Iona has two faded scars on the left side of her chest.
“That’s the first defibrillator and that’s the second one,” she said.
She’s had six heart surgeries in the past 10 years. She also had an abortion. We aren’t using her full name to protect her identity because she’s uncomfortable with people knowing about the pregnancy termination procedure.
Iona said her doctor gave her a choice: “My life or termination.”
Her doctor said her heart is failing and felt it couldn’t handle the pregnancy. Iona is insured through the Arizona Health Care Cost Containment System (AHCCCS), which has paid for Iona’s expensive heart surgeries. But when it came to the $580 abortion, she said, “I was just assuming it had to come out of pocket.”
She was able get some money from a national abortion fund and she scrounged up the rest from family members.
“My dad gave me $100, and my uncle gave me $100” She said.
Iona’s doctor didn’t even apply to AHCCCS to get the procedure covered, even though her condition should qualify as a medical exception.
According to state records, since 2010 Arizona’s Medicaid system paid for only 31 pregnancy terminations. That’s a fraction of the more than 50,000 abortions performed statewide in that time.
The doctor explained it's too difficult to get the paperwork through the system. In part because Arizona has some of the nation’s strictest anti-abortion laws, one of which restricts AHCCCS to only cover costs for an abortion procedure in the case of rape, incest or medical necessity.
It’s nearly impossible to find out how many abortions in Arizona should have been covered under the listed exceptions — partly because many patients didn’t attempt to qualify and AHCCCS said it doesn’t keep records on how many people or physicians applied for coverage and were turned down.
AHCCCS said in an email they deferred to policymakers for comment.
Dr. Gabrielle Goodrick is a family physician in Phoenix. She said in her more than 15 years of performing abortions, she’s gotten AHCCCS to pay for one medically necessary procedure.
“It took over two years,” she said. “It was more just a mission that we were going to try to get paid.”
Goodrick said the insurance battle alone took more than 100 staff hours with repeated calls to AHCCCS and a mountain of required paperwork.
Goodrick explained for each pregnancy termination she performs she needs among other forms to have “a notarized statement saying that I’m not performing the abortion on the basis of race or sex ... the form for the pre-abortion certification ... an ultrasound that has to be done 24 hours in advance.”
State laws continue to restrict access to abortion. Lawmakers banned administration of medication abortions over a telemedical consult, and a 2014 law allows unannounced inspections of abortion clinics.
Ilana Addis, chairwoman of the Arizona section of the American Congress of Obstetricians and Gynecologists, said there’s more than good medicine driving these laws.
“While they have the facade of being medically motivated, most of them have been politically motivated," said Addis.
State Sen. Nancy Barto has a different take.
“Reporting and informed consent requirements have not prevented one woman from obtaining a lawful abortions,” Barto said.
As chairman of the Arizona Senate Committee on Health and Human Services, Barto was instrumental in getting this and other anti-abortion laws passed. She said they’re intended to increase safety.
“There are no more hoops to jump through than there have been,” Barto said. “The goal is making sure women are treated with the respect they deserve. Given information about the procedures, the alternatives and the risks.”
Barto expects lawmakers to push another abortion-related law this coming legislative session. This one would add an additional reporting requirement: if fetal tissue is transferred, any money exchange would need to be reported. This is in response to the national scandal around videos that alleged Planned Parenthood sold tissues from aborted fetuses.
Updated 10/23/2015 at 12:50 p.m.
