Regardless of What Happens with Roe v. Wade, Low Income Women Already Face Multiple Barriers 

Roe v. Wade is fundamental to safeguarding women’s reproductive rights and protecting women’s autonomy over their lives. If Roe v. Wade is overturned by the Supreme Court, women across the nation will be deeply impacted in both explicit and covert ways.  

Research reveals that financial constraints are the primary reason that American women seek abortion services. Having a child is an immense financial investment that many women are not able to easily afford. Without the protections established by Roe v. Wade, many more women will be denied abortion services, and far earlier on in their pregnancies. As a result, the overturning of Roe v. Wade will force many women to carry unwanted pregnancies to term and raise children while facing extreme financial insecurity.   

Conservative lawmakers have been fighting to roll back women’s reproductive rights and they have also refused to put supportive measures in place for women who are financially unprepared to have a child. In fact, conservative leaders have championed efforts to actively disadvantage low and moderate-income women and mothers in various capacities. Furthermore, while those groups are aiming to drastically reduce abortion access, they have also increased barriers for women to access contraceptives and family planning services. As a result, women living in conservative-controlled states will be impacted by the overturning of Roe v. Wade in multiple ways.  

Family Cap Policies  

Generally, welfare benefits for families in the United States are determined based on a family’s size and the number of dependents. Nevertheless, several states have passed family cap policies, which severely limit families’ eligibility for welfare benefits and public assistance. In states with family cap policies, families receiving Temporary Assistance to Needy Families (TANF) are not able to receive increased public assistance if they have additional children. 

Family cap policies are historically rooted in sexism, racism, and classism. Initiated in the 1990s, family cap policies were designed to discourage and shame unmarried women from having additional children. Further, this policy thrived on the negative stereotypes that women – and particularly, women of color – are irresponsible and reckless. The National Organization for Women fought these harmful proposals, but others supported family cap policies because they believed the false, racist notion that black women had additional children solely for the purpose of collecting greater public assistance from the federal government. However, there is strong evidence that disproves this; research has actually shown that family cap policies have had no effect on birth rates for families on public assistance.      

Family cap policies are inherently disadvantageous to the greater economy. When families lack adequate financial support, child poverty is significantly exacerbated. Family cap policies contribute to homelessness, food insecurity, and push families even further below the federal poverty line. Low-income families require additional financial resources in order to provide their children with safe, nurturing, and fulfilling childhood experiences. Investing in the nation’s children is crucial; as child poverty is reduced, economic growth is fostered.  

The only function of family cap policies is to punish low-income families, and more specifically, low-income women of color. In the past decade, many states have repealed their family cap policies, recognizing that they are unsupported by data and discriminatory by nature. Still, eleven states still have these unfair policies in place, and low-income women continue to be discriminated against.  

If Roe v. Wade is overturned and replaced with a 15-week abortion ban, mothers on public assistance who live in the eleven states with family cap policies will be deeply and disproportionately affected. In these states, many low-income mothers seeking abortions will not only be turned away from clinics but will be denied any additional financial support. As a result, many more women and children will fall even further beneath the poverty line.  

Contraceptive Coverage and the Affordable Care Act  

In order for women to avoid unwanted pregnancies and intentionally plan their futures, contraceptive options are imperative. Almost all women in the United States have or will use contraception at some point over the course of their lifetimes. For this reason, it is essential that contraceptives are both affordable and accessible, especially as the constitutional right to abortion is increasingly threatened. Signed into law by President Obama in 2010, the Affordable Care Act (ACA) revolutionized contraceptive accessibility throughout the nation. The ACA included a contraceptive mandate for insurance companies, meaning that millions of women across the United States were entitled to a range of contraceptives without bearing any out-of-pocket costs. This mandate covered contraceptives ranging from hormonal birth control to intrauterine devices to medical sterilization procedures  

Because of the contraceptive mandate, as of the fall of 2020, 64.3 million women had insurance plans that covered contraceptives without any cost-sharing. Prior to the enactment of the ACA, unless a state mandated coverage of contraceptives, individual insurance providers had the ability to determine whether to cover contraceptives, leaving many women unable to afford birth control. This particularly hurt women of color, who are disproportionality more likely to face barriers to accessing contraceptives, due to systemic inequalities in wealth and income.  Consequently, the ACA specifically uplifted the lives of women of color, allowing them greater autonomy over their health and life outcomes.   

