The Hyde Amendment bans federal funding for abortion except in cases of rape, incest, and life endangerment. Though it’s often discussed as if it’s permanent law, it is not. Hyde is what as known as a “rider,” or amendment, that must be renewed each year with the bills that appropriate—or approve—funds for the government to operate.

Hyde blocks the use of funds from Medicaid—the federal program that provides insurance to people with low incomes—to cover the costs of abortion care. Following years of concerted advocacy by women of color, eliminating Hyde now has unprecedented support among Democrats—including most 2020 White House contenders.

The Hyde Amendment was first passed in 1976. Three years after the U.S. Supreme Court made its landmark abortion rights decision in Roe v. Wade, Rep. Henry Hyde (R-IL) introduced the amendment as part of the 1977 Departments of Labor and Health, Education, and Welfare, Appropriation Act. It passed by a wide margin in the House—which was at the time held by Democrats.

Speaking about his intentions in 1977, Hyde said he wanted to stop all abortions but could only restrict access at the time through Medicaid. “I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman,” he said. “Unfortunately, the only vehicle available is the … Medicaid bill.”

Megan Donovan, senior policy manager at the Guttmacher Institute, told Rewire News Group that Hyde was “clear in his intent to limit access to abortion and also clear that he understood that what he was doing effectively was targeting a program intended to provide access to health care for people with low incomes—targeting that population for this restriction because it was a mechanism that was available to him.”

The Hyde Amendment’s reach is far-ranging, according to the Kaiser Family Foundation (KFF), because its annual reauthorization is attached to the U.S. Department of Health and Human Services’ appropriation bill. It therefore covers Indian Health Service, Medicare, and the Children’s Health Insurance Program.  Similar language has also “been incorporated into a range of other federal programs that provide or pay for health services to women including: the military’s TRICARE program, federal prisons, the Peace Corps, and the Federal Employees Health Benefits Program.”

Building on the legacy of restrictions like the Hyde Amendment, additional restrictions have been placed on insurance coverage of abortion care using federal policies. President Obama’s changes to Obamacare, for example, imposed restrictions on coverage of abortion care for plans available through the Affordable Care Act’s health insurance exchanges. These kinds of restrictions affect “millions of women who get their health care or coverage through the federal government through other programs,” Donovan said.

States can opt to cover abortion care through Medicaid with their own funds, but just 16 do—the vast majority of states instead have Hyde-like restrictions.

‘An extreme punishment’

Since few states allow the use of Medicaid funds for abortion, access to care can vary drastically. “Depending on which state you live in, depending on the type of insurance you have, depending on how much money you make, you have different access to abortion in this country. And that’s on top of other bans that are already happening around clinics, around waiting requirements, etc.,” Destiny Lopez, co-director of All* Above All, a campaign to lift bans on insurance coverage for abortion, told Rewire News Group. 

About 2 in 10 women in the United States between the ages of 15 to 49 are enrolled in Medicaid, and roughly 48 percent of all low-income women were enrolled in the program in 2016, according to KFF.

“We know because of social and economic inequality linked to racism and discrimination [that] women of color are disproportionately likely to be insured through Medicaid,” Donovan said. “And so, therefore, they’re disproportionately likely to be subject to the Hyde Amendment ban on abortion coverage.”

Jessica Gonzalez-Rojas, executive director of the National Latina Institute for Reproductive Health, called the Hyde Amendment “discriminatory” because it targets “those who may need coverage the most.”

“The main impact is essentially that those who have resources can continue to … access abortion care while those who often have the least are denied access to abortion care, it’s out of reach for them,” she said.

Many on Medicaid who find out they are pregnant and decide to seek an abortion must come up with the money to cover care on their own. But, the longer it takes “to pull the funds together, the more expensive the abortion becomes,” Gonzalez-Rojas said. “So there’s a compounding impact of the Hyde Amendment for those who are low income and are really struggling to make ends meet.”

“We heard the stories of folks who have … to make decisions like, do I put food on my table? Do I feed my family? Do I pay for the transportation I need to get to work?” she said. These people “make major sacrifices” to come up with the funds they need to get care, but often “they’re dug deeper in a hole because it becomes more and more expensive as the process gets delayed” while people put together funds. 

“When people are denied insurance coverage of abortion, then the costs can be a significant barrier to timely and affordable care,” Donovan said. “On average, an abortion at 10 weeks cost around $500,” and those costs increase over time. Somebody seeking an abortion may be forced to travel great distances to access services—which can mean taking time off work, paying for child care, and other related costs. To pay for it, people may need to divert money from food, rent, and other necessities.

“The consequences of the Hyde Amendment are multiple,” she said. “Studies do show that when policymakers place restrictions on Medicaid coverage of abortion, it forces 1 in 4 poor women seeking abortion to carry an unwanted pregnancy to term,” Donovan said.

Other research shows dire consequences for those who want an abortion but aren’t able to have one. The Turnaway Study, which from 2008 to 2010 interviewed 1,000 people who sought abortions, found that those denied an abortion “have four times greater odds of living below the Federal Poverty Level.” They are also more likely to stay in an abusive relationship and to experience serious complications from the end of pregnancy.

“Even when the Hyde Amendment doesn’t ultimately block someone from getting the abortion care they need, it essentially can serve as an extreme punishment in effect for people by forcing them to really struggle and sacrifice in order to access the care that they need,” Donovan said.

Women of color leading the way

Women of color have “been the driving force” behind efforts to end the Hyde Amendment, Lopez said. All* Above All, launched publicly in 2013, is a reflection of that—but not the only example.

