When the Stupak amendment passed in the House of Representatives, I thought of Bethany, who was 16 weeks pregnant when she visited my Washington, D.C., family planning practice. Bethany had an alcohol problem. She knew she could not be a good mother. She also knew that she might have already damaged her fetus with her heavy drinking.

In my 15 years as an OB-GYN, I have seen what happens when women can’t afford the abortions they need. But my patients and their pain don’t matter to the architects of the Stupak amendment.

Bethany came to me for an abortion. I had to tell her she had a condition with her placenta that made abortion risky. She would need to have her abortion in the hospital, making it much more expensive.

But Bethany didn’t have insurance or enough money to cover the termination. She had no choice but to continue the pregnancy. I got her into prenatal care. That was the best I could do.

I would like to think Bethany stopped drinking and became a caring mother, but I have seen too many mothers whose infants came a distant second to alcohol or drugs. Equally unlikely is that Bethany put her baby up for adoption, or that there were adoptive parents ready to take on the problems caused by fetal alcohol syndrome.

In my 15 years as an OB-GYN, I have seen what happens when women can’t afford the abortions they need. According to the Guttmacher Institute, 60 percent of American women who obtain abortions are already mothers, looking to better care for the children they already have. Whole families are affected when a woman is denied the right to terminate her pregnancy. But my patients, their families, and their pain don’t matter to the architects of the Stupak amendment. Under Stupak, the middle-class women who will rely on the government to help pay for insurance will not be allowed to buy a plan that covers abortion. These millions of women will suffer because “America’s Affordable Health Care Act” keeps the health care they need unaffordable.

I practice in Washington, D.C., where women on Medicaid, the public health-insurance plan for the very poor, don’t have abortion coverage except in cases of rape, incest, or a threat to their life. The Stupak amendment mirrors these Medicaid restrictions, which also currently apply to women in the military and female federal employees, no matter where they live. These patients—as well as the women who can’t afford any insurance or have insurance that doesn’t cover abortion—give my colleagues and me a preview of what women’s health care would look like in Rep. Bart Stupak’s America.

I had a 31-year-old patient named Joan who was eight weeks pregnant and on Medicaid. She had three extremely serious health conditions: a kidney disease, a seizure disorder for which she took medicine that causes birth defects, and a history of blood clots that once nearly killed her by entering her lungs. Joan’s health complicated her use of birth control. She never found an effective method, and subsequently became pregnant.

Any one of Joan’s health conditions could have become much worse if she continued her pregnancy. But we couldn’t be sure that Medicaid would agree that her case qualified as life endangerment and pay for her abortion, which, due to Joan’s delicate health, would require a hospital stay costing thousands of dollars.

Still, Joan and her family were convinced abortion was the best option to preserve her health. Joan had to sign a promissory note before her procedure, taking full financial responsibility for the hospital bill if Medicaid refused to pay. She and her family knew the abortion could put them in debt for a long time.

I hope Medicaid came through for Joan—her health and finances are as important as anyone else’s. Yet the Stupak amendment is premised on the idea that Joan and her family deserve to be punished, along with women unlucky enough to have high blood pressure, severe diabetes, or another medical problem that worsens with pregnancy.

I have spent years learning how to take care of women’s health. But because of my religious beliefs, I didn’t provide abortions right away. It took me a while to realize that by refusing to end a woman’s pregnancy when she decides abortion is the best course for her, I was compounding her suffering, the very opposite of my goal as a physician.

I can no longer separate abortion from the rest of women’s medical needs. The Stupak amendment makes a distinction that I cannot support medically or morally. Every woman should have the same chance at staying healthy, whether she pays part or all of her insurance bill.

Note: The names of the patients in this piece have been changed to protect their privacy.

Willie J. Parker, MD, MPH, is an obstetrician/gynecologist who practices in Washington, D.C. He is a board member of Physicians for Reproductive Choice and Health.