Your Story is Your Word: Personal Testimony in the State Legislature
American politicians have been committed to dismantling Planned Parenthood even before its inception. In 1916, Margaret Sanger was arrested for distributing birth control from a Brooklyn storefront—five years before she founded the organization that would become Planned Parenthood. Sanger was acting in response to the Comstock Laws, federal legislation from 1873 that criminalized the sending of contraceptives through the U.S. Postal Service. But if you were a young prairie homesteader with six kids already and an unsympathetic local pharmacist, how else would you get birth control? Better tear out the lingerie section from the Sears catalogue and tell your man to take care of himself.
Over one hundred years later, conservative rhetoric has changed, but efforts to deny basic reproductive rights to American women continue: now the party line seems to espouse the idea that birth control is mildly acceptable, but abortion will always be a sin against nature, man, God, or any combination of the three.
Earlier this year, when Trumpcare was a legitimate possibility, President Trump pacified moderate Republicans with his generous declaration that Planned Parenthood could keep its federal funding only if abortions were off the table. Planned Parenthood refused the offer (perhaps because their slogan is “Care. No Matter What.”) and the healthcare bill made it to the House of Representatives. A highly comedic series of events ensued in which the healthcare bill was pulled because Republicans could not get enough members of their OWN party to vote for it. Republican members of the Freedom Caucus—the most far right group within the House of Representatives—felt the bill didn’t go far enough in its efforts to fully repeal the Affordable Care Act. Can’t wait to see how they do with tax reform.
Conservative legislators have been trying to defund Planned Parenthood for years. Although they couldn’t make it happen this time, their threats are so ubiquitous as to appear mundane. But that’s how they get you, right? When the loss of basic rights and privileges appears commonplace, you don’t exactly notice their slow erosion when you could be re-living Cold War-era scandals instead.
Real talk: a defund is never quite off the table. If tax reform is the next big agenda item for this administration, watch for legislative language that will question Planned Parenthood’s tax status as a way of delegitimizing its work. See how quickly the idea of a defund gets thrown in again.
A defund is bad news for people who get their health insurance through Medicaid or Medicare. A crude breakdown goes like this: Medicaid is for poor people, Medicare is for old people. These two groups have gotten a ton of legislative focus lately, namely in the form of how their government-supported benefits can be reduced without anyone noticing.
A defund means that every time a Planned Parenthood clinic were to treat a person whose health insurance is issued through either Medicaid or Medicare, none of the associated costs of care will be reimbursed. Health insurance in America is a complete horror show, but it’s supposed to work something like this:
Mirah has health insurance through her work. Her throat has been sore for a few days and she thinks she has strep. Mirah goes to see her in-network primary care physician. She pays a $20 co-payment for the visit and has a strep test done. A few days later, Mirah will visit the pharmacy where her doctor has called in a prescription for strep antibiotics. Mirah will pay a $10 co-payment and receive a bottle of pills.
On the back-end, Mirah’s doctor will submit a claim to Mirah’s health insurance company, billing them for all the services Mirah received at the office. The health insurance company will pay the claim (usually after negotiating a lower rate with an in-network practitioner). Weeks later, Mirah will receive an explanation of benefits in the mail, a document that will show the date and nature of the visit to the doctor’s office, and what the health insurance company ended up paying for it. By this point, Mirah will feel fully recovered from her strep throat.
Let me know if you want to see the version where I have a high deductible plan. That’ll be $3,500 in upfront health costs before my insurance even kicks in. To quote my father in all his dadly wisdom, “It’s like you don’t even have health insurance.”
Maybe you want to see the Medicaid version? That one’s easy. Everything’s the same, except generally I would have no co-payment for a visit to my primary care doctor. When I go to the pharmacy to pick up my antibiotics, I’ll make a nominal payment, say $1 instead of $10.
Things get tricky here on the back-end: if I’m on Medicaid, my health insurance company is the United States government. But let’s say my strep throat is instead STI testing at Planned Parenthood and legislators are popping corks at the Capitol because they’ve finally passed that defund bill.
I’m on Medicaid, remember? My primary care doctor doesn’t offer STI testing and the private clinic she recommends won’t take my government-backed insurance. But I know Planned Parenthood offers STI testing and they accept Medicaid. Any claims Planned Parenthood submits to the government on behalf of their patients with Medicaid should be reimbursed, right?
