Paula Westwood, the executive director for Right to Life of Greater Cincinnati, wanted to make one thing clear when asked why her organization was suing to block Ohio’s forthcoming Medicaid expansion. “First of all, it’s not that we don’t care about the poor.”
Westwood’s organization, as well as Cleveland Right to Life, filed suit this week to prevent Republican Gov. John Kasich from covering an additional 270,000 uninsured people under the state’s Medicaid program under the Affordable Care Act. But Ohio Right to Life, a state organization affiliated with the National Right to Life Committee, supports it. It's a split that mirrors national debates within the Republican Party about how to approach—and oppose—the Affordable Care Act.
“Caring about the poor” is, in fact, the elephant in the room when it comes to the anti-abortion movement and health care access. Right-to-lifers are well aware that they’re accused of only caring about the unborn at the expense of everyone else, and the state Medicaid program already refuses to cover abortion except in cases of life endangerment, rape and incest.
So why oppose more poor people getting health insurance coverage? "What Medicaid expansion will do is place thousands of people on the rolls that are able-bodied, primarily men, and that opens up a whole another can of worms for disincentives for work and healthy lifestyles for these people," said Westwood. She pointed out that Ohio's Medicaid program automatically enrolls pregnant women who meet the income requirements, as well as their children until age 18. For low-income mothers themselves, that coverage currently ends a few weeks after giving birth.
As an example of how the program would change if Medicaid were expanded, Westwood cited a restaurant worker without employer-provided insurance being covered on Medicaid. Wasn’t that person already working? “I’m not going to get into specifics. I’m not trying to go after restaurant workers,” said Westwood.
Cincinnati Right to Life also opposes the fact that more insured people means more people getting access to “contraceptives, abortion-inducing drugs, and sterilization,” as Westwood put it. “Some of the hormonal contraceptives will cause an unborn baby, an embryo—will harden the lining of the uterus to the embryo cannot implant,” Westwood said.
No scientific study has ever found that hormonal contraception blocks the implantation of a fertilized egg; it is known to prevent ovulation. And the ACA doesn’t expand access to abortion—in fact, 23 states rushed to restrict abortion coverage on their exchanges, meaning that some people who switch to plans offered on the exchange may actually lose coverage of the procedure.
“We don’t believe it covers abortion,” said Mike Gonidakis, president of Ohio Right to Life and a board member of the National Right to Life Committee. “And certainly neither this governor nor Ohio Right to Life would support it if we believed it did.” Ohio Right to Life, he said, "has never taken a position on contraception. We never have and never will. We’d be naïve in not noting that contraception has reduced the number of abortions."
On Medicaid expansion, too, Gonidakis's organization has gone the opposite direction of the Cincinnati and Cleveland groups. (Cleveland Right to Life did not immediately return a request for comment). "We were the first and probably only perceived social conservative organization that came out and supported Medicaid expansion," he said. He argued that the hypothetical low-income woman who would normally lose insurance after giving birth would, under Medicaid expansion, gain "a heightened awareness for raising her child in a healthy environment." The National Right to Life Committee has not taken a position on the Medicaid expansion.
Westwood said one of the reasons her organization opposes Medicaid expansion is because Planned Parenthood is a qualified provider for non-abortion care under the plan. But Gonidakis claimed Medicaid expansion would divert women away from Planned Parenthood. "If we can make sure that those women can go to a real doctor, we can continue to shrink the market share of Planned Parenthood," he said.
He called the split in the organizations, which are run independently of one another, a "difference in tactics and strategy, never in mission." It wouldn't be the first time: Cincinnati Right to Life supported a Heartbeat Bill that would ban abortion at the first detection of a heartbeat, while Ohio Right to Life thought it was a strategic error that would lose in court.
"Of course we would like to end all abortion tomorrow," said Gonidakis. "It's just not the case that it could happen."