Roe v. Wade isn’t enough. Here’s how President Biden can make abortion accessible

In January 2021, Joe Biden was sworn in as the 46th president of the United States and Kamala Harris as vice president — the first woman and woman of color to hold the office. Two days later marked the 48th anniversary of Roe v. Wade, the 1973 U.S. Supreme Court decision that affirmed the right to abortion for every person in this country, no matter who they are or where they live.

Marking the anniversary of Roe v. Wade with the inauguration of a president committed to expanding access to reproductive health care is reason to celebrate, and get to work. The Advocacy Fund President and CEO  Dr. Jennifer Childs-Roshak laid out the policy stakes of this moment in GBH: President Biden and Vice President Harris have a mandate to dismantle barriers to care across the country, but, they face a tough landscape in the fight to expand access to reproductive health care.

The Roe v. Wade Court decision set the bare minimum for legal abortion, and anti-abortion politicians have  been chipping away at it for decades. Access to abortion in the U.S. is horrendously limited. Anti-abortion legislators across the country have passed literally hundreds of laws making it harder and harder to get an abortion. These laws are based in stigma and hostility to abortion, not medical reality. Someone’s ability to get an abortion depends not only on the state where they live but also their employer, insurance, income — and whether they can find a provider, afford transportation, and take time off from school, work, or home responsibilities. Hostile laws and patchy access to care have the most debilitating effects on people who are already marginalized and underserved, especially Black people, people of color, immigrants, Indigenous people, and queer and trans people.

After fighting off attacks for the past four years, we must now ensure that everyone who needs an abortion can get care when and where they need it. Just as Roe v. Wade defined the constitutional right to abortion but did not guarantee access to care, action on the federal level can’t fill every gap in access — but President Biden can take some actions that will clear obstacles to abortion for people in every state. 

• Championing the elimination of  the Hyde Amendment would mean people who rely on Medicaid can seek abortion care and ending restrictions on insurance coverage would mean that someone who can’t afford the cost of care won’t have to pay out of pocket, borrow money, or go into debt to afford their abortion. 

• Lifting medically unnecessary restrictions on medication abortion would meanthat more people will be able to get the medication to safely end their pregnancies at home, without having to risk exposure to the still-raging COVID-19 pandemic. 

• Eliminating the unethical domestic gag rule would mean that close to two million people would be able to get care they may not be able to afford otherwise. The domestic gag rule prohibits providers in the Title X program from discussing abortion, even if a patient asks about it. This forced health care providers who provided their patients with full and accurate information out of the federal Title X program. Title X is the only federal family planning program, and it enables people with low incomes to get preventive reproductive health care. Ending the gag rule would mean more providers could once again participate in the program and  that more people would be able to get the care they need.

These are just some of the ways that the Biden administration can immediately improve access to abortion. Dismantling restrictions on abortion will have the most immediate effects for Black people and other people of color who currently struggle to get care and experience disproportionately negative health outcomes. 

But these are spot fixes, not the structural change needed to make reproductive freedom a reality: insurance coverage for all reproductive health care is important, but 2019, almost 30 million people had no health insurance at all, and in 2020, almost half of nonelderly adults had inadequate insurance. Six states have only one clinic that provides abortion, and even good policy can’t build more clinics from scratch. In Massachusetts, we’ve just achieved an incredible victory with the passage of the ROE Act, which dismantled some of the last remaining barriers to abortion in state law. But even here, we’ve got work to do.

Every political barrier to abortion makes it harder to get the safe, legal care that everyone hass a right to. In every state, restrictive laws and logistical barriers mean that people still struggle to make travel arrangements, come up with the costs, and take time out of their schedules so they can get their abortion. The right to abortion doesn’t guarantee access, and it never will until everyone can get any reproductive health care without delays, burdens, or stigma.

President Biden and Vice President Harris have taken on a country staggering under a catastrophic pandemic, an inadequate health care system, and centuries of systemic racism. Their policies will change people’s lives. And it’s up to us to keep the pressure on so that their administration enacts real change that will move us all toward reproductive freedom for everyone, everywhere, no matter what.