Deb Hauser was a married mother of a 6-month-old when her husband “went to work one day and didn’t come home.” Two weeks later, she realized she was pregnant.

“I’m working full time. I’ve got this 6-month-old, and all of a sudden I’m pregnant,” she remembers. “I didn’t have any idea what was going to happen. I didn’t know if he was going to come back; if my marriage was going to stick. I didn’t know where I was going to get the money I needed. All I know is I had a responsibility to my 6-month-old.”

Hauser had an abortion, “which was absolutely the right thing to do for me, and for my son,” she says. “I never ever regretted it.” Eventually her husband was diagnosed with bipolar disorder, they were divorced, and she remarried and raised her son, who is now 20. “Abortion has played a really important role in my life,” she said. “It got me stable again.”

Now she wants to help other women tell their abortion stories. It’s part of an effort by her organization, Advocates for Youth, and several others to “de-stigmatize” abortion. As the 42nd anniversary of the Roe v Wade decision that legalized abortion approaches Thursday, abortion rights forces hope this new tack will help them reverse the momentum gained by abortion opponent in recent years. Not only have states passed a growing list of abortion restrictions, but with the U.S. Congress now in GOP hands, federal restrictions are likely to pass as well.

“It’s very clear that pro-life legislators and people running for office are on the offense now,” said Marjorie Dannenfelser, president of the anti-abortion advocacy group, the Susan B. Anthony List. “It’s also very clear that our opponents are on the defense.”

Planned Parenthood President Cecile Richards, who appeared at the National Press Club in Washington a day before Dannenfelser, conceded as much.

“The new Congress is introducing anti-women’s health bills at the rate of one per day,” she said. The House is expected to vote on a bill to ban abortions after 20 weeks of pregnancy on the day of the Roe v Wade anniversary.

But in addition to fighting legislative efforts, abortion rights backers hope to change the public view of abortion, much as gays and lesbians have done of homosexuality in recent years.

Having more women talk about their experiences, they say, will help underscore the statistic that an estimated one in every three American women will have an abortion during their reproductive lifetime.

“Probably everybody knows somebody who’s had an abortion,” said Lindsay Rodriguez of the National Network of Abortion Funds. “They just don’t know they know somebody who’s had an abortion.”

The stigma around abortion “permeates every aspect of our culture,” says Steph Herold of the Sea Change Program, another group working to make it easier to talk not just about abortion but about other “stigmatized reproductive experiences,” including infertility and miscarriage.

Herold says the stigma is everywhere, from media depictions “where a person who’s had an abortion is often stereotyped as selfish or immoral” to hospitals, which may refuse to provide the procedure not because of ideology, “but because they’re afraid of the backlash or anti-abortion protesters.” Herold says stigma even prevents women from talking about abortion with people they’re close to “for fear it might ruin their reputation or their friendships.”

Advocates for Youth has launched the 1 in 3 Campaign, which has so far collected some 700 abortion stories in audio, video, and print versions. Last fall, the project hosted an eight-hour online “speak out,” at which more than 100 women shared their stories. It’s also prompted a book and a play, Out of Silence, debuting this week in Washington D.C., based on some of the stories.

The goal is two-pronged — to give women a safe place to talk about their experiences and to boost support for abortion rights, says Hauser. “We know from the research that the No. 1 predictor of whether or not you say you’re pro-choice and vote pro-choice is if you know someone who’s had an abortion,” she says.

Richards says the movement to de-stigmatize abortion also has a special appeal to younger women. “They are much more open about sex, sexuality, sexual identity, and abortion,” she said.

Planned Parenthood consulted on the production of last year’s indie film “Obvious Child,” in which a young comedian played by Jenny Slate finds herself unexpectedly pregnant after a one-night stand. “It was so refreshing,” Richards said. “Most of the time abortion is talked about [in the media] it’s some gothic story. This was really about a young woman’s life. What happened, what she decided to do with the support of her family, even her boyfriend.”

Advocates of women “coming out” with their abortion stories are quick to admit that they’re following a page from the same-sex marriage playbook.

“More and more people in the U.S. became aware of the people in their lives who they knew who were gay,” said Jessica Arons of the Reproductive Health Technologies Project. “And they started to become more comfortable with it.” Even abortion opponent Marjorie Dannenfelser says the effort is good politics. “In terms of tactics, it’s smart. I have never underestimated their ability to do the smart thing,” she said.

Which is not to say she agrees that speaking out will – or should – eliminate the stigma. “It’s very true that women are afraid to talk about their abortion,” she says. “It’s very true that there is a lot of shame associated with it. The question is what are the root causes of those things? If this is a child, it’s complicated in a different way.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Are you thinking about tax day yet? Your friendly neighborhood tax preparer is. IRS Commissioner John Koskinen declared this tax season one of the most complicated ever, and tax preparers from coast to coast are trying to get ready for the first year that the Affordable Care Act will show up on your tax form.

Sue Ellen Smith manages an H&R Block office in San Francisco, and she is expecting things to get busy soon.

“This year taxes and health care intersect in a brand new way,” Smith says.

For most people, who get insurance through work, the change will be simple: checking a box on the tax form that says, “yes, I had health insurance all year.”

But it will be much more complex for an estimated 25 million to 30 million people who didn’t have health insurance or who bought subsidized coverage through the exchanges. To get ready, Smith and her team have been training for months, running through a range of hypothetical scenarios. One features “Ray” and “Vicky,” a fictional couple from an H&R Block flyer. Together they earn $65,000 a year, and neither has health insurance.

