As the abortion access crisis escalates in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, the stark truth is that for Medicaid enrollees, where you live has determined your ability to access abortion for decades. This week marks the anniversary of the Hyde Amendment, a harmful federal budget rider that prohibits the use of federal funding for abortion coverage, with narrow exceptions for cases of rape, incest, and life endangerment. While states are allowed to use their own funding to provide abortion coverage for Medicaid enrollees, for nearly fifty years the Hyde Amendment has functioned as a de facto abortion ban for people who receive health coverage through federal health care programs and live in one of the 34 states that only provide coverage for Hyde’s narrow exceptions.
When insurance doesn’t cover abortion, it forces people to pay out-of-pocket when seeking care, which can be catastrophic for people with low incomes. Research shows that the average first trimester abortion costs around $500, compounded by the fact that some are forced to travel long distances and may pay exorbitant gas prices or airfare, hotel costs, or face potential lost wages from time off work. These unexpected costs can force people to choose between affording rent, groceries, utility bills or carrying the pregnancy to term. This forced choice is a real one, as one study showed a quarter of Medicaid-eligible women are forced to continue an unintended pregnancy to term due to financial constraints.
Since the Dobbs decision, the media has been flooded with stories of people living in states with abortions bans that are forced to travel, sometimes hundreds of miles, to seek abortion care. But this has often been the lived reality for many Medicaid enrollees, and people who rely on Medicaid for coverage are often those least equipped to deal with the unexpected costs associated with seeking an abortion. Furthermore, research shows that states have regularly failed to meet even the bare minimum required by Hyde, overruling providers’ medical determinations in cases of life endangerment and imposing burdensome reporting requirements that block coverage.
The Hyde Amendment has created a patchwork of abortion access, as your ability to access affordable care depends on whether or not you live in one of the sixteen states that provide abortion coverage for Medicaid enrollee. It disproportionately harms Black, Indigenous, and other people of color, people with disabilities, LGTBQ individuals, and young people, who as a result of intersectional systems of oppression, are more likely to receive coverage or care through Medicaid and other federally funded programs. A truly equitable abortion access landscape cannot exist until Congress repeals the Hyde Amendment.
But not all hope is lost. State advocates continue to lead the way in making progress toward a health care system that treats abortion like the basic health care it is. Rhode Island recently became the newest state to provide abortion coverage to Medicaid enrollees, the culmination of a multi-year effort to enact the Abortion Coverage Act into law. Thanks to the tireless work of advocates on the ground, Minnesota recently passed a bill that improves reimbursement for Medicaid abortion providers, as sustainable reimbursement is crucial in light of the increased demands on abortion providers post-Dobbs. And Michigan just introduced a comprehensive proactive abortion bill to repeal many of the state’s restrictions and enact new protections, including Medicaid coverage of abortion.
It might be easy to dismiss these as one-off victories but that would be a mistake. While Rhode Island enacting Medicaid abortion coverage doesn’t directly help the people living in a state with an abortion ban, comprehensive Medicaid coverage of abortion means that limited abortion fund dollars can go to the people who are forced to travel to seek care. It is abhorrent that this is the world we live in – where you live and how much money you make should not determine your ability to access care. The Hyde Amendment must be repealed and that work continues, despite the dysfunctional nature of Congress. But advocating for comprehensive insurance coverage is a crucial part of normalizing abortion as basic health care and state advocates should be lauded for centering policies to improve abortion access.