“We’ve had efforts led by different organizations and different groups of folks almost since [Hyde’s] inception in the late ‘70s,” Lopez said, “but most if not all, and certainly this effort, have really been led and driven by women of color in particular, recognizing that … our communities are among the most impacted.”

All* Above All, according to Lopez, is working to “educate and organize the public, particularly young people and people of color as well as low-income folks who are most impacted by coverage bans like the Hyde Amendment,” and is advocating for policy on the federal, state, and local level.

The campaign “is incredibly exciting because it’s not just a campaign that is looking to shift policy, but we’re actually looking to shift our culture, and we’ll also looking to elevate the leadership and the activism of communities of color who are at the forefront of this,” said Gonzalez-Rojas, who sits on All* Above All’s steering committee and whose organization is a partner of the effort.

The National Latina Institute for Reproductive Health has made ending Hyde a priority for well over a decade, Gonzalez-Rojas said. “We’ve been working really hard along alongside our sisters and partners in the reproductive justice movement who acknowledge and understand that the Hyde amendment disproportionately impacts our communities,” she said.

“We’ve been really unapologetic about pushing both our movement and the reproductive health rights and justice movements to actually be more bold on this issue and pushing our lawmakers to fight against” Hyde, Gonzalez-Rojas said.

And that work may be paying off.

A recent history of efforts to end Hyde

The first comprehensive bill to eliminate Hyde was introduced in Congress two years after All* Above All launched. Rep. Barbra Lee (D-CA) in 2015 introduced the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act. Among other things, it sought to ensure that all receiving health care or health insurance through the federal government were covered for abortion care.

The next year, the Democratic Party embraced ending the Hyde Amendment in its official party platform. 

Democratic presidential candidates Hillary Clinton and Sen. Bernie Sanders (I-VT) opposed Hyde during the 2016 election cycle. During the 2016 Iowa Brown and Black Presidential Forum, Clinton said the restriction was “hard to justify because … certainly the full range of reproductive health rights that women should have included access to safe and legal abortion.” Her running mate, Sen. Tim Kaine (D-VA), however, voiced his support for it—though Clinton’s campaign promised he would follow her lead on it should they win the White House.

During his 2016 presidential campaign, Sanders also promised that if elected he would work with Congress to repeal Hyde. When he unveiled his new “Medicare for All” bill in 2017, it included language to pre-empt the abortion restriction. Otherwise, as Rewire News Group reported, it could potentially “apply to every person who moves off their private insurance into a public option.” Subsequent versions of “Medicare for All” bills, such as Rep. Pramila Jayapal’s (D-WA) Medicare for All Act of 2019, have sought to end Hyde.

The 2018 midterms ushered in a pro-choice majority into the U.S. House of Representatives. A ThinkProgress analysis after the election found that this meant unprecedented support for eliminating Hyde. By its count, “at least 183 House members” supported ending the restriction.

Then in March 2019, pro-choice lawmakers reintroduced the EACH Woman Act. The bill currently has 143 co-sponsors in the House. The legislation for the first time was introduced in the Senate, where it currently has 22 co-sponsors, including several Democratic candidates for the 2020 nomination Sens. Kamala Harris (CA), Kirsten Gillibrand (NY), Amy Klobuchar (MN), Elizabeth Warren (MA), Cory Booker (NJ), and Sanders.

Despite their stated opposition to the Hyde amendment, House Democrats included it in their 2019 budget. In early June, Reps. Ayanna Pressley (D-MA), Diana DeGette (D-CO), Barbara Lee (D-CA), Jane Schakowsky (D-IL), and Jayapal introduced an amendment to strike Hyde and instead expand access to abortion coverage. Their efforts were ultimately unsuccessful.

The Hyde Amendment is poised to be a critical topic in the 2020 presidential election. Many contenders for the Democratic nomination have come out against the policy, and former Vice President Joe Biden recently twice switched his position on the matter (ultimately being against it). Meanwhile, President Trump supports codifying Hyde into law.

What will it take to end Hyde?

Ending Hyde “is a marathon, not a sprint,” Lopez said. “We’re trying to undo 40-plus years of bad policy, and so it is not an overnight victory that we are going to get.”

Doing so is “going to take us taking back full control of Congress,” she said. “It’s going to take us taking back the White House. It’s going to take us continuing to do the education that we’re doing so that every person who identifies as pro-choice understands that you can’t do that unless you support the repeal of the Hyde Amendment.”

It also requires educating “more moderate folks in Congress [and] more moderate members of the voting public, around why this issue is important,” Lopez said.

Accountability, Gonzalez-Rojas said, could ultimately be the key to ending the anti-choice restriction. She pointed to recently released data from Intersections of Our Lives, a coalition of reproductive justice organizations that includes the National Latina Institute for Reproductive Health. Their polling found that 88 percent of voters who are women of color said the stakes in the 2018 midterm election were too high not to vote, and 62 percent said they would be watching elected officials more closely than they had in past elections.

“They know that we voted them in,” Gonzalez-Rojas said. “They know that we’re showing up, and we’re going to hold them accountable.”

Advocates say today’s national dialogue around the issue is a positive step forward. “I think the more it’s a part of a national discourse and dialogue, the less stigmatized these issues become,” Gonzalez-Rojas said.

“We’re really heartened by all of the attention that this issue is getting—good and bad,” Lopez said. “It provides an opportunity for us to continue the work of education that we need to do of the public and of policymakers and elected officials around this country. And I am convinced that once we are able to help people understand the impact that we will win.”