Except maybe President Trump’s just signed a new defund bill into law. If Planned Parenthood is no longer getting reimbursed for Medicaid health insurance claims, they can’t treat me and women like me. How will they pay the lab technician who processes my STI testing? How will they pay the nurse practitioner who counsels me on contraceptive options? How will they pay for cancer screenings and gynecologic exams?
I am lucky. I am a 28-year-old middle-class white woman who lives in a mostly forward-thinking, mostly progressive state: Maryland. I say “mostly” because we have plenty of problems when it comes to social justice and racial inequality—I know you know. You’ve seen The Wire; you’ve seen my city on the news. But when it comes to women’s healthcare, we’re doing pretty well. Even our Republican governor, Larry Hogan, signed off on the Contraceptive Equity Act last year to ensure that Maryland women have equal access to affordable birth control options. Like I said, we’re doing okay.
But what if that national defund of Planned Parenthood finally goes into effect? If that happens, we need the state of Maryland to pick up the slack. The state should support all Marylanders by paying for the Medicaid and Medicare claims that the federal government will deny. This action will allow people on government-sponsored insurance plans to continue seeing their preferred healthcare providers, even when one of those providers is Planned Parenthood.
So that’s how I ended up in Annapolis, our state capitol, just me and my IUD. I am a long-time Planned Parenthood volunteer, but in June 2016 I also became a patient. They were first on my list for a LARC (long-acting reversible contraceptive) and, in case you’re wondering, everything went well. I’ll happily proselytize my IUD another time.
On March 8, 2017, International Women’s Day, two bills were presented for committee debate at the state house: HB1083 was up before a House of Delegates committee and SB1081 was up in front of a State Senate committee. Both bills included language that framed the issue as a continuation of care initiative. This means that legislators wanted to present these bills as a necessary measure to allow Medicaid and Medicare patients in Maryland to see their own doctors, regardless of federal funding.
Surprisingly, neither bill mentioned Planned Parenthood—instead the bills specified that the state government of Maryland would guarantee funding to support family planning services, including funding that would come through our state-sponsored medical assistance program (i.e. Maryland Medicaid). So what’s the subtext? Maryland will reimburse health insurance claims from Medicaid and Medicare patients seen at ANY organization that provides family planning. It just so happens that in Maryland, Planned Parenthood is one of the largest providers of these services.
I was there to testify in front of each committee about my experience as a patient at Planned Parenthood. You know about the IUD already. But I haven’t told you exactly what happened after the strep test:
Mirah has health insurance through her work. Her throat has been sore for a few days and she thinks she has strep. Mirah goes to see her in-network primary care physician. This doctor suggests a general physical since it’s been awhile since Mirah’s had one.
Her doctor asks, “Have you had a pap smear done recently?”
Mirah says, “Yes, I had one done at Planned Parenthood when I went to get an IUD put in.”
Mirah’s doctor takes a step back. Mirah’s doctor looks at her and says tersely, “I’m not really comfortable dealing with those and I wouldn’t know what to do. You know how they function, right? They work by causing an abortion to happen, and that goes against my religious beliefs.”
A few days later, Mirah will visit the pharmacy where her doctor has called in a prescription for strep antibiotics. Mirah will charge a co-payment to her parents’ credit card because she is poor and taking care of your health is expensive when your plan has a $3500 deductible. She will receive a bottle of pills.
I am telling you this story that I told in Annapolis to two roomfuls of mostly male legislators because I want you to see how easy it is to speak up when you’re a woman like me. I want you to see what it looks like when a 28-year-old middle-class white woman who lives in a mostly forward-thinking, mostly progressive state tells a group of men I’m between jobs right now and actually I am on Medicaid and I know I look all wrong for the demographic you had in mind, but let me tell you how Planned Parenthood did right by me.
Anyone can need Medicaid. Anyone can need Planned Parenthood. When you look like me, but you’re benefiting from services that are always falsely accused of helping marginalized people scam the government, it is your responsibility to testify.
I chose to appear in front of these two committees and recount my story because I knew they would listen. The bitter recognition of privilege is that a woman who looks like she shouldn’t need government assistance to pay for her healthcare is a woman who will be taken seriously by legislators.
When I spoke to members of the General Assembly, I leaned hard into the shame and respectability of my story. I became the educated, articulate young woman whose doctor chastised her for making a responsible decision about her future. Look at me, making my meager $14 an hour, choosing to get an IUD so that I won’t have children I can’t afford. Look at my partner, fortunately a biological man, one who is starting a PhD program in the fall and can’t have children disrupting his plans for future success.