“The biggest misconception I hear people say is, ‘Oh the penalty’s only $95, that’s easy,’” says Smith, but the Rays and Vickys of the world are in for a surprise that will hit their refund. “In this situation, it’s almost $450.”

That’s because the penalty for being uninsured in 2014 is $95 or 1 percent of income, whichever is greater. Next year, it’s 2 percent. Smith says the smartest move for people to avoid those penalties is to sign up for insurance before Feb. 15, the end of the health law’s open enrollment period.

But a lot of people may not think about this until they file their taxes in April. For them, it will be too late to sign up for health insurance and too late to do anything about next year’s penalty too, says Mark Steber, chief tax officer for Jackson Hewitt Tax Services.

“They’re kind of stuck,” says Steber. “Quite frankly, that’s a very difficult discussion.”
Steber’s team at Jackson Hewitt is also doing role playing with tax advisors to prepare them for delivering bad news – in case taxpayers want to blame the messenger.

Lou Graham works at an H&R Block office in Hartford, Conn., and he is facing the same concerns. He is bracing to tell people who underestimated their 2014 incomes that they received too generous a subsidy and that they’ll soon have to pay the government back.

“I’m going to tell a client, ‘I’m sorry, $300 of your return is not going to be yours.’ Well, that will send them right through the roof,” Graham says.

Like his colleague Smith in California, Graham is afraid some people may be completely unaware of the penalty for not having insurance. That means Graham may have to deliver two pieces of bad news: First, he’ll tell them they owe a penalty for 2014, and then he’ll tell them it’s too late to sign up for 2015.

“So they’re going to get stymied twice,” he says.

But he also hopes to guide people to some good news. A lot of people may not know that they’re able to get an exemption from the law’s mandate to get insurance. And it’s his job to pull it out of them.

“‘I didn’t have insurance for six months, but, you know what? I had got a notice that my electricity was going to be cut off.’ Well, you fall into a hardship case,” Graham says. “Those things need to be explored and not many people want to bring that forward.”

Discussing these issues is important. Tax preparers like Graham can only help if tax filers seek them out. And most people don’t. Not in January, anyway.

“It’s real early. People don’t really start thinking about tax work until they get their W-2s in their hands,” he says.

And that presents a real time crunch. Most people won’t get those W-2 wage statements until the end of January. That gives them just two weeks before the Obamacare clock runs out on them on February 15.

This story is part of a partnership that includes WNPR, KQED, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

The U.S. Supreme Court heard arguments Tuesday in a case that could block hospitals, doctors — or anyone else — from suing states over inadequate payment rates for providers who participate in the Medicaid program for low-income Americans.

Federal law requires Medicaid, which covers 70 million people, to provide the same access to care as that given to people with private insurance. But many doctors avoid seeing Medicaid recipients, saying the program pays too little. That can lead to delays and difficulties in getting care for millions of poor people.

In Armstrong vs. Exceptional Child Center, several providers for developmentally disabled Medicaid patients sued the state of Idaho after officials failed to increase Medicaid payments as required under a formula approved by the federal government. An appellate court upheld a judgment in favor of the providers last year, noting that Idaho had conceded that it held rates flat since 2006 for “purely budgetary reasons.”

The issue before the high court is whether the U.S. Constitution gives providers the right to sue the state to increase their pay. And the court appeared split on that issue based on their remarks Tuesday. Chief Justice John G. Roberts Jr. expressed concern about opening the door to a flood of lawsuits that could have federal judges determining state payment rates and potentially gutting state budgets, while more liberal judges appeared more sympathetic to the providers.

“It seems to me that this is a prescription for budget-busting across the board.” Roberts said of allowing provider lawsuits. “It seems to me [we] will be putting the setting of budget priorities in the hands of dozens of different federal judges, and I just don’t know what the practical significance of that is going to be.”

In the past two decades, providers and patient advocates have sued Medicaid programs in numerous states, including California, Illinois, Massachusetts, Oklahoma, Texas and the District of Columbia — with many of those suits resulting in higher pay for doctors and other providers.

But Justice Sonia Sotomayor noted that in the case before them, Idaho officials had failed to follow the federally approved Medicaid payment formula.

Idaho is asking the Supreme Court to hold that neither providers, nor any other private party has the right to challenge payment rates in court; indeed that only the federal government has that ability.  A decision is expected by June.

More than half the states and the Obama administration have backed Idaho’s position. Major provider groups including the American Medical Association and the American Hospital Association — along with patient advocacy groups such as the National Health Law Program — have sided with the providers.

During the hearing, Roberts and Justice Antonin Scalia questioned why providers don’t take the issue up with the federal Centers for Medicare & Medicaid Services, which oversees state Medicaid programs. But the federal government has few options to sanction states other than cutting off a state’s federal Medicaid funding — the so called “nuclear option,” which CMS has never used, said an attorney representing the Idaho health providers.

The last time the court considered the issue, in a 2012 case from California called Douglas vs. Independent Living, a narrow majority sent the case back to lower court without clearly affirming or negating the right to sue. But four conservative justices in their dissent said that without explicit language from Congress saying that such a right exists, private parties such as providers and patients could not challenge Medicaid fees.

State Medicaid programs typically pay low rates — at least one third lower than Medicare, the federal plan covering the elderly and disabled. The Affordable Care Act widened eligibility for Medicaid to cover more low-income adults, adding nearly 10 million people to the program in the past year. The law temporarily increased reimbursement rates for primary care providers, but only in 2013 and 2014.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.