Unfortunately, opponents of women’s reproductive rights led an effort in the courts to undermine the ACA’s contraceptive coverage mandate which resulted in a 2014 Supreme Court ruling. The Burwell v. Hobby Lobby Stores, Inc. decision permitted private, for-profit companies to exercise a religious or moral objection to deny health insurance coverage for contraceptives.   

Limited Choices for Contraceptives 

There is no universal contraceptive that is effective for all individuals. Every person reacts in a different manner to medications and health procedures, and contraceptives are no exception. As a result, it is crucial that women are able to access a vast and wide array of contraceptives and can make autonomous choices regarding their health.  

Although the ACA is supposed to provide women with a range of contraceptives with no cost-sharing, this is often not the reality. New forms of birth control continue to be released and approved by the FDA; however, most are not automatically added to the list of contraceptives required to be covered by insurance providers. Consequently, many insurers are finding ways to circumvent the ACA’s contraceptive requirements and denying women from accessing and affording the specific contraceptive products they need. With Roe being threatened, women are in dire need of the ability to choose and access contraceptives that are effective for their bodies and lifestyles.  

Conservative Lawmaker’s Efforts to Prevent Contraceptive Coverage  

Undoubtedly, the impact of the Affordable Act on women’s access to reproductive healthcare has been critically important.  Nevertheless, conservative lawmakers have made significant efforts to circumvent the ACA’s contraception coverage requirement. Although insurers were required to cover a range of contraceptives, the ACA allowed for religious exemptions in certain circumstances. These exemptions were intended for religious organizations and houses of worship on the basis of religious and moral objections. However, in 2018, the Trump administration broadened the criteria for these exemptions, allowing many more insurance providers to object to contraception coverage. In 2020, the Supreme Court upheld these new rules, allowing greater leniency for religious and moral exemptions to the contraceptive coverage requirement.  

Given the precarious status of Roe v. Wade, this recent Supreme Court ruling is particularly threatening to women’s rights and bodily autonomy. Without guaranteed insurance coverage for contraception, more and more women will face barriers to accessing birth control. Arguably, the status of Roe is being threatened at a time when many women need abortion access more than ever before.  

Resistance Towards Medicaid Expansion  

Under the Affordable Care Act, Medicaid was expanded to ensure that no low and moderate-income Americans were forced to live without health insurance. Specifically, the ACA expanded eligibility for Medicaid to individuals with incomes up to 138% of the federal poverty level. Nevertheless, many states have refused to honor this expansion. As of June 2, 12 states had still not adopted this critical expansion. 

According to data from 2019 – when 17 states had not yet adopted this expansion – almost one out of five women of reproductive age was living without health insurance. The lack of affordable health insurance in these states places low and moderate-income women in deeply precarious situations. Without health insurance, if women become pregnant, they face a significantly increased risk of serious pregnancy complications, as well as maternal mortality. If Roe v. Wade is overturned, the remaining states without Medicaid expansions may enact abortion bans and a number have already done so. As a result, more and more low and moderate-income women will go through pregnancy without health insurance, placing themselves in acute danger. These women will not only be burdened with extreme financial worries regarding raising a child but will also face severe and potentially fatal health risks.  

Multi-Faceted Impacts Faced by Women  

These various policies and regulations have created impossible circumstances for low and moderate-income women, children, and families. To make matters worse, many of the states that have maintained family cap policies and are fighting to roll back contraceptive coverage are the same states that have attempted to enact unconstitutional 6-week and 15-week abortion bans, and that have trigger laws in place to ban abortion if Roe is overturned.  

Conservative lawmakers have not only established barriers to accessing contraceptives and reproductive health services but have refused to offer crucial support to the women who are struggling as a result of these very policies. Combined, the effects of these harmful policies will lead to a myriad of dire consequences for many women across the nation, especially in states controlled by conservatives. It is clear that the implications of these sexist policies will solidify systemic racial inequality, perpetuate women’s inequality, and rob millions of autonomy over their bodies and lives.    

By Nora Weiss, Government Relations Intern 

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