In a just world, poor women get equal health care

Journalist Barbara Ehrenreich’s best-seller “Nickel and Dimed: On Not Getting by in America” documents what the Bible shouts about on nearly every page: Poverty is oppressive. It sucks the life out of people and crushes their bodies and spirits. In Ehrenreich’s words, poverty is “a state of acute emergency.”

To investigate life on the margins, especially for women moving off welfare and into the work force, Ehrenreich decided to go underground. For a month at a time, she traveled to various U.S. cities, including Portland, Maine, and took a series of low-wage jobs. She soon discovered that if you’re poor, it takes constant effort to locate safe housing, acquire food on a daily basis, and secure reliable transportation. Not only is poverty exhausting. The odds are against your making it out of poverty. Even with her reasonably good health, education and lack of family responsibilities, Ehrenreich barely scraped by.

As the Bible recognizes, the nonpoor often don’t get it. “It is common among the non-poor,” Ehrenreich writes, “to think of poverty as a sustainable condition – austere perhaps, but they get by somehow, don’t they?” The reality is, no, they don’t. Being poor means suffering all manner of ill health and assorted indignities that others cannot begin to imagine.

One of the areas of enormous discrepancy between poor and nonpoor women is reproductive health care. Statistics from summer 2006 show that poor women are four times as likely to have an unplanned pregnancy as their affluent counterparts. They’re five times as likely to have an unplanned birth. At the same time, Maine women with the lowest incomes have less than adequate access to reproductive health care services. This is not only a hardship. It’s an insult to women’s dignity and fundamental human right to make their own decisions regarding something as intimate and precious as whether or not to become a parent.

Yes, if a poor woman in Maine chooses to continue her pregnancy, MaineCare and other federal insurance programs provide her with assistance for necessary health care. However, if that same woman needs to end her pregnancy, MaineCare will not provide coverage to her for an abortion. Such restrictions are harmful to women’s health and well-being. That’s trouble enough, but in addition, they’re discriminatory. They penalize women for being poor. Without MaineCare coverage for abortions, poor women are forced to continue unwanted pregnancies or to make even greater sacrifices – perhaps go without heat or food, or even lose their housing and end up on the streets – in order to pay for abortion care.

The Bible names the problem rightly: It’s poverty, not the poor themselves. Poverty is a sign of injustice, not just “bad luck,” because the community’s sharing patterns are skewed. The solution is not to “fix” poor people, but rather to change the economic conditions that impoverish some while giving others excess in everything.

While eliminating poverty is the long-term goal (the Bible says that in a just community “there will be no poor among you”), an immediate, short-term step that will make a real difference is to insist on equity in MaineCare funding for women’s reproductive health care. Already 17 other states provide Medicaid coverage for all medically necessary abortions. Citizen support in Maine is gathering momentum in the same direction.

A recent poll shows that three-fourths of Maine voters agree that MaineCare’s comprehensive health services should be extended to cover abortions that a doctor determines are necessary to protect a woman’s health. Importantly, support for nondiscrimination in health care comes from every section of the state: 75% of voters in southern Maine, 73% in central and western Maine and 68% in northern and Down East Maine. Moreover, health care justice for women wins the support of Democrats (82%), Republicans (65%), and Independents (71%). If that’s not enough, a majority of Protestants (79%) and Catholics (70%) agree, as well as a slim majority of evangelical Christians (51%).

It appears that most Mainers get it, after all, that the problem is economic inequity, and the solution is greater fairness. The Bible offers two tests for judging whether conditions are just or not. First, see how the most economically vulnerable are doing, and then ask whether they’re experiencing life with dignity and hope. Second, ask whether you’re willing to trade places with them.

If anyone balks at the prospect of trading places with low-income Maine women who are facing unwanted pregnancies but lack access to comprehensive health care services, then even more of us might appreciate why justice, not charity, is what’s called for.

Marvin M. Ellison of Portland is the Willard S. Bass Professor of Christian Ethics at the Bangor Theological Seminary.