This story was originally published on September 30, 2015.
Today marks the 39th anniversary of the Hyde Amendment, which ended federal funding for abortion except in cases of rape, incest, or direct endangerment of the mother's life. It was the legislative equivalent of a huge, ugly asterisk on the Roe v. Wade decision the Supreme Court handed down four years prior, in 1973, to protect women's constitutional right to abortion. Recently, as Republicans threaten an eventual government shutdown if federal funding to Planned Parenthood is not cut, we've heard again and again the pro-Planned-Parenthood arguments that the organization does "more" than "just abortions" — and that the abortions it does provide are never paid for by the government.
These arguments are well-intentioned, but they ignore the growing number of women (especially low-income women, federal and military employees, and young people) who rely on government-funded insurance such as Medicaid (which now covers one in 10 women, of whom 72% are of reproductive age). These arguments send the message that when women in this group inevitably need Medicaid-assisted abortion services, their needs, bodies, and lives are worth less than other women's. And 39 years of this message is 39 too many.
In the 1970s, anti-abortion politicians dreamed up Hyde as the next best thing to overturning Roe v. Wade. Rep. Henry Hyde (R-IL) attached the amendment to a spending bill for the '70s counterpart of today's Department of Health and Human Services, declaring it his weapon for keeping as many women as possible from accessing abortion care. "I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman," Hyde announced to his colleagues in Congress in 1977. "Unfortunately, the only vehicle available is the…Medicaid bill."
It just so happened that the women Republicans could most directly affect were poor women; in the words of the Guttmacher Institute's director of public policy, Heather Boonstra, "Poor women have been pawns in the congressional debate over abortion since the procedure became legal nationwide." An abortion can cost from $375 to $6,531 depending on the stage of pregnancy (the median charge is $490), and that's not even including attendant costs of childcare, transportation, lodging, or time off work. Of women who have abortions, 42% are low-income. Largely due to these financial barriers, 25% of low-income women who would opt for an abortion if they could are forced to carry an unwanted pregnancy to term.
"The Hyde Amendment continues to enshrine two levels of care in this country, so given that people can’t outlaw abortion, they’ve forced it to be framed in terms of 'You can have an abortion if you can pay for it,'" Willie J. Parker, MD, board-certified OB/GYN and board member of Physicians for Reproductive Health, tells me. Dr. Parker, who has been providing abortions for 10 years, moved from Chicago back to his home state of Alabama last year to serve in local clinics, "where there is a profound, pressing need," he says. He knows better than anyone the disastrous effects of Hyde.
Dr. Parker points out that not only low-income women but also women who work for the government are covered by Medicaid and thus denied abortion coverage: "What comes to mind most readily is military women, who are more likely to be victims of sexual assaults, ironically are barred from having abortions with [their healthcare plans]," he explains. Per the Department of Labor, 20-48% of female veterans have experienced military sexual assault.
What's more, even women who don't live below the poverty line or work for the government are now enrolling in Medicaid under the Affordable Care Act, which allows people making up to 138% of the federal poverty level to qualify. The Guttmacher Institute reports that the share of women of reproductive age without health insurance dropped from 17.9% to 13.9% between 2013 and 2014 — great news, except for the fact that to push the ACA through Congress, Obama was forced to sign an executive order pledging that expanded coverage would play by Hyde rules. Every year since, creative new restrictions on women's ability to access abortion care (such as mandatory delays between counseling sessions and the actual abortion, which can indirectly drive up the procedure's cost) have amplified the toll the amendment exacts.
Especially given that women denied an abortion are three times as likely as other women to have dropped below the federal poverty level two years later, let's call the Hyde Amendment what it is: structural violence against the most vulnerable women in America. "We must never forget that Hyde was created because low-income women were seen as easy targets, and it has persisted because of a pernicious disregard for the needs of low-income people," says Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health.
Since poverty rates among black and Hispanic women soar above the national average, the amendment is especially destructive to women in those groups. "For nearly four decades, this policy has wrought its damage on the lives of Latinas," González-Rojas continues, "going back to Rosie Jimenez, a Latina mom and teaching student who died because the Hyde Amendment denied her a safe and legal abortion."
Financial consequences aren't the only burden on women who have no way out of unplanned, unwanted pregnancies. "We know that, prognostically, unplanned pregnancies correlate with lack of access to healthcare [and] prenatal care," Dr. Parker states. "You take people [who] already have multiple issues that compromise their health and well-being, and then you force them to continue pregnancy: In that context, it stands to reason that we’re not assuring that every child gets a start in the healthiest way." More than half of women who have an abortion are mothers, he adds: "They know what goes into having a child and having the resources to raise that child. When a woman decides to have an abortion, she’s understanding that she needs to have all of the resources necessary to do the parenting job that she is obligated to do."
In Congress this past July, Representatives Barbara Lee (D-Calif.), Jan Schakowsky (D-Ill.), and Diana DeGette (D-Colo.) introduced the EACH Woman Act to require public health insurance programs to cover abortion services. According to Dawn Laguens, executive vice president of Planned Parenthood Action Fund, "The EACH Woman Act is our chance to right that wrong and allow every woman — no matter where she lives or how much money she makes or who provides her health insurance — to access the health care she needs."
At a time when many in Congress would rather shut down the government than continue to fund Planned Parenthood, it's hard to feel optimistic about the act's chances — especially when so many, including people who are pro-choice, cite the lack of federal funding for abortion as a defense of Planned Parenthood. Abortion is one of the most crucial health services the organization provides. The fact that Planned Parenthood has no government support in providing that service isn't a "pro" — it's proof that publicly insured women are the lowest priority on Congress' list.