The Hyde Amendment's Prohibition of Federal Funding for Abortion -- 30 Years is Enough!
July/August 2006
By Susan Schewel, CRNP, Ph.D.
A.B. sounded close to tears on the phone as she told her story of seeking an abortion. As a resident of Pennsylvania, she receives $316 per month in TANF (Temporary Assistance for Needy Families) cash assistance to support herself and her young child. She is enrolled in Medicaid for her family's health coverage. She had just learned that her abortion will cost $300, which she must pay up-front, and that Medicaid does not cover abortions. If she is unable to obtain the money soon, the abortion's price will increase as her pregnancy progresses.
This was a call to the helpline of the Women's Medical Fund, an abortion access fund located in Philadelphia, PA. But the call could have been received by any of the National Network of Abortion Funds' 110 member funds. This association of grassroots groups provides over $2 million annually to help about 22,000 low-income women and teens have a safe and legal abortion. Most of the association's abortion funds raise money from individual donors, although some also receive grants from local family and community foundations.[1]
Why does this nationwide, community-based safety-net for poor women seeking abortions exist? Immediately after Roe v. Wade legalized abortion in 1973, anti-choice forces began working toward their ultimate goal of re-criminalizing abortion. Part of their strategy has been to relentlessly pursue measures that limit access to legal abortion by chipping away at access for different groups of women. As the mainstream pro-choice movement has focused on keeping abortion legal overall, the promise of Roe v. Wade has been broken for poor women, young women, rural women, women in the military, and others affected by specific restrictions on their right to choose.
Anti-choice activists' first major victory in their strategy was the 1976 Congressional passage of the Hyde Amendment, which bans the use of federal Medicaid dollars for abortions. This amendment was added to the appropriations bill for the Department of Health, Education and Welfare (HEW, now the Dept. of Health and Human Services). Representative Henry Hyde (R-IL), sponsor of the amendment, was forthright in his intention when he said, during the floor debate, "I would certainly like to prevent, if I could legally, anybody having an abortion: a rich woman, a middle class woman, or a poor woman. Unfortunately, the only vehicle available is the HEW Medicaid bill."[2]
Since then, anti-choice activists have succeeded in passing similar bans to prevent the use of state Medicaid dollars to fund abortions as well. Today, 32 states prohibit the use of state Medicaid funds for abortion, except the federally required exceptions in cases of rape, incest, or life endangerment. In direct violation of the federal standard, South Dakota honors only the exception that Medicaid fund abortion if the woman's life is put at risk by the pregnancy.[3]
For the 12.8 million women of reproductive age who depend upon Medicaid for health care today, the impact of the Hyde Amendment is staggering.[4] Between 1973, when abortion was decriminalized nationally, and 1977, when the Hyde Amendment went into effect, Medicaid paid for about one third of all U.S. abortions.[5] Today, women who are least able to pay for an abortion must cobble together the fee or continue an unwanted pregnancy to term. In Philadelphia, a first trimester abortion costs about $350, but delays can result in fees as high as $2,000.
Women who are able to raise the money for an abortion often do so at great cost to themselves and their families' using meager public assistance checks or paychecks from low-wage jobs, forgoing payments for rent and heat, sometimes risking homelessness or resorting to prostitution. The time it takes to raise the needed money means that low-income women often have to delay their abortion procedure by two or three weeks; as a result, they are more likely to have later abortions and to need more complicated and expensive second trimester abortions than do women with higher incomes.[6] Those who continue the pregnancy to term may be forced to stay in abusive relationships, end their formal education, or experience greater difficulty raising their children with dignity.
When the Hyde ban was implemented, the pro-choice movement immediately challenged this inequitable measure in the courts. In 1980, the Supreme Court found the Hyde Amendment to be constitutional. Since its inception, both Congress and the courts have fluctuated about including exceptions to the Medicaid coverage ban. Presently, federal Medicaid funds can be used in cases where the pregnancy resulted from rape or incest, or if the pregnancy endangers the woman's life. Yet states have set up myriad bureaucratic hurdles that make it difficult for individual women -- often already traumatized by the circumstances of their pregnancy -- to take advantage of these exceptions.
F.S. is a day student at a local Philadelphia college. She became pregnant when she was raped by an acquaintance. Luckily she is enrolled in Medicaid and, in the case of rape, Medicaid will pay for her abortion. Yet, due to Pennsylvania state regulations, arranging for the procedure is complicated, and requires special and confusing paperwork to be signed by both F.S. and her doctor. When F.S. called her primary care provider to make an appointment for this purpose, she learned that he is anti-choice and refused to sign the papers.
As part of the successful anti-choice strategy to chip away at reproductive rights, Congress has restricted use of federal funds to pay for abortion services for publicly-insured women and teenagers, including federal employees, military personnel, and their families; Peace Corps volunteers; teenagers participating in the State Children's Health Insurance Program (S-CHIP); women incarcerated in the federal prison system; and Native Americans who use the Indian Health Service.
C.A.'s husband is a solider deployed in Iraq. They support their five children on his military pay of $800 per month. C.A. felt that another child would create an unbearable strain on her mental health and she and her husband decided on an abortion. When she sought care, she was dismayed to find that her husband's military insurance, upon which the family relies, is forbidden to pay for abortion.
As the loss of abortion coverage spread nationally, feminist activists created abortion access funds to ensure the right to choose for low-income women and teens. Members of the National Network of Abortion Funds understand that public funding for abortion is a matter of reproductive justice, and that the right to abortion is meaningless without resources to exercise that right.
All of the women described in this article received support from the Women's Medical Fund to help them access a safe and legal abortion. Yet, while we cannot ignore the serious and immediate needs of individual women, we must not accept that our funds should replace the government as a funder of abortion services.
With this understanding, the National Network of Abortion Funds has launched the "Hyde -- 30 Years is Enough! Campaign" to mark the 30th anniversary of the Hyde Amendment this year. (The NWHN is proud to be part of this campaign.) Through this campaign, the Network has joined with allies in the reproductive and economic justice communities to repeal the Hyde Amendment and similar state bans, and to ensure that abortion services are covered by Medicaid in cases in which it is mandated. This is a simple matter of dignity and justice for all women.
For Further Information:
Hyde - 30 Years is Enough! Campaign
National Network of Abortion Funds
References:
1. Towey S, Poggi S and Roth R. Abortion Funding: A Matter of Justice. Policy Report. Amherst, MA: National Network of Abortion Funds, 2005.
2. Emmens C. The Abortion Controversy. New York: Julian Messner, 1987. p. 68.
3. Henry J. Kaiser Family Foundation (KFF). Issue Brief: Medicaid's Role for Women. Menlo Park, CA: KFF. May, 2006.
4. Donovan P. The Politics of Blame. New York: Alan Guttmacher Institute. 1995. p. 34.
5. Henshaw SK and Wallah LS. "The Medicaid Cutoff and Abortion Services for the Poor." Family Planning Perspectives 1984;16:170, 1984.
6. Guttmacher Institute. Policy Brief: State Funding of Abortion Under Medicaid. New York: Guttmacher Institute. July 2006.
Susan Schewel is the executive director of the Women's Medical Fund in Philadelphia, PA, a women's health nurse practitioner, and the treasurer of the board of the National Women's Health Network.
