This blog post was authored by Alexandra Porter, Legal Intern, with supervision from Madeline Morcelle, Senior Attorney
Since the Supreme Court’s decision to overturn Roe v. Wade three years ago, many have called on Congress to mandate a federal right to receive abortion. But having a legal right to abortion means little if people have no meaningful access — and research has shown that cost is often the determining factor.
Comprehensive abortion coverage is essential for eliminating cost barriers. Calls for a legal right to receive abortion neglect longstanding coverage restrictions such as the Hyde Amendment, an annual appropriations bill rider that bans federal funding for abortion services except in narrow cases of rape, incest, and life endangerment. For nearly five decades, Hyde has operated as a de facto abortion ban for beneficiaries of health programs such as Medicaid. But for immigrant communities, ending the Hyde Amendment and mandating abortion coverage would not be enough to ensure equitable abortion access.
Discriminatory laws such as the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 deny many immigrants health insurance eligibility. Many immigrants go without health insurance coverage — for example, 50% of undocumented immigrant adults and over 18% of legally present adults are uninsured. Additionally, 32% noncitizen immigrant women and many transgender, nonbinary, and intersex immigrants aged 15 to 44 lack coverage. These health insurance exclusions further exacerbate efforts to create meaningful abortion access, because removing abortion-specific barriers alone is insufficient. Health insurance coverage is necessary not just for facilitating affordable abortion access but for actualizing the vision of reproductive justice: the right to have children, not have children, and raise children in safe and sustainable communities. Immigrants and their families with Limited English proficiency also face language access barriers, which obstruct their ability to effectively access and communicate during care. Moreover, the Trump administration’s radical expansion of attacks on immigrant communities, from increasing immigration raids, mass deportations, and surveillance to illegally releasing Medicaid applicant and enrollee data to immigration officials, can have a profound chilling effect on health care access, including abortion.
Structural barriers to health care for immigrants, rooted in systemic racism and xenophobia, left many immigrants unable to access abortion long before Dobbs. They reflect a broader pattern of using immigration status and length of stay to control access to health care, including sexual and reproductive services. This subjugation represents a form of health care apartheid: an unequal system of health coverage and access based on immigration status and length of stay, rooted in xenophobia and racism. This tiered system of health care access is a tool of reproductive oppression, regulating and controlling individuals’ access to essential health care and thus controlling who can become a parent and when. So long as immigrant coverage gaps exist, we cannot achieve meaningful abortion access and more broadly, reproductive justice.
Congressional Republicans’ budget reconciliation bill threatens to deepen these inequities. Proposed changes to Medicaid financing and affordable Marketplace coverage eligibility will result in massive losses of already scant health insurance coverage for immigrants and their families. These cuts would bring our country in the wrong direction, widening coverage gaps instead of closing them.
A Reproductive Justice Response: The HEAL for Immigrant Families Act
To advance a vision of health care access, including abortion access, grounded in dignity, equity, and self-determination, we must pursue a better vision: taking bold legislative action to end immigrant coverage gaps. So long as immigrant coverage gaps remain, abortion access will remain out of reach. The Health Equity and Access Under The Law (HEAL) for Immigrant Families Act offers a clear and urgent path forward. It aims to dismantle most systemic coverage gaps and related barriers preventing immigrant families from accessing comprehensive health care, including abortion, by:
- Ending the five-year bar (i.e., waiting period) on Medicaid, Children’s Health Insurance Program (CHIP), and Medicare Part A and B eligibility, as well as removing barriers related to sponsor deeming and liability for Lawful Permanent Residents (LPRs);
- Ensuring that all immigrants with federally authorized presence in the U.S. (e.g., Deferred Action for Childhood Arrivals recipients) are recognized as lawfully present for eligibility in Medicaid, CHIP, and Marketplace plans, including eligibility for Marketplace premium subsidies and cost-sharing reductions;
- Creating a new State Plan Amendment (SPA) option for Medicaid coverage of undocumented immigrants, allowing for federal financial participation; and
- Expanding eligibility for Marketplace plans, related premium tax credits and cost-sharing reductions, and state Basic Health Programs, to undocumented immigrants.
Reproductive justice demands more than the legal right to abortion — it demands transforming the systems that govern whose bodies are valued and whose families can access the health care they need to thrive. We must ensure that every family, regardless of immigration status, has the chance to control their reproductive destinies. There can be no equitable abortion access until we close health insurance coverage gaps, including those that specifically target immigrants. To this end, Congress must reject the harmful health care cuts in the reconciliation bill and commit to legislative solutions such as the HEAL for Immigrant Families Act along with abortion coverage mandates. By removing arbitrary barriers to coverage and centering the needs of immigrant communities, HEAL advances a vision of equitable abortion access and more broadly, reproductive justice for all.
