On Roe anniversary, let’s remember the US women for whom abortion is a right on paper only

This March, the Supreme Court will hear a case that presents the most serious threat to abortion rights in decades. At issue in this case, Whole Woman’s Health v. Cole, is whether Texas politicians can enact sham health regulations that are a thinly veiled attempt to force most or all abortion providers in the state to close down.  

If the court upholds the Texas law, it will make legal abortion harder or impossible to obtain for many women. Some other states have already enacted similar laws or would rush to do so. And, unquestionably, the effect will fall hardest on the most vulnerable women. 

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But forgotten in this debate is that, for many women in the United States, safe and legal abortion has long been out of reach. Since 1976, the Hyde Amendment has severely restricted abortion coverage for low-income women enrolled in Medicaid, making real reproductive choice a privilege of those who can afford it—rather than a fundamental right.  

To counter the harmful impact of this long-standing policy, supporters of abortion rights in Congress have coalesced behind a bill that would lift the Hyde Amendment. The Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act would restore Medicaid abortion coverage so that our country’s poorest women no longer face a financial barrier to safe and legal abortion care.  

The Hyde Amendment and Its Progeny 

Bearing the name of its author and chief promoter, the late Rep. Henry Hyde (R-Ill.), the Hyde Amendment bans abortion coverage for women insured by the Medicaid program, except in cases of rape, incest or where a woman’s life is threatened. The harmful impact of the Hyde Amendment is only mitigated for women who happen to live in the 17 states that use their own funds to provide abortion coverage for Medicaid recipients. 

In addition to the Hyde Amendment itself, Congress has enacted a series of policies that similarly restrict abortion coverage or services for other groups of women who obtain their health insurance or health care from the federal government, including federal employees, military personnel, federal prison inmates, poor residents of the District of Columbia (since Congress can dictate policy to DC) and Native American women.  

The Affordable Care Act (ACA), enacted in 2010, also incorporates the Hyde Amendment. Given the ACA’s significant Medicaid expansion, the law represents the largest expansion of abortion funding restrictions since the Hyde Amendment was first implemented. The ACA also invites states to prohibit abortion coverage in private plans—and many have done so: Twenty-five states have laws essentially banning abortion coverage in plans that will be offered through the health insurance exchanges, including 10 states that ban insurance coverage of abortion more broadly in all private insurance plans regulated by the state. And, just like the federal government, 21 states have banned abortion coverage in insurance plans for public employees. 

Insurance Coverage Matters 

Women who lack insurance coverage for abortion often struggle to pay for the procedure. Many women are forced to divert money meant for living expenses—such as rent, food or utilities and other bills—to pay for their procedure. 

Because of the time and effort needed to scrape together the funds, many low-income women have to postpone their abortion—increasing both the cost and risk of the procedure. In 2010–2011, the median charge for an abortion was $495 at 10 weeks’ gestation, but jumped to $1,350 at 20 weeks. And the risk of complications from abortion—although exceedingly small at any point—increases exponentially with gestational age. 

Thus, a low-income woman seeking an abortion is often caught in a vicious cycle: The longer it takes for her to obtain the procedure, the harder it is for her to afford it—even as the risk to her health increases. 

It is especially perverse that many of the same lawmakers who most vigorously oppose the availability of later abortion also insist on policies like the Hyde Amendment that push women’s abortions later into pregnancy. 

Although most low-income women who want an abortion manage to obtain one, many do not, and the result is an unplanned and often unwanted birth. One in four women with Medicaid coverage subject to the Hyde Amendment who seek an abortion are unable to obtain one due to the lack of coverage. And women who are denied abortion care and subsequently have a child (or another child) are statistically more likely than women who obtained an abortion to be unemployed, living below the poverty line and on public assistance. 

EACH Woman Act

The issue of Medicaid funding for poor women goes to the heart of who has access to abortion in this country and under what circumstances. Restrictions on public and private insurance coverage of abortion fall hardest on poor women, who are already disadvantaged in a host of other ways, including in their access to the information and services necessary to prevent unplanned pregnancy in the first place.  

As a first step in an accelerating, albeit undeniably uphill, campaign to repeal the Hyde Amendment, abortion rights lawmakers and advocates have united behind the EACH Woman Act. The bill offers a model for restoring abortion coverage for women enrolled in Medicaid, and serves to inform and activate grassroots activists, the public and legislators around the basic principle that poor women deserve the same reproductive rights as those who are more fortunate.  

For too long, antiabortion politicians have been allowed to get away with denying a woman abortion coverage just because she is poor. It was wrong and unjust 40 years ago. It still is.  And that is why reproductive rights supporters are now saying “Enough.”

Boonstra is the Guttmacher Institute’s director of Public Policy. She is responsible for promoting the institute’s sexual and reproductive health agenda in federal law and policy.