The Hyde Amendment prohibits federal Medicaid dollars from covering abortion, except in cases when a pregnancy results from rape or incest or if someone’s life is endangered by a pregnancy. This restriction wasn’t always the case; when abortion first became legal in 1973, it was covered under Medicaid, just like any other medical procedure. In fact, the joint state-federal Medicaid program was used to cover about 300,000 abortions each year, and federal Medicaid dollars paid for about a third of all abortions performed in the US. Medicaid was able to serve its purpose and provide vital coverage for low-income and otherwise-eligible folks who needed it.
The Hyde Amendment came into effect in 1977, and was ruled constitutional in 1980. It is not a permanent law; it is a rider to an annual appropriations bill that allocates money for the Department of Health and Human Services, which runs Medicaid. This means that Hyde expires and must be renewed by Congress each year, and that each year, Hyde has the potential to change, or be dropped altogether. After the initial implementation of Hyde, similar bans on federal dollars being used to fund abortions became more and more commonplace, extending to people with federal worker health plans, people in federal prisons, people in the military, Peace Corps volunteers, and almost anyone else who relies on federally-funded insurance. Although Hyde does not allow state use of federal Medicaid dollars to cover abortions, states can still use their state Medicaid funds for abortion coverage. As of right now, 17 states allow for abortion coverage under their Medicaid plans, but 32, including Virginia, do not. DC is a special case: Congress can control DC’s funding, and it has restricted DC from using its own funds to provide abortion coverage for low-income folks. The Hyde Amendment is a devastating restriction that quite tangibly harms people, particularly low-income people.
Nearly 13 million women aged 19 to 64 have Medicaid coverage. According to a report from the Guttmacher Institute, in 2008, 42 percent of women seeking abortions were poor, but almost 60 percent of abortions were paid for out-of-pocket. The cost associated with a first-trimester abortion is hundreds of dollars, and this cost can be more than what a family on public assistance receives in a month. When funding is restricted, people can be forced to make huge sacrifices to put together the money, delay their procedures, or carry a pregnancy to term. When abortions are delayed, the financial burden and risk of complication they bring with them increase. The impact of not being able to afford an abortion is very real; someone who seeks an abortion, but is denied access, is three times more likely to fall into poverty than someone who is able to access the care they need. According to a review by the Guttmacher Institute, 67 percent of poor and low-income women who have had an abortion say that they wish they could have had it sooner. For many women, the cost ends up being too high, or the wait too long — approximately one quarter of women who would otherwise have had Medicaid-funded abortions are forced to carry their pregnancies to term. No one should be denied coverage for any medical procedure on the grounds that they are covered by government-funded health insurance. No one should be denied access to a full range of choices due to the size of their wallet or their zip code.
When someone finds themselves in a situation that feels impossible, and restrictions like Hyde are in place, it is very easy to feel alone. In the midst of unnecessary and unfair restrictions like the Hyde Amendment, and the increasingly hostile political climate surrounding abortion, the DC Abortion Fund seeks to cover the gap between what someone can afford and the cost associated with an abortion — and make access to choice a reality for people, regardless of their income or insurance status. For many of the people that call, the cost of access to a safe and timely abortion is just one burden in the midst of many. As the only organization that focuses solely on this work in our community, DCAF’s case managers confidentially answer hundreds of calls from clients and work with clinics and other funds to fill in the funding gaps people face. DCAF also works closely with other organizations to make sure that people know where to go when they need assistance.
With Hyde and restrictions like it, policymakers fail to treat abortion as what it is — an important medical procedure that preserves people’s physical, emotional, and financial well-being. The ability to make one’s own reproductive and sexual health care decisions is a fundamental step toward economic and social self-determination, and we cannot have equality until everyone’s needs are met.
By volunteer Deepika S., art courtesy Megan J. Smith and the Repeal Hyde Art Project.