On August 1, something truly momentous occurred. Thanks to the new health care law—known as the Patient Protection andAffordable Care Act, or just the Affordable Care Act, or even Obamacare—insurance companies are required to cover women’s preventive health services without additional charges, such as co-pays. For many women, this means that they can now afford the contraceptive method that is best for them. Now, there are some important caveats to this—not every insurance plan provides the same benefits, and only newly written plans have to comply with the law at first so not everyone’s insurance will offer this benefit for now, and the vast numbers of uninsured women in the United States will still be paying out of their pockets for their reproductive health care—or, even worse, not getting the health care they need.

But it’s still exciting to see birth control on the health care reform agenda. The August 1 deadline ushered in many other benefits for women too, including diabetes screenings for pregnant women, STD screenings and counseling, screening for domestic violence , breastfeeding equipment and support, and other services that insurance companies can no longer choose to ignore or only partially cover. It doesn’t fix all the problems women face when they seek health care, but it’s definitely something to celebrate. The August 1 coverage changes represent a big step, one of many steps that women have been waiting for when it comes to being able to access the health care they need to make decisions around their own reproductive agency.

While there’s no denying that the new health reform law is a huge victory for women’s health, there’s a quieter defeat that underlies the conversation. We’ve asked before, and we ask again: Where’s the health care reform when it comes to abortion?

We’ve talked about the Hyde Amendment before, and how it prevents women from accessing the abortion services that they need. The Affordable Care Act only reinforces the Hyde Amendment. Health insurance plans will not be required to cover abortion, and any federally funded benefits (like tax credits) won’t be able to be used for abortion coverage or care. While insurance companies will have the option to provide abortion coverage in the health care exchanges that will start in 2014, states are already lining up to pass laws that prevent women from purchasing abortion coverage through this system. Nine states have already passed this legislation—and, unsurprisingly, our home state of Ohio is one of them. In fact, Ohio has done virtually nothing to set up a health insurance exchange except ban insurance policies that cover abortion from being offered in the not-yet-created exchange. The unspoken message is that abortion isn’t worth the same consideration as other forms of health care—that it’s optional  health care, a bargaining chip that a politician or political party can use to rally support with their base or afford to lose if push comes to shove.

We know that this isn’t the case. Abortions are not elective health care. They are necessary procedures that allow women to take care of their bodies, take care of their minds, and sometimes even save their own lives. We know that the reality of abortion in women’s lives is complex and different for every person, every pregnancy. Those who are in desperate need of abortion are the hardworking female heads of households who don’t have the resources to care for another child, the young women who are still planning the path of their lives, the victims of rape and incest, and those whose minds and bodies cannot withstand the physical toll of a pregnancy—in short, they only reinforce the idea that abortion is necessary and needed health care.

Our clients do not deserve to meet roadblocks or discrimination when they seek that care. We also know the clients who choose abortion because they simply cannot or do not desire to have a child, for whatever reason, and we respect their right to make that choice. Abortion is a legal medical procedure in the United States, and women deserve access to it as they deserve access to any other form of care. Denying them that care for reasons related to creed or religion is unacceptable. Health care reform that ignores the realities of abortion access and continues to quietly reinforce the idea that we don’t “need” abortion coverage does American women a great disservice. We can’t just accept that abortion will not be a part of it, and we will not see true reform until abortion is acknowledged as a necessary part of health care.

The Affordable Care Act is slowly coming into effect, and while we have gained a great deal, we have also lost a major opportunity to make sure that every woman can access ALL the health care she needs to make choices about her body and her life. As the health care reform conversation continues, let’s make sure to raise our voices in support of true reform, and not let our policymakers forget that we’re paying attention. In the meantime, we will celebrate the new and improved access to contraception without co-pays.
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