Public Funding for Abortion
What is the Hyde Amendment?
Passed by Congress in 1976, the Hyde Amendment excludes abortion from the comprehensive health care services provided to low-income people by the federal government through Medicaid. Congress has made some exceptions to the funding ban, which have varied over the years. At present, the federal Medicaid program mandates abortion funding in cases of rape or incest, as well as when a pregnant woman's life is endangered by a physical disorder, illness, or injury.
Most states have followed the federal government's lead in restricting public funding for abortion. Currently only seventeen states fund abortions for low-income women on the same or similar terms as other pregnancy-related and general health services. (See map.) Four of these states provide funding voluntarily (HI, MD, NY,1 and WA); in thirteen, courts interpreting their state constitutions have declared broad and independent protection for reproductive choice and have ordered nondiscriminatory public funding of abortion (AK, AZ, CA, CT, IL, MA, MN, MT, NJ, NM, OR, VT, and WV).2 Thirty-two of the remaining states pay for abortions for low-income women in cases of life-endangering circumstances, rape, or incest, as mandated by federal Medicaid law.3 (A handful of these states pay as well in cases of fetal impairment or when the pregnancy threatens "severe" health problems, but none provides reimbursement for all medically necessary abortions for low-income women.) Finally, one state (SD) fails even to comply with the Hyde Amendment, instead providing coverage only for lifesaving abortions.
Additional provisions adopted by Congress may further burden access to abortion services for Medicaid recipients, even those in states with nondiscriminatory funding. The Balanced Budget Act of 1997, for example, permits health maintenance organizations (HMOs) serving Medicaid recipients to refuse to cover counseling or referral for services, such as abortion, to which the HMO objects on moral or religious grounds. As a result, even in states with nondiscriminatory funding, women seeking abortions may face obstacles in even finding a provider.
Who else is affected by the funding bans?
By the early 1980s, Congress had passed restrictions similar to the Hyde Amendment affecting programs on which an estimated twenty million women rely for their health care or insurance. In addition to poor women on Medicaid, those denied access to federally funded abortion include Native Americans, federal employees and their dependents, Peace Corps volunteers, low-income residents of Washington, DC, federal prisoners, military personnel and their dependents, and disabled women who rely on Medicare.
New health initiatives are likewise being burdened by the legacy of the Hyde Amendment. The Children's Health Insurance Program (CHIP), a program providing expanded health insurance for children aged 19 or younger, includes a ban on the use of federal funds for abortions unless the pregnancy endangers the teenager's life or results from rape or incest.
Why is it important that Congress repeal the Hyde Amendment and other bans on abortion funding?
The Hyde Amendment and other bans should be repealed because they are discriminatory and harm women's health. If a woman chooses to carry to term, Medicaid (and other federal insurance programs) offer her assistance for the necessary medical care. But if the same woman needs to end her pregnancy, Medicaid (and other federal insurance programs) will not provide coverage for her abortion, even if continuing the pregnancy will harm her health. The government should not discriminate in this way. It should not use its dollars to intrude on a poor woman's decision whether to carry to term or to terminate her pregnancy and selectively withhold benefits because she seeks to exercise her right of reproductive choice in a manner the government disfavors.
With these bans, the federal government turns its back on women who need abortions for their health. Women with cancer, diabetes, or heart conditions, or whose pregnancies otherwise threaten their health, are denied coverage for abortions. Only if a woman would otherwise die, or if her pregnancy results from rape or incest, is an abortion covered. The bans thus put many women's health in jeopardy.
Does Medicaid pay for other reproductive health care?
Yes. Medicaid offers comprehensive reproductive health care, including family planning, prenatal care, and services related to childbirth. By singling out abortion for exclusion, politicians have attempted to impose their own choices on poor women.
How have women on Medicaid paid for abortions since the
Federal funding restrictions have left some women on Medicaid little choice but to use money they need for food, rent, clothing, or other necessities to pay for an abortion. One study showed that nearly 60% of women on Medicaid were often forced to divert money that would otherwise be used to pay their daily and monthly expenses, such as rent, utility bills, food and clothing for themselves and their children. Some even resorted to pawning household goods to come up with the necessary cash.4 Many Medicaid-eligible women delay their abortions, increasing their medical risks, while they scrape funds together. Other women have been forced to carry their pregnancies to term or to seek illegal abortions. Studies have shown that from 18 to 35 percent of Medicaid-eligible women who want abortions, but who live in states that do not provide funding for abortion, have been forced to carry their pregnancies to term.5
Will it cost taxpayers money to fund abortions?
No. Because the costs associated with childbirth, neonatal and pediatric care greatly exceed the costs of abortion, public funding for abortion neither costs the taxpayer money nor drains resources from other services.6
What about those who are morally or religiously opposed to abortion?
