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Illinois’s Republican Gov. Bruce Rauner infuriated some members of his own party on Thursday by signing a bill that would significantly expand access to abortion in his state.
By expanding state Medicaid coverage of abortion, the new law will put the procedure within reach for more low-income women. It also removes a “trigger” provision that would have made abortion illegal in Illinois if Roe v. Wade were overturned.
Previously, state Medicaid funds could typically only be used to cover abortion in cases of rape, incest, or a threat to the life of the mother, as Kim Geiger and Rick Pearson report at the Chicago Tribune. The Hyde Amendment imposes similar restrictions on federal Medicaid coverage for abortion, and 32 states impose them on state Medicaid funding. In practice, Medicaid coverage of abortion in Illinois was complicated, as this 2010 study by Ibis Reproductive Health makes clear. “Many consider Illinois a state that does not allow Medicaid coverage of abortion at all,” the study authors wrote.
The new law removes Medicaid coverage restrictions in Illinois, a state where 3.1 million people get health insurance through Medicaid or the Children’s Health Insurance Program, according to the Kaiser Family Foundation. Medicaid covers one in seven Illinois adults under 65, and one in two low-income Illinois residents.
When abortion isn’t covered by insurance, patients can struggle to pay for the procedure, sometimes having to forgo necessities or delay the procedure until later in pregnancy, when it can be more expensive.
“No woman should be forced to make a different decision than another woman would make purely based on her income," Rauner said on Thursday. "I believe that a woman living with limited financial means should not be put in the position where she has to choose something different than a woman of higher income would be able to choose."
Republicans in the state’s Democratic-controlled legislature harshly criticized Rauner’s move, with one saying his signature on the bill ensured he would serve only one term, according to the Tribune. Rauner has not yet said whether he will run for reelection, but if he does, his signature on the abortion bill may not hurt him. As Geiger and Pearson point out, he made his support for abortion rights clear during his 2014 campaign in a full-page ad in the Tribune, taken out by his wife and other abortion rights advocates. And his signature could help him with moderates in the Chicago suburbs, who voted for Hillary Clinton in November.
Unlike the expansion of Medicaid coverage, removing the trigger provision won’t have an immediate impact on patients in Illinois. In the event that Roe v. Wade were overturned, the provision would have made abortion illegal in the state except to save the life of the mother. Striking the provision was especially important under President Trump, abortion rights advocates argued, because a change in the makeup of the Supreme Court could threaten Roe.
“If Trump has the ability to appoint another justice, we do not want to wait to see what happens. We want to make sure abortion stays safe and legal in Illinois,” Brigid Leahy, director of public policy at Planned Parenthood of Illinois, told the Chicago Sun-Times in January.
While some Republican state lawmakers denounced Rauner’s move, Corinne Wood, a Republican former lieutenant governor of Illinois, appeared with the governor on Thursday and praised his decision, according to the New York Times. “It’s always about doing what’s right, not necessarily what’s politically expedient,” she said. “And this governor has the courage to stand up and do that.”
