36 years ago this week the Hyde Amendment was passed, prohibiting Medicaid coverage of abortion in most cases. It is because of the Hyde Amendment that people who have health insurance coverage through the government are deliberately denied access to affordable abortion care, which result in someone putting off paying bills, selling belongings, or even putting his or her family at risk to pay for an abortion. In the reproductive justice movement we talk a lot about Hyde, which has far reaching and devastating consequences for people on Medicaid, and has also paved the way for further abortion restrictions, including barring abortion coverage for federal employees, people on Indian Health Services and Medicare, and those serving in the US military.
There is no question that Hyde was put in place by politicians who wanted to outlaw abortion completely, but could only restrict access for poor people. There is also no question that the consequences of Hyde, compounded with poverty in the US, hurts people and limits health care decision-making. 36 years ago, the mainstream pro-choice movement did not fight this, and dropped poor people from their agenda – a legacy that continues to this day. Since then, we, as reproductive justice activists and abortion fund volunteers have been struggling to pick up the shattered pieces.
Those of us fighting to repeal Hyde and to increase abortion access understand the complicated and harsh realities for people trying to obtain abortion in the US. But the abortion access landscape varies from state to state, and even from even city to city. What we do not often discuss are our success stories, where there are fewer gaps to care or hoops to jump through. We don’t discuss them because we are afraid; we know the attacks are coming fast and strong from the other side and we want to hold on, quietly, to what we have. But in not discussing the places where more people have abortion coverage, or are able to access timely and safe care, we risk letting a valuable asset slide away.
We talk about Hyde all the time, but we rarely talk about the 17 states that have extended their own funds to cover abortion in all or most cases. (However, research shows what advocates have long known—that two of these 17 states (Arizona and Illinois) do not offer that coverage to women in practice.)
Amanda Dennis, Associate at Ibis Reproductive Health, explains: “In states like Massachusetts, New York, and Oregon, Medicaid covers abortion regardless of personal circumstances in both policy and practice. Individuals seeking abortion in these states report being able to weigh their pregnancy options, easily secure accurate information about whether their insurance plan covers abortion, find a health care provider who accepts Medicaid, and make an appointment with confidence.” In these states (“Medicaid states”), a person on Medicaid is able to receive care with fewer stressful complications, compared to his or her counterpart in a non-Medicaid state, where he or she, unable to afford it, may not be able to get an abortion at all.
As people who have worked in Medicaid and non-Medicaid states will tell you, the differences are stark. For a person who has comprehensive health insurance coverage, finding out that it does not cover abortion is unexpected, jarring, and upsetting. It means that she or he can’t get care quickly, will struggle to come up with the money on top of other living expenses, and may jeopardize his or her health or safety. The landscape is vastly different in Medicaid states, where state governments have stepped up to fill the gap and to make it possible for more people to obtain coverage for abortion, trusting that each person should have the ability to make the best decisions for themselves and their families. For people accessing abortion services in these states, it is covered like other health services are covered. That is how it should be: abortion is a legal health service in our country. It is unfair for the federal government to interfere with personal decision-making, and we should applaud the states that allow individuals to think for themselves.
There is still work to be done in Medicaid states to ensure that all people can obtain abortion, particularly for immigrants and minors, We know that Medicaid states aren’t perfect, and the work that we are doing despite Medicaid-covered abortions is necessary and will not go away any time soon. We do not live in utopias, but we do acknowledge abortion is vastly more accessible and affordable. If we don’t talk about Massachusetts, New York, and Oregon, among others, as successes, we will not be able to demonstrate the importance of insurance coverage for abortion, which is desperately needed in the current climate. We, no matter the state we live in, must work together repeal Hyde and to ensure that all people are able to access abortion care regardless of their financial means or insurance status. We can also be proud of those states that have stepped up when the federal government has failed. Let’s shout our success stories loud enough until more state and local governments hear us, loud enough that they take on the responsibility of protecting the health of all of their citizens, not just the ones who can afford it.