As a child of immigrants, I grew up with a strong sense of justice and giving back to society. Because of this, I came to be an obstetrician/gynecologist in western rural New Mexico after training and working in Boston, due to New Mexico’s shortage of health care providers. Here, I take care of patients who are proud of their heritage and their homeland, and are fiercely protective of their families and community. Most patients here receive health care at federally funded facilities.
Many in this community have experienced barriers to health care because of institutional and historical racism, including significant barriers to accessing abortion care. For 43 years, the Hyde Amendment has blocked federal funds from being used for abortion care, rendering abortion care effectively inaccessible to 14.5 million people in the United States. This policy impacts a wide swath of people: People who have their insurance through Medicaid, Medicare or the Children’s Health Insurance Program. Military personnel. Peace Corps volunteers. D.C. residents. People who receive care primarily through federally funded facilities like the VA or Indian Health Service. People in prison.
Many of my patients are part of those 14.5 million. I am also part of those 14.5 million. Because my health insurance comes through the Federal Employees Health Benefits Program (FEHBP), and because I also receive my care at a federal facility that is prohibited by the Hyde Amendment from providing abortion care, I would need to travel 140 miles and spend anywhere from $500 to $15,000 to receive abortion care.
I recognize that, although these restrictions represent a financial and logistical inconvenience to me, to many of my patients, this lack of access and insurance coverage is ruinous. Over my career, I have seen how the Hyde Amendment impacts many people, which is already problematic, but this is a regulation that is intended to most directly impact, and thus harm, communities with low incomes, those who live in remote areas and people of color.
Now, I counsel patients only about their pregnancy options due to limitations of providing abortion care at my place of work, but I am uniquely positioned to understand what rural patients in New Mexico experience to access abortion care. My patients have to cancel appointments after a brief rainfall makes the roads impassable, when a new job’s inflexible schedule doesn’t allow for time off, when child care falls through, when an unreliable car breaks down or when a ride doesn’t show up. When patients can afford transportation, child care and time to make their way to the clinic, there are huge additional out-of-pocket costs if the health care they are seeking is not otherwise covered.
In McKinley County, the median household income is less than $1,500 a month; a simple, straightforward first-trimester abortion procedure that costs $500 can be financially devastating, which can delay the procedure, driving up its complexity and cost. Some patients are lucky to have a supportive partner, sibling or friend who can loan them money, drive them to Albuquerque or just provide a sounding board; less lucky are those who are alone and cannot turn to family because of stigma or who are simply overwhelmed and cannot navigate past the many logistical and financial barriers that confront them.
I see so many different kinds of patients every day. Their beliefs vary on most aspects of reproductive health, including birth control, fertility, pregnancy and abortion. One belief, however, has been consistent: All value the ability to make decisions about their bodies and their health care. Knowing all this, I work hard to ensure that patients understand all of their options and that they feel empowered to make the decision that is right for them. This is especially important when I work with those who may already distrust a health system that has historically and repeatedly failed to be guardians of their community’s well-being.
I would like to tell the people who come to see me truthfully that they are able to fully make their own medical decisions, but the choice to have an abortion is a false one when a patient’s only options are far away and unaffordable.
We are lucky that New Mexico is one of 15 states that mitigates the harm of the Hyde Amendment by using state funding to provide this gap in coverage for their Medicaid patients. Still, many New Mexicans receive coverage through other federal, non-Medicaid sources, such as Tricare – health insurance for active duty personnel, veterans and their dependents – or through the Indian Health Service, and this critical coverage is denied. And federally funded facilities, which are often the primary source for care in remote areas, cannot provide abortion care.
We could be doing so much more to ensure that everyone has choice and equitable access to health care. Congressional lawmakers have introduced a bill called the Equal Access to Abortion Coverage in Health Insurance Act (EACH Woman) Act. It would lift the Hyde Amendment, prevent politics from harming the patient-provider relationship and eliminate many barriers to abortion care. As a doctor, I know that this is the right thing for patients.
Dr. Connie Liu is a member of Physicians for Reproductive Health.