How Medicaid Bans Affect DC Residents

On January 24, the U.S. House passed H.R. 7 to codify — and expand — the Hyde Amendment and related longstanding restrictions on federal funding for abortion. For the last four decades, the Hyde Amendment and other budget riders like it have created financial hurdles for abortion access for DC Abortion Fund’s Medicaid patients. Our patients who live in the District face an additional hurdle because of Congress’ constant meddling in DC’s budget — and sadly, that’s unlikely to change anytime soon.  

The Hyde Amendment bans the use of federal money for abortion except in cases of rape, incest, or when the pregnant person’s life is in danger. Some states mitigate the effects of Hyde for their low-income residents by using their own funds to provide abortion access to people enrolled in Medicaid. But almost continuously since 1989, Congress has prohibited the District from using its own locally-raised Medicaid funds to pay for abortions through a rider known as the Dornan Amendment. (The ban was temporarily lifted in 1993, 1994, 2009, and 2010, but otherwise it has been in effect every year since 1989.) H.R. 7 converts these riders, which previously needed to be re-enacted every year, into permanent funding restrictions.

For many politicians and anti-choice advocates, DC residents are just another pawn in an ongoing effort to reverse the constitutional guarantee of abortion rights. It’s an easy “win” for them because the federal government exerts full control over DC’s budget while DC residents have no representation in Congress. Congress could not exert the same control over the residents of any other jurisdiction.

But for DCAF’s patients, this Medicaid ban is not just a move on a political chessboard.

When the Medicaid ban, also known as the Dornan Amendment, was suddenly reinstated in April 2011, DCAF saw “an immediate spike in need within our community,” and that need continues today, as DCAF board member Emily discussed on a recent episode of the Kojo Nnamdi Show.

In Fiscal Year 2016, 72 percent of our DC patients who reported their insurance type said they were insured under DC’s Medicaid program. The DC Medicaid ban stretches DCAF’s budget and forces many of our patients to scramble for funds that wouldn’t be needed if Medicaid covered abortion just like other medical procedures.

A first-trimester abortion can cost between $300 and $950. By comparison, the monthly income limit for an individual to be eligible for DC Medicaid is $2,128 — and that’s the upper limit, the maximum that a person can make and still be eligible for Medicaid. Many people make less than that, and when they can’t use their Medicaid coverage to pay for abortion, they often have to turn to family and friends who may also have a low income, pawn their belongings, consider which bills they can delay, or make other difficult choices.

In spite of all of this, we have a history in DCAF of turning rage into resilience. Our volunteers continue to take calls seven days a week, 52 weeks a year. In an ideal world, the Hyde Amendment — and all of its spinoff restrictions like the Dornan Amendment and H.R. 7 — would be history. We stand with our allies every day to try to make that world. And in the meantime, we keep answering the phone. Always.

By volunteer Deborah S.