Abortion Funding: Laws Prohibiting Government Support

The Hyde Amendment, first passed in 1976, is a legislative provision that prohibits the use of federal funds for abortions in the United States. The amendment has been re-enacted annually since 1977, with exceptions for abortions that save the life of the woman, or if the pregnancy is a result of incest or rape. The Hyde Amendment has guided public funding for abortions under the joint federal-state Medicaid program for low-income people, with some states using their own funds to pay for all or most medically necessary abortions.

The Hyde Amendment

The amendment has been re-enacted every year since 1976, but the exceptions have varied. The version in force from 1981 until 1993, for example, prohibited the use of federal funds for abortions, "except where the life of the mother would be endangered if the fetus were carried to term". In 1993, the Hyde Amendment was expanded to include exceptions for rape and incest cases.

The impact of the Hyde Amendment varies by state. As of 2024, 19 states and Washington, D.C., follow the Hyde Amendment, while 17 states use state funds to pay for abortions for women with low incomes insured by Medicaid beyond the Hyde limitations. Additionally, some states have specific stipulations that either remove or extend the reach of the restrictions put in place by the Hyde Amendment. For example, in Iowa, approval from the governor is required to receive an abortion under the Medicaid program, while Iowa, Mississippi, and Virginia have provisions for cases of fetal impairment.

Federal-level attacks on abortion access

The Hyde Amendment restricts abortion coverage for recipients of federally funded healthcare, affecting women enrolled in Medicare and Medicaid, Native American women, US servicewomen and veterans, women in the Peace Corps, federal employee families, DC women residents, and women in immigration detention facilities and prisons. This amendment is considered an unfair restriction on insurance coverage, as it interferes with access to safe and legal abortion, particularly for those with low incomes.

In addition to the Hyde Amendment, federal-level attacks on abortion access include attempts to implement a 20-week ban on abortions and a federal abortion ban. The federal abortion ban, upheld by the Supreme Court in 2007, criminalizes abortions in the second trimester, taking the decision-making power away from patients and their doctors. This ban prioritizes political interference over patients' health and sets a dangerous precedent for further restrictions on abortion access.

The ongoing efforts to restrict abortion access at the federal level have serious consequences for individuals seeking abortions, especially those from marginalized communities. These attacks on reproductive rights have far-reaching implications, impacting the ability of individuals to make personal medical decisions and access safe and legal abortion services.

To counter these federal-level attacks, advocates for abortion rights have proposed legislation such as the Abortion Justice Act and the EACH Woman Act, aiming to prohibit the federal and state governments from restricting insurance coverage for abortion in public and private health insurance programs. The fight against restrictive abortion policies is ongoing, with Planned Parenthood and other organizations committed to helping people access safe and legal abortions and reduce the number of unintended pregnancies through improved sex education and affordable birth control.

State-level abortion bans and restrictions

In June 2022, the U.S. Supreme Court overturned Roe v. Wade, handing the power to restrict or prohibit abortion entirely to individual states. Since then, nearly two dozen states have banned or limited access to the procedure. As of September 1, 2023, abortion was illegal in 13 states, with 33 states banning the most common second-trimester abortion method, standard dilation, and evacuation (D&E). 21 states ban the provision of "partial-birth" abortion, with 13 of these laws similar to the federal version upheld by the U.S. Supreme Court.

The overturning of Roe v. Wade has had a significant impact on abortion access, particularly for those with Medicaid coverage. The Hyde Amendment, first passed in 1976 and enacted in 1977, bans the use of federal funds for abortions except in cases of life endangerment, rape, or incest. This amendment has been attached as a temporary "rider" to the annual Congressional appropriations bill for the Department of Health and Human Services and has been renewed annually. The amendment has restricted abortion coverage for recipients of federally funded healthcare, including women enrolled in Medicare and Medicaid, Native American women, U.S. servicewomen, and specific groups such as women in immigration detention facilities and prisons.

While the Hyde Amendment sets federal restrictions, some states have implemented their own policies regarding public funding for abortions. 17 states have a policy to use their own Medicaid funds to pay for abortions beyond the Hyde Amendment requirements. Four of these states provide state funds for abortions in cases of fetal impairment, and another four provide funds when necessary to prevent long-lasting damage to the person's physical health. However, one state only provides abortions in cases of life endangerment, violating federal standards.

The fight over abortion continues in state legislatures and courts. For instance, the Georgia Supreme Court reinstated the state's six-week ban, while a judge in North Dakota overturned the state's near-total ban, allowing abortions until viability. These varying state-level abortion bans and restrictions have resulted in a patchwork of abortion access across the country, with some states becoming "abortion havens" and others, "abortion deserts."

The Supreme Court's decision to abandon precedent

The Amendment restricts the use of federal funds to pay for abortions provided through the Medicaid program, a joint federal-state program for low-income individuals. While it allows exceptions for cases of life endangerment, rape, or incest, it has significantly limited abortion access, particularly for low-income women, women of colour, younger women, and immigrants.

The Supreme Court's decision to uphold the Hyde Amendment was based on the determination that it did not violate the Due Process, Equal Protection guarantees of the Fifth Amendment, or the Establishment Clause of the First Amendment. The Court also recognised the right of states to fund only those medically necessary abortions for which they received federal reimbursement. This decision set a new precedent, allowing states to enact measures restricting abortion funding.

The impact of the Hyde Amendment has been significant, with critics arguing that it disproportionately affects certain groups of women and has resulted in many women being unable to afford abortions. The Amendment has also influenced other bans and restrictions on abortion at the state and federal levels, contributing to an ongoing effort to further limit or outlaw abortion in the United States.

The Supreme Court's decision to abandon the precedent set by Roe v. Wade has had far-reaching consequences, shaping abortion policy and access in the United States for decades. It reflects the ongoing debate and polarisation surrounding abortion in the country.

The impact on low-income women

The Hyde Amendment, in effect since 1977, bans federal funding from being used for abortions for women insured by Medicaid. This has a significant impact on low-income women, who are already less likely to have a regular doctor than women in other high-income countries.

Low-income women who lack insurance coverage for abortion often struggle to pay for the procedure, and experience delays in obtaining an abortion or are forced to carry their unintended pregnancy to term. The average out-of-pocket cost of an abortion at 10 weeks' gestation was $480 in 2011-2012. This is a significant sum for low-income women, and the cost of an abortion rises to $775 in the second trimester. The Turnaway Study found that many women who received an abortion faced logistical barriers, including difficulty finding a provider and raising funds for the procedure and travel. These barriers were more common and had greater consequences for those seeking an abortion at or after 20 weeks of gestation.

The Hyde Amendment has been criticised for disproportionately affecting low-income women, women of colour, younger women, and immigrants. An estimated 42% of abortion recipients live below the poverty line, and since the passage of the Hyde Amendment, more than one million women have been unable to afford abortions. 18 to 33% of Medicaid-eligible women who desire abortions have also given birth because they live in states that do not provide funding.

The impact of the Hyde Amendment is somewhat mitigated by the fact that 17 states have a policy (either voluntarily or by court order) requiring the use of state funds to cover abortions for low-income women enrolled in Medicaid. However, this still leaves many low-income women without access to safe and legal abortion care. The amendment has been challenged by abortion rights supporters, who have coalesced behind several state and national-level initiatives to end it.

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