Over the course of more than four decades, Congress has annually renewed the Hyde Amendment, a highly controversial measure that reproductive rights activists say keeps abortion inaccessible to marginalized communities. That could all change, however, as the House Appropriations Committee held a historic, virtual hearing yesterday on the disproportionately negative impacts of the amendment.
Simply put, the Hyde Amendment broadly bars federal funding for abortion costs, meaning Medicaid recipients—who overwhelmingly come from communities of color or low-income communities—lack abortion coverage. Since the measure’s 1976 passing, Congress has extended the amendment to also apply to federal employees and their dependents, Native Americans, immigrants, Washington, D.C., residents, Peace Corps volunteers, and military personnel, according to Planned Parenthood. A 2009 report from the Guttmacher Institute found that 25 percent of women who “who would have Medicaid-funded abortions instead give birth when this funding is unavailable.”
After the election of Joe Biden and Kamala Harris—both of whom have publicly rejected the provision, though Biden only recently rescinded his support of the amendment during the 2019 Democratic primary presidential race—some activists are hopeful for the measure’s repeal.
To fully grasp the destructive reach of the Hyde Amendment and the building momentum to finally eliminate it, BAZAAR.com reached out to NARAL Pro-Choice America, a leading reproductive rights organization, and some of the testifiers at yesterday’s hearing: Dr. Herminia Palacio, the president and CEO of Guttmacher Institute; and Dr. Jamila Perritt, the president and CEO of Physicians for Reproductive Health. Read on to learn more about what they had to say about the next frontier in the battle for reproductive freedom.
What is the Hyde Amendment?
NARAL: The Hyde Amendment was introduced by Henry Hyde in 1976, three years after Roe, and as a way to block access to abortion care for low-income women. The Hyde Amendment primarily withheld abortion coverage from Medicaid enrollees; however, the phrase is now used to describe a series of bans on coverage of abortion care for those who receive their health insurance through the federal government, including those who are insured through Medicaid, Medicare and CHIP, federal employees and their dependents, military service members, veterans and their dependents, Peace Corps volunteers, Indigenous communities, women who are incarcerated or held in immigration detention facilities, and people with low incomes in Washington, D.C.
Jamila Perritt: The Hyde Amendment is a discriminatory policy that blocks those relying on federally funded health programs from getting coverage for abortion care. This includes people receiving their insurance coverage via Medicaid, the military, the Indian Health Service, people receiving care in federal prisons and detention centers, D.C. residents, federal employees, and Peace Corps volunteers. It is a rider to the annual appropriations bill for the Department of Health and Human Services, and Congress has voted to pass the annual spending bill with this rider attached almost every year since its passage in 1976.
For 44 years, the Hyde Amendment has denied abortion coverage to people enrolled in Medicaid. Removing such blatantly coercive, racist, and demeaning language is a critical step toward ensuring people can get the abortion care they need.
How does it disproportionately affect Black and Latinx communities, and other marginalized communities?
JP: Barriers to abortion care like the Hyde Amendment disproportionately impact those who already face the most barriers in our health system, including Black women, Indigenous women, other people of color, young people, transgender and nonbinary people, LGBTQIA people, and those living in rural communities. Especially in the midst of a pandemic that is inequitably impacting communities of color, it is more important than ever that we address the historically racist policies denying people access to basic, essential health care.
HP: The harmful burdens of the Hyde Amendment are intentionally and unjustly imposed on Black and Brown people, and on people with low incomes. In other words: people who have been historically marginalized.
Because of the legacy of systemic racism in this country, Black and Brown women are disproportionately likely to be insured through Medicaid: 31 percent of Black women and 27 percent of Hispanic women aged 15 to 44 are enrolled in Medicaid, compared with 16 percent of white women. As our country undergoes a racial reckoning, I want to be clear: The Hyde Amendment is a racist policy.
As our country undergoes a racial reckoning, I want to be clear: The Hyde Amendment is a racist policy.
The United States has the highest maternal mortality rate among developed countries, with dramatic but preventable racial inequities. Black and Indigenous women’s maternal mortality rates are two to three times the rate of white women.
Reflect on these overlapping and perverse indignities: The Hyde Amendment disproportionately withholds abortion coverage from Black and Brown communities—a potential consequence of which is being forced to continue a pregnancy in a system in which Black and Indigenous people are astonishingly more likely to die.
NARAL: The importance of ending inequitable and discriminatory abortion bans like the Hyde Amendment and ensuring that Americans have access to health care, including abortion care, is highlighted by the COVID-19 pandemic and national protests against a system that upholds white supremacy and perpetuates life-threatening disparities in health care, criminal justice, and more. Over 270,000 people have died this year in the United States from COVID-19; millions are struggling with hunger, housing, and joblessness; and communities of color have been disproportionately affected.
What is the status of Hyde right now?
NARAL: The Hyde Amendment remains in place, but there is more support than ever to repeal it. President-elect Joe Biden and Vice President-elect Kamala Harris have joined a growing number of elected leaders, including Speaker of the U.S. House of Representatives Nancy Pelosi and incoming Appropriations chair Rosa DeLauro, in supporting the repeal of the racist and discriminatory Hyde Amendment. The Democratic Party included repealing the Hyde Amendment in its platform for the first time in 2016 and reiterated that commitment in the 2020 Democratic platform.
HP: Across 34 states and the District of Columbia, the Hyde Amendment leaves seven million women who are already struggling financially without abortion coverage. On average, an abortion at 10 weeks costs around $550, which could be someone’s entire rent payment. And the cost increases over time. Contrast that with the fact that—even before the current recession—37 percent of Americans said they would struggle to cover an emergency expense of $400, for any purpose.
