Here’s One Thing Lawmakers Could Do Today to Expand Health-Care Access

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Commentary The Politics of Politics

Here’s One Thing Lawmakers Could Do Today to Expand Health-Care Access

Imani Gandy

They can repeal the decades-long ban on Medicaid covering abortions.

Do you think it’s fair that the amount of money you have determines the type of health care you can receive?

Because that’s exactly what has been happening for more than 40 years: Republicans—with scant protest from Democrats—have been deciding which pregnant patients get to have abortion care and which don’t, based solely on how much money those patients have and how they’re insured.

“Ah-ha!” any anti-choicer would respond. “But abortion isn’t health care!”

But abortion is health care. It is quite obviously health care.

What’s one of the first things you do when you find out you’re pregnant? After either freaking out or jumping for joy, you call a doctor. If you decide to carry the pregnancy to term, a doctor helps you with that. If you decide not to, a doctor helps you with that as well—if you can afford it, that is.

If you rely on the government for your health-care needs—if you’re in the military, if you use Indian Health Services, if you work for the federal government, if you’re in federal prison, or if you are on Medicaid or Medicare—then, generally, you are prohibited from getting an abortion unless you can pay for it yourself. (The government will pay for your abortion if the pregnancy is a result of rape or incest, or if carrying the pregnancy to term will kill you. How nice of them.)

That’s because in 1976, an Illinois Republican named Henry Hyde attached a temporary “rider” to Congress’ annual Health and Human Services spending bill to exclude abortion from the health-care services available to low-income people through the federal Medicaid program. And every year since then, that rider has been attached to HHS’s spending bill. At first the rider—what we call the Hyde Amendment—banned insurance coverage only under Medicaid. But over the years, it was expanded to cover almost every person who relies on the government for insurance coverage.

Before 1976, Medicaid covered abortion care. It was considered standard medical care, as it should have been, because—and feel free to say it with me—abortion is health care.

But Henry Hyde despised abortion. And since Roe v. Wade had legalized abortions a few years earlier, Hyde knew he couldn’t outright prevent people from having them. So he decided to attack poor people and do his damnedest to make sure that the only people who could get abortions were people who could afford them.

Hyde was explicit about his reasons for targeting poor people: “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. Unfortunately, the only vehicle available is the… Medicaid bill.”

Even the way he talked about poor women and abortion was foul:

Mr. Speaker, let the poor women of America make a list of those things that society denies them and which are enjoyed by rich women. Decent housing, decent education, decent food, decent income, and then say to them, “Now, those will take second place. But we will encourage you to kill your unborn young children. Besides, there are too many of you anyway.”

Don’t you just love how it never seemed to have occurred to Hyde that, instead of stripping the right to abortion from poor women who can’t afford to care for children, the government could actually provide decent housing, education, food, and income—and in doing so, make it easier for poor women to have the children that Hyde wanted to force them to have?

The Hyde Amendment creates a discriminatory hierarchy of health-care access when it comes to government-run programs, and people who rely on those programs for their health-care needs are particularly vulnerable. They are usually people of color, young people, low-income people, or some combination of the three; they are people who need reproductive health care, including abortion, but can’t afford it on their own.

According to a 2009 study by the Guttmacher Institute, banning Medicaid coverage of abortion forces 1 in 4 poor women seeking an abortion to carry an unwanted pregnancy to term. And a person denied a wanted abortion is more likely to fall into poverty and stay there for years. Moreover, 59 percent of people who get abortions already have children, according to a 2014 Guttmacher survey. So this cruel policy places even more pressure on the already strained resources of families living in poverty.

The fact that politicians are intentionally discriminating against people when it comes to delivering health-care services—just because they don’t like abortion—is perverse. Politicians should not interfere with a pregnant person’s ability to make the health-care decision that is right for them. It is immoral for politicians to force poor people and people of color to carry pregnancies to term because they don’t have the money to end an unwanted pregnancy.

It’s inhumane.

But perhaps that’s what anti-choice politicians are banking on. After all, this country’s prison system demands a constant stream of bodies to contribute to the multibillion-dollar prison labor industry in which incarcerated people are paid next to nothing to do everything from making hand sanitizer and face masks (a bitter irony considering the COVID-19 infection and death rates in this country’s prisons) to fighting raging wildfires in California. Clearly, inhumanity does not pose a problem for most politicians.

More than that, the Hyde Amendment is also undignified.

Where is the dignity in overburdening already strained families by withholding coverage for abortion, thus forcing people to have babies they can’t afford to raise?

Someone already struggling to make ends meet should not have to decide whether or not to end a pregnancy based on how they get their health coverage or how much money they have. And politicians shouldn’t be in the business of picking and choosing who gets abortion care and who doesn’t.