Along with other health care and human rights advocates, the National Health Law Program (NHeLP) saved the Affordable Care Act (ACA) once again when Senate Majority Leader Mitch McConnell (R-Ky.) ended a planned vote on the Graham-Cassidy repeal proposal. The defeat of the proposal preserved the gains achieved by the ACA and Medicaid, the largest single health insurance program in the United States, from draconian cuts and caps. Medicaid is a lifeline for 13 million women of reproductive age. It provides coverage for 48 percent of reproductive-age women with incomes below the federal poverty line, and accounts for 75 percent of all public funding on family planning.
While Medicaid has allowed access to reproductive health care to millions of individuals, there are still restrictions that prevent full coverage. Enter the Hyde Amendment. This is a federal appropriations bill rider that for 41 years has allowed federal funding of abortion only in cases of rape or incest, or when the individual’s life is in danger because of the pregnancy. These limited circumstances are not easily enforced: incidences of rape or incest are underreported and often the life endangerment provision is left to the state Medicaid office or the managed care plan. Moreover, the definition of life endangerment does not take into account any potentially life-threatening psychological or emotional harm that may result when a woman is forced to continue a pregnancy she does not want. Abortion is the only medical procedure banned from the Medicaid program in this way.
While states can use their own funding to provide abortion coverage for Medicaid, only 16 states do so. Studies demonstrate that the Hyde Amendment falls hardest on women of color, immigrant women, and young women. These restrictions staunch women’s ability to make the health care decisions that are best for them and their families. Furthermore, these restrictions force Medicaid enrollees into unfathomable situations where they must decide to pay for utilities and food or health care costs.
When there is no comprehensive reproductive health coverage, women have few options about what to do when faced with an unwanted pregnancy. One in four Medicaid-eligible pregnant women who seek an abortion is forced to carry her pregnancy to term because of these restrictions. When abortion access is denied, low-income individuals are three times more likely to fall into poverty than people who are able to pay for that care. The Hyde Amendment presents an undeniable problem of racial discrimination. As the prominent Supreme Court Justice Thurgood Marshall rightfully expressed, these public funding restrictions are “designed to deprive poor and minority women of the constitutional right to choose abortion.”
But there is light at the end of the tunnel. Congressional members have introduced the EACH Woman Act as a first step to end barriers to Medicaid coverage of abortion. While this bill faces an uphill battle in the current Congress, it helps to establish an important vision for the kind of health care our country needs. Whether she has private or Medicaid health insurance, every woman should have coverage for a full range of reproductive health services, including abortion. We need bold legislation so that Medicaid can continue to be the number one insurance plan that it was intended to be.
