The “All* Above All” Bus Went Cross-Country For The Abortion Rights You Hadn’t Heard About
If it weren't for the dry-erase boards lining its sides, the All* Above All bus wouldn't look so out of place rolling through Boston's Copley Square in early September. By noon, the tiny two-door truck with flashes of lime green was covered with scrawled slogans and pleas: "Because all women and families deserve equal access to health care — keep up the fight!" Free-hand drawings of Massachusetts filled the spaces in-between, along with sketches of the states that came before: Illinois, Minnesota, California. This was a well-traveled truck, and it still had about more six states to go.
What was more out of place than the truck was its message — repeal the Hyde Amendment, a federal ban on abortion coverage — laid out during the noon-time rally by Boston City Councilor Ayanna Pressley:
There’s nothing wrong with being publicly angry about injustice. In fact, it’s mandatory to be publicly angry about injustice. And this is an injustice. We must demand equal access to abortion. I’m pleased to be here as your sister in solidarity in this struggle, united with you to lift the bans the deny abortion coverage. ... It’s a moral outrage. It’s a tax on our poor, on the most vulnerable amongst us. This is simply a matter of justice.
If that sounds like a radical position, it's because you probably haven't heard too much about federal funding for abortion in 2014. Over the last several years, anti-abortion legislators have been alarmingly successful at shuttering clinics from North Carolina to North Dakota, forcing abortion rights advocates to shift their focus from increasing to preserving abortion access. For policy-makers caught in the crosshairs of legislative battles, it's not only risky to advocate for federally funded or insurance-covered abortions; it's almost irrelevant. Keeping a city's or state's sole abortion clinic open has taken precedent over ensuring affordable abortion care among marginalized communities.
The slow death of abortion clinics across the United States has left thousands of women in a bind. Fewer clinics means more miles to travel. More miles to travel means an overnight hotel stay. An overnight hotel stay means more days off from work. All of this drives up the cost of an abortion for the women the Hyde Amendment left behind.
38 Years Of Hyde
During the hottest days of August, activists with All* Above All — a coalition composed of reproductive rights organizations — climbed aboard the two-door truck, endearingly nicknamed "the Bravemobile." They launched their "Be Bold" road trip in Los Angeles, snaking up the West Coast and around the upper Midwest to the Northeast, stopping at 12 cities. Their target, at the end of the six-week tour, was Washington, D.C., where they rolled up to Capitol Hill with a petition urging Congress to repeal the Hyde Amendment, a 38-year-old provision that bars federal money from funding abortion procedures.
A budget rider tacked onto federal bills each year, the Hyde Amendment is perhaps the greatest barrier to abortion in the United States, says Stephanie Poggi, executive director of the National Network of Abortion Funds, the umbrella organization for abortion funds in 42 states, and co-organizer of the All* Above All road trip. "Hyde was really the first major [abortion] restriction that has affected more women than any other restriction over time," Poggi tells Bustle. "Every other restriction that has happened, from waiting periods to biased counseling to these clinic regulations — all of that just compounds the impact."
Under Hyde, women enrolled in Medicaid can't use their health insurance coverage for abortion procedures — though they can use it for the cost of childbirth. Some states — 17, to be exact — have tried to rectify the burden, allowing Medicaid funds from their own coffers to cover abortions in all cases. Still, that means low-income women in 33 states are denied abortion coverage.
"The statistics show that at least one in four women enrolled in Medicaid who would have an abortion is unable to have one at all," Poggi says. "If you can’t make your own decision about having a child, or another child, then what can you make a decision about?"
Over the years, Hyde has had a trickle-down effect, inspiring dozens of abortion-insurance bans. Currently, 25 states bar abortion coverage in plans offered through their insurance exchanges, while 10 states block abortion coverage in private health care plans written in the state, according to the Guttmacher Institute. Of those 10 states that block abortion coverage in private plans, just one allows women who are raped to use their private insurance without buying so-called "rape insurance."
