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Poor Women in the United States Don’t Have Abortion Rights

For decades, the ban on using Medicaid dollars to pay for abortions has kept many poor women from being able to end their pregnancies. Finally, some pro-choice lawmakers are trying to change that—or at least show how unjust the status quo is.
(Photo: citizenbobnyc/Flickr)

(Photo: citizenbobnyc/Flickr)

Earlier this month, a group of Democratic Representatives, led by Barbara Lee of California, Jan Schakowsky of Illinois, and Diana DeGette of Colorado, introduced legislation that would end restrictions on using federal funding to pay for abortions. It’s the first attempt in two decades to overturn the Hyde Amendment, which for nearly 40 years has prevented Medicaid from covering the cost of abortion with few exceptions.

Similar bans affect millions of Americans who rely on other federal programs for their health insurance, including federal employees, military personnel and their families, Peace Corp volunteers, Native Americans who use Indian Health Services, federal prisoners, and youth enrolled in the Children's Health Insurance Program. The Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act would restore abortion coverage to all of them, as well as invalidate state laws restricting coverage of the procedure in private insurance plans.

The best estimate, according to a 2009 review of the research by the Guttmacher Institute, is that 18 to 37 percent of women on Medicaid who would otherwise get an abortion instead give birth due to the lack of funding.

Though there’s pretty much zero chance of the bill clearing the Republican-controlled Congress, the fact that it was introduced at all represents progress. While the Hyde Amendment was fiercely debated when it was first passed, eventually it came to be framed in Congress as a reasonable compromise—one that, to the ire of many pro-choice advocates, was re-affirmed by President Obama during passage of the Affordable Care Act. As Irin Carmon notes, “To opponents of abortion, the phrase ‘taxpayer funding for abortion’ is practically magic, conjuring both fears about the use of other people’s money and discomfort with abortion.” Meanwhile, most reproductive rights groups, focused on trying to stanch the tidal wave of new anti-choice laws, didn’t think it was worth going on the offensive about Hyde until recently.

Now, though, they see introducing a doomed bill as a way of helping expose how unjust the status quo is. Most people simply aren’t aware of the Hyde Amendment, let alone what a huge hardship it poses to some of the most disadvantaged Americans. Let’s do the math: On average, a first-trimester abortion costs nearly $500 out-of-pocket. Even after the expansion of Medicaid under Obama, it is a program for the extremely poor. In the 29 states that have accepted the expansion, a family of three must make below about $27,700 a year to qualify. In the states that have refused the expansion, the average eligibility limit is less than $9,200 for a family of three, and childless adults don’t qualify at all. In other words, the Hyde Amendment ensures that, in many states, mothers who are getting by on less than $800 a month are one broken condom away from being forced to pay, at minimum, more than half that in order to avoid having another child.

If that seems like a nearly impossible calculus, that’s because it’s supposed to be. It’s no secret that the intention of the Hyde Amendment was to keep women from getting abortions. Just take it from then-Congressman Henry Hyde when he made his case for the policy on the House floor back in 1977: “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. Unfortunately, the only vehicle available is the ... Medicaid bill.” The Supreme Court put it slightly more delicately when it declared the policy constitutional in 1980, deciding that the government could choose to “encourage” childbirth over abortion by paying for the former but not the latter.

So how many women have been “encouraged” to carry an unwanted pregnancy to term thanks to the policy? The best estimate, according to a 2009 review of the research by the Guttmacher Institute, is that 18 to 37 percent of women on Medicaid who would otherwise get an abortion instead give birth due to the lack of funding. Over the past 39 years, that has amounted to more than one million people who have been unable to exercise a constitutionally protected right solely because of their economic status. (Or, in the gleeful language of the anti-choice side, 1.1 million Americans are alive today because of the Hyde Amendment.)

In truth, it’s somewhat surprising that it’s not more. In part, that’s because 17 states use their own funds to provide the coverage for their Medicaid enrollees. It’s also thanks to local abortion funds that have sprung up across the country to fill the gap. In recent years, the National Network of Abortion Funds has distributed about $3 million annually to nearly 30,000 women seeking abortions who otherwise couldn’t afford one.