Aren’t we decent, morally upright people who just need some time to get our adult lives in order? Let me have my IUD now, without shame, and I promise one day soon I’ll get married to my boyfriend (after all, “partner” is for gay people, isn’t it?) and we’ll have a couple of white, well-behaved kids. Don’t I remind you of someone you know? Couldn’t I be your sister, an old girlfriend, or your best friend confiding a secret?
They can relate to me easily. Everyone’s been between jobs and I’m a plucky young thing who will get back on her feet soon. I won’t need Medicaid forever—I’m using it the way it was always intended to be used, as a stop-gap for that in-between time when we could all use a little extra help. If I’m telling them Planned Parenthood is a quality, respectable organization that helps women just like me, whether we have insurance through work or we’re on the take, that’s good enough, right?
When I testified in Annapolis, I wrapped myself in a cloak of perceived respectability. It’s stifling, heavy, but let’s face it: no one is ever going to listen to a woman speaking from the naked vulnerability of her personal experience. Our experiences as women, and the experiences of any marginalized people, are worthless unless we can cloak them in acceptable coverage.
In both hearings, I sat at a rectangular table in front of a U-shaped seating configuration where delegates and state senators could see and hear me from all sides. I spoke on the second panel with two other young women who had been patients of Planned Parenthood and a long-time midwife. The first panel had included Planned Parenthood of Maryland’s president, legislative advocate, and director of education, as well as another young female patient.
After each panel testifies, delegates and state senators are given an opportunity to ask questions. In the House of Delegates, some members took this as an opportunity to bring up funding for abortion services at Planned Parenthood. At first, it was both amusing and frustrating to watch the women on the first panel repeat themselves to the few holdouts who had already made up their minds long ago: Planned Parenthood does not use federal funding for abortions. If I had taken a shot every time I heard a panelist speak some variation of this fact, I might have been more relaxed for my testimony. Instead, each utterance of casual misinformation made by a conservative delegate, followed by the ubiquitous replies of the panel (Planned Parenthood, does not, I repeat, does not use federal funding for abortions), stoked a white-hot flame inside me.
I don’t know how my House testimony went: by the time I spoke, the rational part of my brain had gone on holiday. Every breath I took lit me up even brighter and words leapt from my mouth like sparks. I remember with certainty the way my hands shook as I started to tell my story, and how my entire body pulsed with anger afterward, a sensation of constriction in my chest cavity. I can see why the lone female conservative delegate excused herself after the first panel. I hope she was watching from a video monitor in the backroom.
Since both committee hearings were on the same day, I testified in front of the State Senate less than an hour later. I remember this hearing better because I was feeling less personally antagonized by my state legislature. I recall thinking, “Hey, most of these guys are probably on your side.” I even got a few chuckles when I joked that a screaming baby would not be conducive to my partner completing his PhD program. It was easy the second time around.
It was easy to tell my story because of the inherent benefits conferred upon me by my race, my class, my immediately perceptible gender. I don’t love shaping my experience into a narrative that is palatable to people in positions of legislative authority, but it’s not that hard to do. If you have a safe story, a story with broad appeal that elicits recognition in your listeners, tell it to your legislators. Tell it to the people who can affect change.
On March 28, the Maryland General Assembly passed these bills into law. On April 6, the new legislation went into effect without Governor Hogan’s signature. Governor Hogan refused to sign the bills, but he didn’t veto them either, knowing that the General Assembly would override him. That’s okay. We didn’t need him. If you’re reading from Maryland, don’t forget that he’s up for re-election next year. You know what to do. We vote so that our government will hear us. We tell our stories in ways that make our legislators listen. But what about the difficult stories? What about the stories that aren’t instantly relatable, the ones that don’t conjure up immediate empathy? Tell those stories anyway. Tell them to anyone who will listen and tell them to people who won’t. Keep talking and keep listening and do whatever it takes to be heard. Dress up your story in a red pantsuit and your good heels and take it right to the top, or scream it naked and wild from a street corner. They’ll get the message. And if they don’t? Just know that I am listening, and I’m not the only one.
Mirah Ippolito is a writer living in Baltimore, Maryland. She’s into knitting, book clubs, and questioning authority. She’s currently working on her first novel.