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Conservative State Attacks on Abortion Access Affect Access in Liberal States

Conservative State Attacks on Abortion Access Affect Access in Liberal States

November 17, 2015 — Abortion clinics in many states considered politically progressive are facing as much hardship as those in politically conservative states amid growing abortion restrictions nationwide, The Guardian reports.

Dwindling Access in Progressive States

According to The Guardian, the Abortion Care Network "found that for every three clinics that closed in a red state in the past few years, two clinics closed in a more liberal state -- one of the 17 states where Medicaid covers abortion, or one of 23 states that the Guttmacher Institute ... does not consider hostile to abortion access." Meanwhile, The Guardian found that just over half of the 50 clinics that shut down in 2014 were in liberal states.

ACN Executive Director Nikki Madsen said, "The trend is disturbing," adding, "It's taking root in states we traditionally think of as 'friendly' to abortion rights, without many people noticing."

According to The Guardian, each attack on abortion access in a conservative state takes resources from abortion-rights supporters focusing on challenges in more progressive states. Amanda Kifferly, head of patient advocacy for the Philadelphia Women's Center, said, "The south is where we have to put most of our energy," adding, "Any time there's a crisis, that's where it's coming from, and it goes right to the top of our to-do list."

Medicaid Reimbursements

According to The Guardian, abortion has been "isolated" from other medical services through "40 years of anti-abortion policies," making it one of the few procedures "that takes place almost exclusively in dedicated facilities." Meanwhile, "a confluence of factors make it difficult, financially, to sustain standalone clinics," such as low Medicaid reimbursement rates, The Guardian reports.

For example, Amy Hagstrom Miller, founder of a network of clinics called Whole Woman's Health, is one of the challengers to Texas' omnibus antiabortion-rights law (HB 2) and not able to dedicate resources to negotiate the Medicaid reimbursement rates her Maryland and Minnesota clinics receive for providing abortion care. According to The Guardian, Maryland and Minnesota both offer Medicaid reimbursements for abortion care, but the rates are so low that Whole Woman's Health loses between $155 and $1,640 for abortions provided for Medicaid beneficiaries, depending on the type and timing of the procedure. Hagstrom Miller said, "It's hurt us tremendously, financially."

A spokesperson for NARAL Pro-Choice New York added that clinics often cannot work on Medicaid reimbursement negotiations because they must prioritize more urgent concerns regarding clinic protesters and whether laws to block protestors from clinics are being enforced. Further, independent clinics sometimes lack the necessary staff to work on Medicaid reimbursement, as they already "are distracted by the copious regulations or the need to be political advocates," The Guardian reports. Hagstrom Miller said, "If we were doing healthcare that wasn't politicized, maybe this could be a top priority."

While some providers opt to stop accepting Medicaid altogether, many do not want to impede reproductive health services for low-income women. "It doesn't make business sense to offer what we offer," Hagstrom Miller said, adding, "But we have a mission and a vision." Jenifer Groves, the director of the Cherry Hill Women's Center in New Jersey, added, "We're not going to not see patients on Medicaid ... They need us. But in doing their abortions, it's a constant game to figure out how we're going to survive."

Abortion Isolated From Other Health Care Services

Meanwhile, Elizabeth Nash, senior researcher for Guttmacher, noted, "Abortion has been isolated to the point that it's not part of standard medical care."

Nash explained that antiabortion-rights harassment has prevented abortion from becoming more integrated with other health care services, which means dedicated abortion clinics have to support themselves on a limited range of services. "And no matter when a clinic closes, women who were dependent on that clinic have lost access," she added.

Some Clinics 'Thriving'

According to The Guardian, some clinics in liberal states have managed to thrive despite antiabortion-rights efforts.

For example, Cedar River Clinic in Washington state is one of the few abortion providers to have successfully negotiated increased Medicaid reimbursement rates. Connie Cantrell, the clinic's executive director, said, "We've only been successful throughout the years because Washington state cares about women, and they've provided more than just lip service to that idea." She added, "We would not have been successful if the state weren't open to those negotiations, if they did not want to make sure those services were available to low-income women" (Redden, The Guardian, 11/12).