On Tuesday, August 15, Texas Governor Greg Abbott signed House Bill 214 into law while flanked by the bill's primary champions in the state legislature. As one might guess from their rictus grins, this law concerns one of Texas Republicans' favorite punching bags: reproductive rights.
Nicknamed the "rape insurance" bill for its cruel lack of exceptions for rape, incest, or fetal abnormalities, HB 214 mandates abortion coverage be removed from all private, state-offered, and Affordable Care Act insurance plans and sold as a separate — and unprecedentedly specific — policy. What this means in theory is that people who want to be covered in the event that they need an abortion will have to purchase extra insurance for it. In practice, it means insurance companies may simply stop covering the procedure altogether, the profitability of an "abortion-only" add-on being questionable at best.
As with many such laws, the state GOP's stated purpose is to "prevent those with moral, religious and philosophical objections from having to pay for the procedure." "As a firm believer in Texas values I am proud to sign legislation that ensures no Texan is ever required to pay for a procedure that ends the life of an unborn child," said Governor Abbott in a press release. "Under this new law Texans will not be forced to pay for elective abortions through their insurance plans." He did not say what Texans who want to subsidize abortions via group health plans are supposed to do, or what religious groups with objections to other legal medical procedures should do to avoid funding them—Jehovah's Witnesses, for instance, who are still paying for blood transfusions despite believing it's a sin to take blood from someone else.
Like many anti-choice laws, HB 214 aims to restrict access to abortion care not by banning it outright, which would go against precedent set by Roe v. Wade, but robbing people of their ability to pay for it. On the upside, the number of people impacted in this instance will be relatively small… but only because abortion coverage is so bad to begin with.
Only a small fraction of insurance plans in Texas cover abortion, and the Hyde amendment has long barred Medicaid — a crucial source of coverage for low-income women, who make up a disproportionate number of abortion patients — from paying for the procedure. Some states work around this by using their own funds; Texas doesn't. Daniel Grossman, an abortion provider in California and a researcher with the Texas Policy Evaluation Project, estimates that while roughly half of the 60,000 people seeking abortions in Texas each year have some kind of insurance, only about five percent use it to pay for their procedure.
"To further restrict women who are already in painful and difficult situations, give them one more thing to be stressed about… it's unconscionable."
"Either their insurance didn't cover it, they didn't know if it was covered, or they didn't want the primary on it to know," Grossman explains. "There are issues related to stigma in all of this that prevent women from using insurance."
So if that's the case, why are lawmakers bothering? "It reflects the will of the Republican primary voters," says one provider, who wishes to remain anonymous, adding that in most parts of Texas, whoever wins the Republican primary wins the election: "They're working against each other to see who can be the most conservative." Other crowd-pleasing causes recently taken up by Texas Republicans include keeping transgender people from using the bathroom and cracking down on sanctuary cities.
This is not to say HB 214 won't impact anyone. Like the "partial birth" abortion bans that still stand in some states, it's a piece of political theater that will affect a relatively small number of people. But also like the "partial birth" abortion bans, many of those affected will be families dealing with wanted pregnancies where something has gone wrong, complicating an already painful situation.
"Over the past couple of sessions, the legislature has decided they don't want to make exceptions for horrible fetal conditions," laments Dr. Sealy Massingill, the chief medical officer for Planned Parenthood of Greater Texas and a member of Physicians for Reproductive Health. "Women who have these conditions and need to have a termination in the hospital, especially if they're medically ill—these bans make it difficult to access care. To further restrict women who are already in painful and difficult situations, give them one more thing to be stressed about… it's unconscionable."
On a tougher to quantify level, the language of laws like HB 214 and its predecessor HB 2 — which shuttered more than half of the abortion clinics in the state before the Supreme Court overturned it — propagate the message that abortion is both immoral and frivolous, somehow less vital than any other medical procedure. "This is not elective cosmetic surgery," emphasizes Massengill. "Every woman that's pregnant is at risk of dying from her pregnancy every time." (In Texas, it's worth noting, the maternal mortality rate recently doubled, and is now the highest in the developed world. Lawmakers in the state have done basically nothing to address this fact.)
A law like HB 214 "has an effect to further carve off abortion care from the rest of healthcare, [but] the reality is that this is just another medical service that reproductive age women need," says Grossman. "These kinds of policies also have a more insidious effect of increasing stigma around abortion and making it seem as not legitimate healthcare."
It's that stigma that people like Candice Russell, an abortion storytelling fellow at the National Network of Abortion Funds, seek to combat by talking about their abortion experiences. Russell credits her two abortions with allowing her to "live a full and happy life," and she worries about way in which laws like HB 214 will impact other women in the state when abortion access has already been so decimated.
Russell connects the principles at play in HB 214 to the larger anti-choice strategy of restricting access to abortion by making it too expensive and inconvenient for all but a privileged few. "We talk about healthcare in broad terms as a right," she says, "and then we live in a society where your ability to access healthcare is based on your wage, and that's asinine to me."
Given the outright hostility of Republicans and recent waffling of Democrats on the issue of abortion rights, the self-described queer, Latina advocate believes we must take matters into our own hands. "Even if it just affects one person, one person is too many," she asserts. "[HB 214] is a warning sign to maybe try harder instead of just feeling safe, to push for progressive things within your state and set that precedent so that we have something to really hold onto…because at this point, we have nothing."