My name is Martha Simmons and I’m a family doctor who provides full-spectrum reproductive health care, including abortion care, in New York. Before I moved to New York, I did my residency in Philadelphia. The story of one patient that I met during that time will always stick with me.

This young woman – let’s call her Sarah – came to see me in my family practice office. She was just out of high school, working a minimum wage job, and living at home with her mother. She knew that this was not a good time for her to become pregnant. We discussed her options, and she decided on the contraceptive implant. Unfortunately, this was before the Affordable Care Act, and when we checked her insurance, they wouldn’t cover the implant. We talked more and she decided to go with the pill. Three months later, she was again in my office. During this visit, she confessed to me that the copay for her pills – the pills I prescribed – was $40, and she had never picked them up at the pharmacy.

Now, she had just gotten a raise at work and felt like she could afford the copay, so she wanted a new prescription. I probed further and found that she’d been having sex with her boyfriend and using condoms only sometimes since the last time I’d seen her. She was also a week late for her period. Her pregnancy test, unsurprisingly to me, was positive at that time. Over the course of two additional visits, we found out how far along she was and talked in detail about what she wanted for her future, what a pregnancy would mean for her life, and what she wanted to do, and after a long discussion with her family, she decided to continue the pregnancy. Over the course of her prenatal care, she became excited about becoming a mother. Like many of the women in this country – 50% of all pregnancies are unintended, and of those, only half end in abortion – so like many of the women I’ve cared for, she embraced this unintended pregnancy.

At her 20 week visit, she came in for a routine prenatal visit, and I couldn’t find fetal heart tones. An ultrasound confirmed what I feared: her fetus had died. In the time since her initial visit, the Affordable Care Act had gone in to effect, and so after she underwent and D&E procedure – which stands for dilation and evacuation, the most common method of treating second trimester fetal losses and also for second trimester abortion – she was able to have her contraceptive implant placed. I can’t stop thinking about her pain, most emotional, but some physical, and what we could have saved her if her contraceptive implant had been covered on her first visit with me.

This is just one patient whose care spans the time before and after the Affordable Care Act, but there’s so many women who were unable to access care they needed before the Affordable Care Act and who have been able to access care now. For all of these patients, and for Sarah, we can’t go back.