In 1976, House Republicans proposed the Hyde Amendment, which bans the use of federal funds from covering the cost of abortion care for poor and low-income people. At the time, Representative Henry Hyde (R-IL), the namesake of the amendment, did what Republicans have become infamous for: saying the quiet part out loud. During a House debate on the amendment, the lawmaker said, “I would certainly like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle class woman, a poor woman. Unfortunately, the only vehicle available is the [Medicaid] bill.”
In other words: “I can’t harm everyone, so I’m going to harm Black, brown, young, and poor people.”
And it worked. Since the passing of Hyde, millions of women, trans men, and nonbinary people have been denied abortion coverage and, as a result, abortion care. Nearly seven million Medicaid-enrolled women of reproductive age live in 34 states and Washington, D.C., according to the Guttmacher Institute, where state or federal healthcare funding services are banned from covering abortion care. Thirty-one percent of Black women and 27% of Latina women ages 15 through 44 were enrolled in Medicaid in 2018, compared to just 16% of white women, and the unintended pregnancy rate among women who live below the poverty line is five times higher than among those who do not.
Studies have shown the long-term ramifications of being denied abortion care, from the financial harm to the mental health effects to the harm it causes the children those seeking abortion services may already have. Harm that, since 1976, has disproportionately impacted Black and brown people.
But that can change. In late March, women of color in congress — led by Sen. Tammy Duckworth (D-IL) and Rep. Barbara Lee (D-CA) — introduced the EACH Act in both the Senate and the House. The legislation would reverse the Hyde Amendment and guarantee insurance coverage for abortion. The bill is endorsed by more than 130 national and state organizations united under the Coalition All* Above All, a women of color-led coalition dedicated to restoring and maintaining public insurance coverage of abortion care.
This marks the first realistic push to reverse a dangerous, racist policy, and abortion providers and those who help patients pay for abortion services say a world without Hyde isn’t just possible: It’s vital.
“I remember once sitting and counting change with a uniformed person in the armed forces, trying to figure out if she could afford her abortion,” Ghazaleh Moayedi, DO, MPH, a board-certified OB-GYN providing abortion care to communities across Texas, tells Refinery29. “It was such an insult: that this woman was in her uniform, in service to her country, and counting quarters to pay for an abortion. Bans on federal funding for abortion care not only impact Medicaid recipients, but also anyone employed by the federal government.”
Dr. Moayedi works in a state that has the most people without health insurance and, as a direct result of Hyde, the least access to affordable abortion care. “Very few people in our state quality fo rMedicaid generally, and pregnancy is often one of the only times people in our communities have health insurance,” she explains. “Hyde therefore disproportionately impacts the communities I serve in in Texas by preventing them from financially accessing abortion care. For a minimum wage worker in Texas, it takes almost three to four weeks of work to pay for an abortion.”
“The people I care for are already living paycheck to paycheck or struggling with joblessness or eviction,” she continues. “The cost of an abortion is often insurmountable for folks.”
Thirty-four states and the District of Columbia follow federal Hyde standards and ban state funds from covering abortion services. But even states that are not hostile to abortion, and do allow state funds to pay for abortion care, feel the ramifications of Hyde.
“I really struggle with the narrative that California is so progressive and therefore there are no issues that arise here,” Jessica Pinckney, executive director of Access Reproductive Justice, an organization that runs an access program called Healthline for people seeking abortion care and provides practical support including funding, lodging, transportation, and childcare, tells Refinery29. “Over 40% of California counties have no abortion clinic in them, so despite the fact that California is more friendly to abortion access and reproductive healthcare than a lot of other states, we’re a massive state so folks still do have to travel significant distances, sometimes, to access their care.”
It’s not just Californians Access assists either. Those traveling from out of state, seeking refuge from states hostile to abortion and lawmakers using the ongoing COVID-19 pandemic to enact harsher abortion restrictions, also seek abortion services in California. And unlike Californians, they are not covered by the state’s health insurance.
“The out-of-state component, that’s really huge to Access’ story,” Pinckney explains. “Just last week, I was talking to our Healthline coordinator about a caller who was coming to California from out of state, had no income so would have qualified for Medi-Cal if they had been a California resident but didn’t because they weren’t, and we were having trouble getting them funding for their procedure from some of the sources we would commonly go to. It’s something we see and experience every day.”
Pinckney says she tries to “stay positive” because California is one of the few states that has Medicaid coverage for abortion — “and yet, it’s not enough,” she says. “And so it’s always really hard to find that balance between having the happiness and the joy that we don’t have those restrictions placed on our Medicaid program here on the state, but also recognizing that appealing Hyde is one of many steps that need to occur to truly improve abortion access across the country.”
Katie Brown, MD, an OB-GYN and abortion provider at San Francisco General Hospital, which provides abortion care for people using Medi-Cal, sees day in and day out the ways in which Hyde compounds the pre-existing barriers to care for her patients, even in a place as seemingly progressive as California. Dr. Brown says that at San Francisco General, around 90% of her patients rely on Medi-Cal to pay for their abortion services, and the other 10% are either uninsured or privately insured, but their insurance does not cover abortion services.
“Everything costs a lot of money, so even for patients who have coverage for their abortion there’s so much [to consider] that it’s still hard to get an abortion,” Dr. Brown tells Refinery29. “Finances, one way or another, are so frequently part of abortion care.” Dr. Brown says that for many patients who are traveling for abortion care, whether from out of state or in-state, the added cost of travel, lodging, childcare, and missed wages add to abortion-related finances in a way that often makes it much more difficult to access care. And when you factor in the cost of the actual procedure — which can be in the thousands of dollars — that care is simply unattainable for many.
“Hyde makes it impossible because there are already so many barriers in the system that have been put up,” Dr. Brown explains. “And these are challenges patients face in a state like California. I cannot imagine what it’s like in the South and Midwest, where only a handful of clinics serve patients and patients have to pay for their own abortions as well.”
Dr. Moayedi in Texas does not have to imagine, though — upwards of 40% of her patients rely on abortion fund organizations to cover the costs of their abortions. And while abolishing Hyde would certainly benefit the predominantly Black, brown, and low-income pregnant people she services, Dr. Moayedi says it’s only one of many steps those in power must take to create more just and equitable access to abortion.
“Even if Hyde was abolished tomorrow, I don't think Medicaid in Texas would all of a sudden start funding abortion care,” she explains. “Our government in Texas has made it very clear that they are willing to forgo federal public health dollars in order to push extremist political agendas. Even if the federal government gave Texas the money to cover abortion care, I don't think they would. We need new systems that protect communities like mine from the harmful policies of extremist politicians.”