New Jersey has a strong track record of supporting progressive reproductive healthcare policies, but access to contraception, abortion and other services remains a challenge for too many women, especially those who are poor, nonwhite, gay or transgender.
Those are among the findings in a report published last week by the New Jersey Policy Perspective, a liberal-leaning research group. It notes that while services may exist on paper, factors ranging from reimbursement rates to transportation challenges to threats of anti-abortion violence can conspire to keep them out of reach for some women.
In “Defending Reproductive Rights in New Jersey By Improving Access to Health Care for All,” author Jazmyne McNeese, a graduate student at Rutgers University in Camden, offers a progressive blueprint for changes, based on input from more than a dozen women’s healthcare providers, family planning organizations and a diverse mix of advocates. Including women and others who have previously been excluded from these conversations is essential to this process, she said.
McNeese examined pending legislation here and policies enacted in other states to map ways Garden State officials can expand access to contraception and abortion, reduce racial disparities in maternal and infant mortalities, improve care coverage for undocumented residents, and treat incarcerated individuals with more dignity, especially when it comes to healthcare. The report credits the state’s efforts to date, but notes protecting and building on these gains is particularly important given federal Republican-led efforts to reduce care coverage.
NJ’s record ‘better than most’
“New Jersey’s record of advancing reproductive health policy — while better than most states — has yet to fully address barriers faced by those who need these services the most,” said McNeese, who is a Kathleen Crotty Fellow at NJPP, a program named to honor the former board chair and executive director of the Senate Democratic majority office, who died in 2015. “Now is the time to protect and expand reproductive freedoms here in New Jersey,” she said.
NJPP Senior Policy Analyst Sheila Reynertson agreed. “Given the intensified political climate at the national level, New Jersey is uniquely positioned to be an incubator of progressive, forward-thinking policy by expanding access to reproductive health care,” she said. Some of the advocates involved have already formed a coalition dedicated to advancing additional reproductive health reforms in the year to come.
The 20-page report credits Democratic Gov. Phil Murphy for investing nearly $7.5 million in family planning services, funding that was suspended for eight years under his predecessor, Republican Gov. Chris Christie; six clinics closed as a result of these cuts. It also praises state Department of Health programs under Murphy for targeting maternal care in black communities.
State Health Commissioner Dr. Shereef Elnahal said he is “proud of the progress made” and that the restoration of family planning funds has allowed for five new programs to open — serving more than 4,000 new patients — and enabled others to add staff, new programs and more hours. The state is committed to supporting these important services, he said, and their connection to reducing racial disparities in maternal care.
“The DOH is committed to reducing and eliminating these disparities, as well as disparities in health outcomes across all healthcare services, through our new Healthy Women Healthy Families grant program,” he said.
Expanding insurance coverage
Despite these successes, the report notes that there are still “many outstanding issues” that require attention in New Jersey, including ensuring that historically marginalized groups are included in the conversation. “This report shines a light on the work that still needs to be done to improve reproductive health care access in New Jersey,” said Casey Olesko, communications director with Planned Parenthood Action Fund of New Jersey.
The report outlines strategies the state can use to fill these gaps in care, starting with expanding access to and insurance coverage for contraception. While Christie signed a bipartisan bill requiring insurance companies to cover up to six months of birth control pills at once, McNeese said extending this to a full year — something already done in at least a dozen other states — reduced unwanted pregnancies by up to 30 percent in a San Francisco pilot program.
Protecting and growing abortion services is also critical, McNeese notes. These facilities — like the Cherry Hill Women’s Center, which was a partner in the report — face costs and other operational burdens unusual for most healthcare providers, she writes. Because of anti-abortion protestors and the potential for violence, they require 24-7 security and can struggle to maintain clinical staff and hire housekeeping and other contracting services.
As a result, abortion services have become increasingly rare in New Jersey. One in four women in the state does not live in a county with an abortion provider, the report says, and many counties have only one family planning services option. For those facing travel challenges, or limited time off from work, this can be a problem.
Cost is also an issue for many women. While insurance plans generally cover abortion, high deductibles and other out-of-pocket costs can be a problem. Three out of four women pay for the procedure out of pocket, the report notes. “For uninsured or under-insured individuals who wish to end a pregnancy, the cost of care can be out of reach,” McNeese writes.
To help address this funding shortfall, the report calls for the state to increase what it pays for abortion services through Medicaid. “Simply put, Medicaid reimbursement rates for abortion care have not kept pace with medical care costs and certainly do not account for the complex challenges faced by abortion providers,” McNeese notes.
In addition, McNeese urged the state to expand Medicaid coverage for doula care —something now under consideration — and to boost promotion and other efforts to increase participation in the state’s paid family-leave program, which she said is not widely used but could benefit families with infants in many ways. (Racial disparities exist in this program too, she found, with white women three times more likely to take leave than black women.)
The report also advocates for improving healthcare services at the Edna Mahan Correctional Facility for Women, which houses 650 inmates and has been criticized for patterns of abuse and inaction in protecting women’s rights. More than eight out of ten women in jail have experienced sexual violence and require care, studies have shown, and New Jersey’s system is failing to address these needs, it notes.
Finally, McNeese advocates expanding Medicaid coverage to undocumented immigrants in New Jersey, as six other states have done. (Some 17 states cover all pregnant women, regardless of immigration status, she notes.) While the state has done well to reduce the uninsured rate here, there are still 70,000 kids without coverage, nearly half of whom don’t have legal status.
“Making the well-being of all children a priority would provide long-range health and social savings to the state,” she writes.