As a provider in Seattle, Washington, I feel lucky that the majority of my patients can get the care they need covered by their insurance, even if their insurance is Medicaid or Medicare, because our state treats abortion and contraception like any other regular medical service.
This is not always the case due to the Hyde Amendment, with prohibits the use of federal funds toward abortion care for women who have certain public insurances, like Medicaid, Medicare, or Tricare. Although Washington’s Medicaid and Medicare patients are covered through state funds, the one exception I see regularly in Seattle are the military women who come to our clinic, as they are covered by Tricare, the insurance that covers military personnel and their families. These patients do not qualify for state assistance, they pay out of pocket for their abortions despite the fact that they have insurance, and they generally wait to go back to the base for contraception, as it will be at least partially discounted.
One patient who had Tricare insurance, I’ll call her Tanya, was coming in to see me for her third medication abortion. I asked her a little bit about what contraception she’d tried in the past, and I was shocked to discover that she had tried it all: pills, patches, IUDs. She had gotten pregnant on every method. Even with condom use and watching her cycles, she’d gotten pregnant, so she and her husband had decided to stay abstinent until they were ready for their next child. We talked about how rare an experience this is, and how frustrating it must be for her while trying to be responsible and plan for her family while serving her country.
While I was going through what to expect at home during the medication abortion, she refused the narcotic pain medication that we provide all women to help with the cramping and discomfort they can feel during the process. She explained to me that she couldn’t have this show up in her urine test on the base.
As her provider for the day, it struck me how isolating and shameful it must feel to have to hide the entirety of this experience from the place she works. Not only does she have to travel, often on a long ferry ride and drive, to seek care off the base, but she also has to find the funds to pay for a standard medical procedure that should be covered just like any other, and then she has to return to work as if nothing has happened. As women in the military are at higher risk of sexual abuse, the lack of support these women get is even more astounding. But Tanya took it in stride. She’d gotten through this before, and she would get through it again.
I was glad to have helped her that day, and my hope for the future is that the military will recognize that helping women plan their families through the use of contraception and abortion should be a standard part of their covered medical care.
