the temptation to insert the beliefs of a small number of legislators into the exam rooms of a large number of healthcare providers and their patients. Pregnancy has significant life altering and sometimes life threatening impacts as well as significant life altering financial impacts.
“It must be in the hands of the individual to determine if they’re ready and able to go forward with a pregnancy. As a state, we do not make it easy for people to parent, and it is unacceptable for the legislature to control the reproductive lives of individuals on Medicaid and state plans, just because we can, and because a small number of legislators think we should. I deeply and wholeheartedly trust women and others to make their own medical choices for themselves. They deserve the liberty that men and individuals on health insurance plans currently enjoy when it comes to making their own decisions. I deeply trust Rhode Island’s healthcare providers to care for their patients and deliver the highest quality reproductive health services.
“Maintaining bans on abortion coverage is not good economic policy, is not good health policy, and it is not good for Rhode Island. Fortunately, the General Assembly settled the question of whether or not abortion would remain available in Rhode Island in 2019. Now we simply need to make the right real for all Rhode Islanders, regardless of the way that they pay for their healthcare.
“I urge this committee to vote this bill out and send it to the house floor so that we can make sure that abortion is available for all.