Guttmacher researchers noted in a recent report these new abortion-insurance bans are just variations on an old theme:
At the federal level, anti-abortion politicians have long interfered in poor women’s health decisions by sharply limiting abortion coverage for women who rely on Medicaid. ... The campaign to end abortion coverage may not be succeeding in stopping abortion entirely, but it is punishing women who need and have abortions.
The Economics Of Abortion
Finding out you’re pregnant when you don't want to be can be terrifying. Finding out you’re pregnant and too poor for an abortion can be all out devastating. The refrain abortion clinic workers hear most often from patients is, “I can’t afford to have a baby." But what happens when you can barely afford the abortion procedure?
This presents a sort of "double stigma" for women, Poggi says. The stigma of having an abortion is already substantial, and so is the stigma of being poor in America. Having to pawn your belongings to raise money for an abortion procedure can be demoralizing, not to mention a heavy burden on low-income and people of color communities.
But it's not just women enrolled in Medicaid who face these circumstances. According to a 2013 Guttmacher study, just 36 percent of the women surveyed lacked health insurance, yet nearly 70 percent paid for their abortions out of pocket; Medicaid provided 16 percent of abortions, while private health insurance accounted for only seven percent. The primary reason women dug into their bank accounts was because their health insurance plans lacked abortion coverage.
So, how much can women expect to pay out of a pocket for an abortion? Guttmacher notes that a first-trimester surgical abortion costs $470, though some doctor's offices and facilities may charge up to $629. Add to that transportation expenses (an average $44), childcare expenses (an average $57) and miscellaneous travel costs, such as hotel rooms (an average $140), and you're looking at at least $711 to obtain an abortion.
Don't forget lost wages for the days you must take off work (an average $198). If your state has at least a 24-hour waiting period, then it's an additional $146, on average, in order to make several round trips to the clinic, according to a 2013 study from the Texas Policy Evaluation Project. And of course, scraping together funds for an abortion can push the procedure into the second-trimester, when the cost increases substantially each gestational week; by the 20th week, an abortion costs $1,500 on average.
Righting A 'Long-Standing Injustice'
Independent abortion funds have been around since the early days of Roe v. Wade, but their impact has grown over the last two decades. These days, the National Network of Abortion Funds isn't just helping women cover the cost of the abortion procedure.
You can’t use the Medicaid coverage that you have, and now you also need to drive 200 miles to get to a clinic. ... We work on travel, and we help people either through rides or paying for bus tickets. Sometimes plane fare. Sometimes we put people up in the homes of members of abortion funds. Sometimes we’ll pay for a hotel, because if you have to go someplace far away, you have to stay there overnight. Those things have been true for a long time, but they’re increasingly high barriers in states like Texas.
Out of the 100,000 calls the National Network of Abortion Funds received in 2013, the organization could only meet the needs of about 28,000 women. "We know there are many, many women who would call us [if they knew about abortion funds]," Poggi adds.
Most women who call the hotline have already raised at least half of the needed funds on their own, either through digging into their savings accounts, asking family members, friends or significant others for assistance, or defaulting on utility bills. Some young women even take to online platforms such as Tumblr to crowdsource their funds — where they can do so anonymously — relying on sympathetic users to reblog their posts as a "signal boost." Yet many patients are still unable to cover the full cost of the procedure and travel.
Individual abortion funds alone can't meet the need — or continue to pick up the slack for politicians and feeble social safety nets. That's why, though the engine has already cooled on the Bravemobile, All* Above All is continuing its repeal-Hyde initiative with social media and educational campaigns, including the "We Are Brave Curriculum," a resource for social justice groups.
"We’re not going to stop fighting until Medicaid funding of abortion is restored, until all these coverage bans are lifted, and every woman gets to make the decision that’s best for her," Poggi says. "These decisions about pregnancy and childbirth and whether or not to be a parent — they’re too important for politicians to be the ones to get to decide."
Images: All* Above All