Hell Yeah: Sanders' Medicare-for-All Plan Would Guarantee Abortion Coverage

It's been a breakout year for Medicare-for-All, also known as "single payer." Two years ago, Sanders was the only Senate Democrat to support single-payer; as of today, at least 15 Senate Democrats (including several 2020 hopefuls) have announced their support of his plan. Medicare-for-All would fundamentally revamp the American healthcare system and create a national, public health insurance program, which would cover everything from primary care to hospital stays to long-term care, without any co-pays or deductibles.

Crucially, the draft form of the bill mandates universal coverage for "comprehensive reproductive care," including abortion. This would radically expand reproductive rights in the US, and it would affirm that abortion care is health care—not something shameful, not an unnecessary elective procedure, not a second-class, so-called "women's issue," but a fundamental right that we should all be able to access, no matter our economic circumstances.

By ensuring that federal insurance plans guarantee full access to reproductive healthcare, this legislation would effectively overturn the Hyde Amendment, the worst federal anti-choice law on the books today. Since 1976, the Hyde Amendment has barred any federal funding—including Medicaid and Medicare—from paying for abortion care or coverage, systematically denying abortion access to low-income people who need it.

In a country where most American families don't have $500 in savings, the average abortion costs $470. That's far more cash than a home-health-aide or a retail worker making $23,000 a year is likely to have on hand. If those workers are on Medicaid (or have insurance through a federal insurance exchange, or don't have insurance coverage at all), they'll have to come up with that money on their own—even if their own health is at risk.

We have a Constitutional right to choose on paper. But as long as the Hyde Amendment is on the books, abortion access remains a privilege for the wealthy. Until we overturn Hyde, the promise of Roe v. Wade—that women have a fundamental right to control our bodies and determine our futures—will remain unfulfilled.

Sanders' bill isn't going to pass anytime soon, especially when Senate Republicans are still trying to resurrect Obamacare repeal. (President Trump has also called it "a curse on the US and its people" and sworn to veto it should it somehow miraculously make its way to his desk.) But still, the bill is a signal that the Democrats' left wing is conscientiously including abortion in its progressive agenda. It's especially welcome to see Sanders putting reproductive health care front and center after his highly (and rightly) criticized endorsement of Health Mello this summer. Mello, a Democrat running for Mayor of Omaha, is a longtime opponent of abortion access who sponsored a 20-week abortion ban in 2010, with no exceptions for rape, and who voted for a bill that would ban insurance plans from covering abortion. Under heavy criticism, Sanders doubled down, telling NPR that Democrats "can't exclude people who disagree with us on one issue."

Sanders, to his credit, has a sterling pro-choice record. But in endorsing Mello, Sanders set an unspoken but clear order of priorities, in which the economic issues like single payer are non-negotiable, and reproductive rights are not. In truth, the dichotomy between reproductive rights and economic justice is a false one: We cannot have one without the other.

Access to abortion—the ability to decide when, and whether, to become a parent—is fundamental to the economic security of women. Advancing New Standards in Reproductive Health's landmark "Turnaway Study" tracked women across 21 states who sought abortion care but were denied it; researchers found that "women who carried an unwanted pregnancy to term are three times more likely than women who receive an abortion to be below the poverty level two years later." This should be obvious: Unplanned parenthood can derail a woman's career, interrupt her education, or throw her into economic precarity, especially in a country where paid leave is a rare luxury and the cost of childcare is astronomical.

Those same women would benefit enormously from universal healthcare, too. Nearly 70 percent of women who obtain abortions live below 200 percent of the federal poverty line, often precisely because they cannot afford to care for a (or another) child. These women, who are disproportionately women of color, are directly targeted both by the Hyde Amendment and by a healthcare system putting basic health care further and further out of reach. In addition to guaranteeing their access to reproductive care, Medicare-for-All could also ensure they never have to choose between putting food on the table and paying for prescription drugs and maternity coverage.

Sanders' bill, and its avalanche of support from Democrats, is a testament to the persistent work of the women of color who've led the fight to overturn the Hyde Amendment, and to expand all health care, for years now. Reproductive rights advocates have played hardball on single payer, opposing plans that exclude reproductive care, and have successfully made abortion access a core tenant of the nation's highest profile single payer model. And it's a model for how a resurgent Left should move forward: boldly, without leaving anyone behind.