JP: While the Hyde Amendment is currently in place, Congress and the Biden–Harris administration have an opportunity to end the Hyde Amendment by ensuring a clean budget, passing clean appropriations bills, and moving forward with legislation like the EACH Woman Act. The EACH Woman Act would prohibit politicians from interfering with personal health care decisions through sneaky coverage restrictions that deny people struggling financially the ability to get the affordable abortion care they need. Abortion care should be made accessible to all people regardless of where they live or how much they make. Pregnant people and their families should have full access to the care they need as decided only by themselves with support from medical providers, not politicians.
On average, an abortion at 10 weeks costs around $550, which could be someone’s entire rent payment. And the cost increases over time.
Why is the House’s December 8 hearing on the amendment so important?
NARAL: This hearing comes at a moment when there is unprecedented support for ending the Hyde Amendment. This hearing would not have been possible without the trailblazing work of women of color in the reproductive justice movement. Their efforts have shed light on the negative impact of these harmful policies and their disproportionate effects on people of color, resulting in politicians finally recognizing the importance of removing harmful limitations on insurance coverage of abortion.
The hearing also demonstrates that pro-choice members of Congress are committed to introducing and passing clean Appropriations bills that do not include the Hyde Amendment and related abortion coverage restrictions.
HP: Looking ahead to the 117th Congress and the Biden administration, the historic significance of this hearing on the Hyde Amendment cannot be overstated. Congresswoman DeLauro was selected by her colleagues to chair the full Appropriations Committee starting next year, and we are especially encouraged by the clear commitments she and her subcommittee colleagues have made to lift the harmful and discriminatory Hyde Amendment and support abortion coverage for all.
JP: We have ignored the real, devastating harms of the Hyde Amendment for decades. When people don’t have access to the abortion care they need, their well-being and the well-being of their families and communities are negatively impacted. It was an honor to testify alongside my colleagues Dr. Herminia Palacio and Amanda Beatriz Williams as we collectively shared the harms of the Hyde Amendment and our vision for a future where all people can access the health care they need, no matter the source of their insurance.
What happens if Congress decides to lift the Hyde amendment?
NARAL: Those who receive their health insurance through the federal government, including the numerous groups listed above, would no longer be blocked from accessing abortion care because of the amount of money in their wallet. Ending the Hyde Amendment would undoubtedly improve abortion access, and consequently, overall women’s health. It would mean that women and families who receive their health insurance through the federal government would be able to make their own decisions about their bodies, their lives, and their futures without political interference.
When we end the Hyde Amendment, abortion care will be treated like the basic, essential health care it is.
JP: When we end the Hyde Amendment, abortion care will be treated like the basic, essential health care it is. Insurance coverage of abortion should be comparable to other essential health care services. Abortion should not be singled out for exclusion or have additional burdens placed upon it.
HP: Repealing Hyde is a necessary step to dismantle systemic racism and ensure that our public policies support bodily autonomy and safe, healthy communities. Repealing the Hyde Amendment would mean greater equity in insurance coverage for abortion, and it would be an important step in making abortion care more available for those who want and need it. But the fight to protect and expand abortion rights and access does not stop there. Both federal and state policymakers must do much more to roll back harmful restrictions and short up and expand abortion rights.
What happens if it doesn’t?
NARAL: If this harmful, racist ban on abortion coverage persists, abortion care will continue to be pushed out of reach for communities already facing the greatest obstacles to accessing health care. Pregnant people will continue to struggle to afford abortion care or be forced to delay care because of their income, zip code, or source of insurance. Studies show that when policymakers place restrictions on Medicaid coverage of abortion, it forces one in four Medicaid-eligible women to carry an unplanned pregnancy to term. Pregnant people whose insurance does not cover abortion care are forced to choose between receiving critical care and paying rent, food, or other necessary expenses. When a woman wants to get an abortion but is denied, she is more likely to fall into poverty, less likely to have a full-time job, and more likely to experience intimate partner violence.
HP: Hyde would continue to pose a major barrier to accessing care for people with low incomes—and an insurmountable one for many of them.
Abortion patients include people of every race, religion, political affiliation, and socioeconomic group, and the majority are already parents. One in four cisgender women in the United States will have an abortion in their lifetime. Likewise, trans men and gender-nonconforming individuals require access to the full range of pregnancy-related care. Overall, 75 percent of abortion patients in the United States are low-income, and the majority are people of color.
Many people with low incomes experience delays accessing abortion care because of the time and effort needed to pull together funds. People get caught in a cruel cycle, in which delays associated with raising the money leads to additional costs and subsequent delays.
A literature review conducted by Guttmacher concluded that among women with Medicaid coverage subject to the Hyde Amendment, one in four who seek an abortion are forced to continue the pregnancy.
Forcing someone who wants an abortion to continue a pregnancy is not only a violation of their reproductive autonomy; it is tantamount to requiring them, against their wishes, to accept the risks of pregnancy- and labor-related complications, including preeclampsia, infections, and death.
JP: We will continue to operate under a two-tiered system of health care where some people get the health care they need and others don’t. This is absolutely egregious, and we cannot accept health care access being dictated by one’s income, socioeconomic status, and zip code.
When a woman wants to get an abortion but is denied, she is more likely to fall into poverty, less likely to have a full-time job, and more likely to experience intimate partner violence.
This interview has been edited and condensed for clarity.
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