Keep Your Hands Off Our Fucking Bodies: Why Reproductive Justice Must Be Part of Medicare for All

There’s some adult language in this episode, so might not be appropriate for our youngest M4A advocates.

The recent leak of what is likely to be the Supreme Court’s decision to overturn Roe v. Wade has us enraged about the future of abortion and healthcare in America. Spoiler: We aren’t loving the fact that five fucking reactionary clowns can take away the bodily autonomy of half the population of the US. Today, we’re making the case for why abortion access and – more broadly, reproductive justice – must be part of the Medicare for all movement. 

Our guest is Stephanie Nakajima, Executive Director of Mass-Care: the Massachusetts Campaign for Single-Payer Healthcare. (But most importantly: former Director of Communications for Healthcare-NOW and former co-host of the Medicare for All podcast!)


Show Notes

Thanks to the Hyde Amendment (passed in 1976), federal funds (like Medicaid or insurance plans for federal/state employees) cannot be used to pay for a person’s abortion, unless that person became pregnant through rape, incest, or their life is in danger. This was a direct response to the original Roe v. Wade decision

It has been reenacted every year since, likely because legislators feel like it’s too much of a hot button issue to mess with (i.e., we should just be happy for the access that is available and try not to push it further)

This isn’t the case in most developed countries. For example, Ireland and Italy, which are famous for their devout Catholic populaces, even allow for publicly funded abortions. 

About 87% of employer-sponsored insurance plans cover medical and surgical abortion services. However:

  • That means only people who have private insurance have access to these services, unless you live in one of the 17 states that fund abortions through state healthcare 
  • 10 states in the US don’t even allow private insurance to cover abortion (Missouri, Nebraska, Kansas, Oklahoma, North Dakota, Idaho, Utah, Indiana, Kentucky, Michigan)

Stephanie has been the leading voice uplifting the importance of reproductive health in the single payer movement. Reproductive care, like most healthcare, is often out of reach for people who are uninsured or underinsured. In addition to the barriers to get an abortion (like protestors, 24 hour waiting periods, mandatory ultrasounds) the cost of the procedure.

If you are poor and/or your healthcare plan is funded by the government, you are paying out of pocket for these services (the average cost of 1st trimester abortion in a non-hospital setting in the US is $508, costs increase into the thousands in later trimesters.)

When we talk about “choice” we’re talking about whether a person has a legal right to an abortion or will they be forced to give birth. By reframing the narrative around reproductive freedom, we broaden the conversation to include abortion rights as well as access to affordable or publicly-funded reproductive care, the right to have children, and access to services to raise and care for children like healthcare, childcare, a living wage, and paid family leave.

Shifting to a Medicare for All system would have profound impacts on access to reproductive care – for better or potentially for worse – the M4A movement has NOT always had a great track record in supporting reproductive care. Many in the movement feel it’s a separate issue that we should leave alone for fear of it taking down the chances of M4A. But if we don’t fight for inclusion of this extremely common healthcare procedure in a M4A system, we are erasing the healthcare needs of a wide swath of the population.

In 2016, Colorado’s single-payer ballot initiative – Amendment 69 overlooked abortion access, which led to opposition from NARAL ProChoice Colorado and Planned Parenthood of the Rocky Mountains, which provided cover for most of the Democratic Party in the state to also oppose the ballot initiative. In large part to the catastrophic impact their single payer ballot initiative would have had on access to abortion, Amendment 69 failed spectacularly, with 79% voting no.

In recent years, the Medicare for All movement has begun explicity including abortion access. Senator Bernie Sanders’s Medicare for All Act of 2017 was the first single-payer legislation to protect reproductive healthcare, by sheltering the “Universal Medicare Trust Fund” from the Hyde Amendment (and similar year-to-year budget amendments).

When Congresswoman Pramila Jayapal took over lead sponsorship of the Medicare for All Act of 2019 in the House, she adopted this language from Sanders’s bill for the House legislation.

Despite this progress, and while poll after poll shows that the majority of Americans support access to abortion, we in the Medicare for All movement still often let a vocal minority scare us from boldly standing up for the right to reproductive healthcare.

While the M4A movement hasn’t always embraced abortion rights, the pro-choice movement very rarely supports single payer too. They tend to ascribe to the narrower definition of “choice” mentioned above, and avoid single payer to keep from angering their supporters who may be opponents of M4A.

California, learning from Colorado’s mistake, intentionally included abortion coverage in their state single payer bill, yet even then, Planned Parenthood still opposed the bill. Stephanie’s 2019 article, “Planned Parenthood: It’s time to get behind single-payer: Planned Parenthood has yet to endorse single-payer — and some chapters have even come out against it” details why it’s imperative for pro-choice organizations who care for underserved populations have to get behind single payer. Having a legal right to an abortion is almost meaningless if uninsured and underinsured patients can’t afford the care.

Pregnancy is one of the most dangerous health conditions that can happen today; our maternal mortality rate is the worst among industrialized nations (and our infant mortality rate isn’t much better). Forced birth in a country that refuses to pass universal healthcare is barbaric.

The recent “Turnaway Study” conducted by the Advancing New Standards in Reproductive Health (ANSIRH), based at the University of California San Francisco (UCSF) demonstrated that giving birth is connected to more serious health problems (including death) than abortion.

In one of the more egregious examples of mansplaining, Justice Anthony Kennedy writes “While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained… Severe depression and loss of esteem can follow.” Please do tell us more about this conclusion you’ve arrived at with zero evidence, Justice Kennedy.

The Turnaway Study, conducted over five years and tracked and interviewed over 1,000 women, actually did find evidence on this topic that directly refutes Kennedy’s bullshit argument. 95% of people who received an abortion said that they made the right decision. People who are turned away from having an abortion actually have much more elevated mental health consequences (as well as physical health issues) than people who did have an abortion.

In conclusion: abortion is healthcare, abortion access should be equitable, and Medicare for All activists need to be in this fight now.

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Resources

All* Above All, a women of color-led catalyst for abortion justice that envisions a world where abortion care is affordable, available, and supported for everyone who needs it.

Healthcare-NOW’s statement on reproductive justice: https://www.healthcare-now.org/blog/statement-on-reproductive-justice/

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