The 26 abortion bans that have passed this year have been the subjects of fierce debate, especially among 2020 presidential candidates. But the Hyde Amendment—which has banned federal funding for nearly all abortions since 1977—has so far been consistently supported, willingly or not, by both Republicans and Democrats.
“Hyde has survived for more than 40 years because historically there has been bipartisan support for the amendment in Congress,” according to Professor Gretchen E. Ely at the University at Buffalo. “And there is certainly not a road to repeal when Republicans hold a majority in the Senate.”
The Hyde Amendment prevents Medicaid, the primary public health insurance program for low-income Americans, from covering abortion, except in the cases of rape, incest, or risk to the life of the mother.
And while the abortion rate in the U.S. has reached its lowest since 1973 within the past decade—17 per 1,000 women—49% of those seeking an abortion were living at less than the federal poverty level in 2014, according to data from the left-leaning Guttmacher Institute.
Even by the 2019 federal poverty level—$12,490 for an individual and $25,750 for a family of four—an abortion that can cost up to $1,000 can be a near-impossible expense, especially when nearly half of Americans have said they can’t afford an emergency payment of $400.
“The Hyde Amendment has effectively served as an abortion ban for those who cannot afford abortion care and all the expenses associated with it,” said Maria Elena Pérez, deputy director at the National Latina Institute for Reproductive Health. “In our Latina/x community, we have seen women working in multiple low-paying jobs that do not provide health coverage.”
Because the Hyde amendment is added to the spending bill each year, eliminating it is “straightforward,” Ely writes. “All that’s required is to vote for lawmakers who will end this practice.”
But while several Democrats have called for the removal of the Hyde Amendment from the federal spending bill, these proposals, at least so far, have largely been symbolic in nature.
In June, Rep. Ayanna Pressley (D-Mass.) proposed an amendment that would remove Hyde from the Department of Health and Human Services funding bill, but the effort was stalled.
“I wish we never had a Hyde Amendment, but it is the law of the land right now,” House Speaker Nancy Pelosi (D-Calif.) said at the Peterson Foundation’s 2019 Fiscal Summit in June. “I don’t see that there is an opportunity to get rid of it with the current occupant of the White House and some in the United States Senate.”
House Democratic Caucus Chairman Hakeem Jeffries (D-N.Y.) said that even 2020 Democrats who have been vocal about repealing the Hyde Amendment, have indirectly supported it in the past, including Sen. Elizabeth Warren (D-Mass.) and Sen. Kamala Harris (D-Calif.)
“I believe that every single candidate for president who served in either the House or the Senate—every single one of them—voted for an appropriations bill that contains the Hyde Amendment,” Jeffries said during a press conference.
After all, spending bills need bipartisan support in order to pass—and avoid government shutdowns—so Democrats who are against the Hyde Amendment, often end up supporting funding bills that are bundled with the Hyde Amendment.
“Let’s be clear, I’ve not voted for the Hyde Amendment,” Harris told NPR in June. “The Hyde Amendment is the law. And so it has been attached to other funding bills, and until we repeal it, which is what I am in favor of, it will be attached to federal government funding bills. That’s the problem with the Hyde Amendment.”
It’s up to individual states—at least for now
Sixteen states—Alaska, Arizona, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, New York, Oregon, Vermont, and Washington—have circumvented the Hyde Amendment by using their own funds to cover most or all abortions for low-income Americans receiving Medicaid benefits.
But state-level abortion bans comprise a variable patchwork of abortion accessibility.
Twelve states—Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Ohio, Tennessee, and Utah—have enacted some form of an abortion ban in 2019. None of these bans are being implemented yet due to either court challenges or effective date.
Even the Affordable Care Act, which closed the un- or under-insured gap by millions of Americans, doesn’t dictate insurance coverage for abortion state to state. Some states have banned private insurers in the Marketplace from offering abortion coverage at all.
“In states that deny insurance coverage for abortion, coming up with the cost to cover abortion care out of pocket can be difficult or impossible for people who are already struggling to make ends meet,” said Liza Fuentes, senior research scientist at the Guttmacher Institute.
A first trimester medication or surgical abortion can cost $400-$500, according to Jeanne Corwin, an OB-GYN based in Ohio. Most terminations are provided up to 12 weeks, leaving 20% of procedures to 13 weeks or more, which increases the cost and the duration of a procedure.
But the cost of an abortion goes beyond the price of service. The growing restrictions on abortion care increasingly force patients to travel farther from their homes for care.
In 2018, Illinois provided abortion care for 5,528 out-of-state patients. So far in 2019, 19 states have passed various forms of abortion access restrictions, and 89% of counties in the United States don’t even have clinics.
The Brigid Alliance, an organization that has provided travel and lodging assistance for patients since 2018, spends an average of $621 for clients who travel an average of 1,220 miles roundtrip for termination services. “There’s a price tag attached to abortion that goes beyond the medical care,” said Odile Schalit, executive director of the Alliance.
Policies like state-mandated periods may force a patient to make multiple trips to a clinic, which are in rare cases more than 100 miles from their home. Targeted Restrictions on Abortion Providers (TRAP) laws and so-called Heartbeat Bills also constrain a patient’s access to in-state abortion care. The economic impact of these policies are felt most acutely by those already struggling to afford the abortion.
“Understand this, women of means will still have access to abortions,” Warren said at an MSNBC town hall in June. “Who won’t will be poor women. It will be working women and women who can’t afford to take off three days from work, and very young women. It will be women who have been raped and women who have been molested by someone in their own family.”
Patients on average spend $44 for transportation and report lost wages on average of $198. Most women who get an abortion already have children, and spend an additional $57 on childcare and $140 on hotel and other costs.
“Access to abortion care shouldn’t depend on how much money one makes or where you live,” Fuentes said. “But unfortunately, right now it does.”
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