Mostly, though, it speaks to the great lengths people are willing to go to in order to get an abortion when they need one. Abortion funds typically don’t pay the full amount of the procedure; they make up the difference after a woman has cobbled together as much money as she can. Interviews with the patients show the sacrifices it takes to raise a few hundred dollars in just weeks when you’re living paycheck to paycheck. They report borrowing money from multiple relatives, working extra hours, delaying paying other bills, pawning possessions, and cutting back on food and other necessities.

As a study by researchers from the Guttmacher Institute and Advancing New Standards in Reproductive Health concludes, “[R]ather than assuming responsibility for the public’s health, governments—both state and federal—have privatized the costs of exercising the constitutional right to abortion to women, their communities, and the private donors who support abortion funds.” In this regard, abortion is similar to other necessary social goods—like, for instance, food—that are increasingly provided by networks of overburdened charities doing their best to fill the holes in our tattered safety net.

But the stakes are especially high when it comes to abortion. Given how challenging it is to raise the funds, it’s no surprise that poor women tend to get their abortions two to three weeks later than average. Two-thirds of them say they wanted to get the procedure earlier—and that’s not just because of the usual psychological stress of being pregnant when you don’t want to be. The cost of an abortion—in addition to the risks—increases substantially the later into pregnancy you get. After you cross into the second trimester, what was once a $500 procedure steadily climbs to two to three times as much. In other words, the longer it takes to gather the money for an abortion you can’t afford, the more unaffordable it becomes.

Of course, even a $1,500 procedure at 20 weeks is less expensive than raising a kid, which is probably why most women do whatever it takes to win this desperate race against the clock. After all, that’s typically the reason they’re choosing to end their pregnancy to begin with: Three-fourths of all the women who have abortions in the United States—40 percent of whom are living below the federal poverty level—say they got one because they could not afford a child. A research project out of the University of California–San Francisco shows the devastating economic consequences for those who lose the race. The ongoing study, following more than 1,000 women, is comparing those who had passed the gestational cut-off—and, thus, were turned away from clinics—to a similar group who just made the deadline. Those who were denied abortions were three times more likely to end up below the federal poverty level two years later.

"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. Unfortunately, the only vehicle available is the ... Medicaid bill."

By drawing attention to harsh consequences like that, the pro-choice movement is hoping that it can put supporters of the Hyde Amendment on the defensive. While abortion funding has been seen as something of a third rail, the public doesn’t seem to be as convinced that poor women should be forced into childbirth as the conservative rhetoric around “taxpayer-funded abortions” would suggest. A new poll of voters, which oversampled young people, commissioned by All* Above All (a coalition of pro-choice organizations pushing to end Hyde) found that nearly 60 percent agreed with the statement: "However we feel about abortion, politicians should not be allowed to deny a woman insurance coverage for it just because she is poor." A majority of voters—including Republicans—agreed that "as long as abortion is legal, the amount of money a woman has or does not have should not prevent her from being able to have an abortion."

More generally, directly making the case for public funding of abortion is an opportunity to highlight the reality that "a right without access is no right at all," as then-Senator Edward Brooke concisely put it during early debates on the Hyde Amendment. While there are some rights—like freedom of speech or worship—that don’t cost anything to access, the right to abortion is not one of them. Yet, in the U.S., it has been treated, legally and legislatively, as if it is—as if the government can protect it simply by refraining from outright banning the procedure.

Four decades after Hyde was first passed, the result is a lattice of abortion restrictions that, individually, aren’t severe enough, according to the Supreme Court, to pose an unconstitutional “undue burden” on the right to choose, but, collectively, they conspire to ensure that Americans have wildly divergent abilities to exercise that right in practice. And in a cruel catch-22, it’s those women who can least afford an abortion—and, worse, can least afford not to get an abortion—who inevitably have the hardest time accessing one.

The Gender Gap explores the persisting gender inequalities of the modern age and society's unwillingness to grapple with them.