Our tax dollars fund many programs that individual people oppose. For example, those who oppose war on moral or religious grounds pay taxes that are applied to military programs. The congressional bans on abortion funding impose a particular religious or moral viewpoint on those women who rely on government-funded health care. Providing funding for abortion does not encourage or compel women to have abortions, but denying funding compels many women to carry their pregnancies to term. Nondiscriminatory funding would simply place the profoundly personal decision about how to treat a pregnancy back where it belongs -- in the hands of the woman who must live with the consequences of that decision.
1. Through its Medicaid program, New York funds medically necessary abortions for women whose family incomes are below 100% of the federal poverty level but denies abortion funding to women with family incomes between 100 and 185% of the poverty level. These women are eligible, however, to receive all other pregnancy-related services. See Hope v. Perales, 634 N.E.2d 183 (N.Y. 1994).
2. See Alaska v. Planned Parenthood, 28 P.3d 904 (Alaska 2001); Simat Corp. v. Ariz. Health Care Cost Containment Sys., 203 Ariz. 454 (2002); Committee to Defend Reprod. Rights v. Myers, 625 P.2d 779 (Cal. 1981); Doe v. Maher, 515 A.2d 134 (Conn. Super. Ct. 1986); Doe v. Wright, No. 91 CH 1958 (Ill. Cir. Ct. Dec. 2, 1994); Humphreys v. Clinic for Women, Inc., 796 N.E.2d 247, 260 (Ind. 2003); Moe v. Sec'y of Admin. & Fin., 417 N.E.2d 387 (Mass. 1981); Women of Minn. v. Gomez, 542 N.W.2d 17 (Minn. 1995); Jeannette R. v. Ellery, No. BDV-94-811 (Mont. Dist. Ct. May 22, 1995); Right to Choose v. Byrne, 450 A.2d 925 (N.J. 1982); New Mexico Right to Choose/NARAL v. Johnson, 975 P.2d 841 (N.M. 1998); Planned Parenthood Ass'n v. Dep't of Human Resources, 663 P.2d 1247 (Or. Ct. App. 1983), aff'd on statutory grounds, 687 P.2d 785 (Or. 1984); Doe v. Celani, No. S81-84CnC (Vt. Super. Ct. May 26, 1986); Women's Health Ctr. v. Panepinto, 446 S.E.2d 658 (W. Va. 1993).
3. In seven of these states, the bans have been challenged, but the courts have refused to order nondiscriminatory funding for abortions. See Renee B. v. Florida Agency for Health Care Admin., 790 So. 2d 1036 (Fla. 2001); Planned Parenthood v. Kurtz, No. CVOC0103909D (Idaho Dist. Ct. June 12, 2002); Doe v. Childers, No. 94CI02183 (Ky. Cir. Ct. Aug. 3, 1995), appeal dismissed, No. 95-SC-783-TG (Ky. Aug. 21, 1996); Doe v. Dep't of Soc. Servs., 487 N.W.2d 166 (Mich. 1992); Rosie J. v. North Carolina Dep't of Human Resources, 491 S.E.2d 535 (N.C. 1997); Fischer v. Dep't of Pub. Welfare, 502 A.2d 114 (Pa. 1985); Bell v. Low-Income Women of Texas, Inc., 95 S.W.3d 253, (Tex. 2002). In Indiana, a court rejected the claim that the state was required to cover abortions on the same terms as other pregnancy-related care, but did require that the state cover abortions for Medicaid-eligible women "whose pregnancies create serious risk of substantial and irreversible impairment of a major bodily function." Humphreys v. Clinic for Women, Inc., 796 N.E.2d 247, 260 (Ind. 2003). See A Choice for Women, Inc. v. Florida Agency for Health Care Admin., No. 02-3079 (Fl. Cir. Ct. Apr. 4, 2002), appeal denied, No.3D0-3039, 2004 Fla. App. LEXIS 5493 (Apr. 21, 2004).
4. Heather Boonstra & Adam Sonfield, Rights Without Access: Revisiting Public Funding of Abortion for Poor Women, THE GUTTMACHER REPORT ON PUBLIC POLICY 3D No.2 (April 2000).
5. Stanley K. Henshaw, Factors Hindering Access to Abortion Services, FAMILY PLANNING PERSPECTIVES, 27TH.No. 2 (March/April 1995).
6. See, e.g., Committee to Defend Reprod. Rights v. Myers, 625 P.2d 779, 794 (Cal. 1981) (finding that ""whatever money is saved by refusing to fund abortions will be spent many times over in paying maternity care and childbirth expenses and supporting the children of indigent mothers"").