As Rhode Island awaits federal funding for its health care exchange, access to abortion and reproductive services remains a hot-button issue.
Gov. Lincoln Chafee '75 P'14 signed an executive order Sept. 19 establishing a state-run health insurance exchange. Part of President Obama's health care legislation requires all states to create their own health insurance exchanges by 2014 in order to receive additional federal funding.
It is unlikely health care plans covering abortion will be prohibited on the exchanges, said Lt. Gov. Elizabeth Roberts '78. While federal funds may not be used for abortion, "people using private dollars will not be restricted access," she added.
There are only a few cases in which women will be excluded from access to abortion under general health care coverage. State employees are prohibited from access to abortion, as well as employees of some employers who will choose to exclude abortion when purchasing health care insurance, Roberts said. Still, large health care providers like Tufts and BlueShield will not limit access, she said.
But the executive order could face a lawsuit from Rhode Island Right to Life. Barth Bracy, executive director of the pro-life organization, said he plans to challenge the order's constitutionality on the grounds that it could allow the state to subsidize abortion.
"The taking of innocent human life is the antithesis of health care," he said.
Carolyn Mark, executive director of the Kent chapter of the Rhode Island branch of the National Organization for Women, said she thinks health care plans under the exchange could restrict women's access to abortions.
The state legislature is largely "anti-choice," since some lawmakers that identify as pro-choice oppose health care plans that would subsidize abortion with tax credits or cost-sharing credits, she wrote in an email to The Herald.
"Rhode Island's General Assembly is overwhelmingly anti-choice," she wrote in an email to The Herald. The right-to-life argument is based on the fact that state and federal law prohibits the use of public funds for abortion, and pro-life advocates argue that if the health exchanges are subsidized in any way by tax credits or cost-sharing credits, public funds would be illegally used to cover abortion, she added.
Rhode Island allows individuals to buy separate coverage for abortion, "But, because no one plans to have an unplanned pregnancy, few people would be expected to actually purchase such coverage," Mark wrote.
Whether state public subsidies will fund abortions will depend on future legislative action. "The executive branch would like to see the executive order codified by the legislature, and the conservative forces in the legislature absolutely want to continue to fight the fight to exclude abortion coverage in the exchange altogether," Mark wrote.
Lawmakers that represent Brown's district in the General Assembly have actively lobbied for abortion to be covered under the exchange.
In an Oct. 14 Providence Journal op-ed co-authored by Sen. Rhoda Perry P'91, D-Providence, and Rep. Edith Ajello, D-Providence, the lawmakers, whose districts include College Hill, wrote that "the General Assembly was unable to pass the health insurance-exchange bill due to deceptive and inflammatory lobbying by the anti-abortion advocates."
Perry said she supports Chafee's executive order. This April, the Senate voted down legislation that included an amendment sponsored by Rhode Island Right to Life, a pro-life advocacy group. The bill would have forced women covered by plans offered under the exchange to pay for abortion out-of-pocket.
Perry voted against the Senate bill. Currently, the federal Hyde amendment allows taxpayer dollars to fund abortion only in cases of rape or incest, or when pregnancy threatens the life of the mother.
"What the amendment would have done would have required not only an accounting segregation but an entirely different policy — a rider," Perry explained. "I could not support a bill that put more restrictions on abortion than are currently there at the federal level," she added.
Ajello also emphasized the importance of granting women access to abortion. "Abortions are a legal, accepted health care practice in this country," she said. "To take this out of exchange policy is unfair, demeaning to women and dangerous."
Roberts said she is optimistic the executive order would survive a court challenge. "We have done everything possible to ensure that this executive order complies with state law and constitution," Roberts said. "We worked with attorneys to draft the order very carefully."
Ajello, too, does not see any question of constitutionality. "Until it comes to the point where the General Assembly must provide funds, there is no reason why (state funds) must be involved," she said.
"The way that (health care reform) was actually passed does enable states to prevent state funding for abortions if they want to," said Perry. But while there is a possibility that Rhode Island policymakers might still restrict access to abortion by preventing plans offered under the exchanges from covering it, Perry said she does not believe it is likely.
Roberts stressed Chafee's opposition to placing restrictions on abortion coverage.
The upcoming deadlines related to the exchanges mostly concern federal funding, Roberts said, adding that there is no deadline for the state to decide whether plans offered under the exchange will cover abortion.