The Hyde Amendment blocks United States federal funding from being used for abortion procedures, except in the cases of rape, incest, or threat to a pregnant person’s life. This means that Americans who have health insurance through the federal government do not have the benefit of abortion coverage.
Affected programs include those that cover low-income people, disabled people, military personnel, veterans, Native Americans, federal employees, federal prisoners, detained immigrants, and Peace Corps volunteers. People who fall into these categories must pay for their abortions out of pocket, which is especially difficult for patients who are already struggling financially, as in the case of those who are poor enough to qualify for Medicaid.
The Hyde Amendment is a significant equity issue: People enrolled in Medicaid are, by definition, low-income; they are more likely to be people of color; and they are more likely to experience an unintended pregnancy. Lack of Medicaid coverage for abortion services means patients must pay out-of-pocket for the procedure. Costs vary widely depending on location, length of pregnancy, and type of abortion chosen, but an uninsured patient can expect to spend at least $500—an enormous burden for someone already struggling financially.
Different Coverage in Different States
Medicaid recipients make up the majority of people who are impacted by the Hyde Amendment. Approximately 14.2 million women of reproductive age (15–44) are covered by Medicaid. These women struggle to survive on salaries that don’t come close to a living wage—a $500 abortion (the average cost of an early procedure) is completely out of reach.
Medicaid is funded by the federal government and by each state’s government. There are currently 15 states that use their own funds to provide abortion coverage for Medicaid recipients who don’t meet the federal allowed exceptions (rape, incest, threat to pregnant person’s life). There are 7.7 million women of reproductive age who receive Medicaid, however, who live in Washington, DC, and the 35 states that do not cover abortion outside of the Hyde exceptions with their own funds.
Initially, the Hyde Amendment was only applied to Medicaid, a joint state/federal health program for low-income populations. Because the amendment restricts funding for the Department of Health and Human Services (HHS), it now also impacts abortion funding under other programs, including Medicare, the Children’s Health Insurance Program, and the Indian Health Service. In the years since its introduction, the Hyde Amendment (and language similar to it) has made its way into other federal programs, including the military health insurance program, the federal employees insurance program, the Peace Corps, and even the Affordable Care Act (ACA)—people who qualify for income-based federal subsidies when purchasing insurance from the ACA marketplace are disqualified from receiving abortion coverage in the states that do not cover abortion outside of the Hyde exceptions.
Origins of the Amendment
Rep. Henry Hyde (R-IL) authored the Hyde Amendment in 1976. When debating the amendment with his colleagues, he said, “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.” Congress approved the Hyde Amendment in the 1977 appropriations bill, as it has done every year since then.
The EACH Act
The Equal Access to Abortion Coverage in Health Insurance Act of 2023 (the EACH Act) would counter the Hyde Amendment and restore abortion coverage to people who get their health insurance through Medicaid and other federal programs. In addition, it would bar federal and state governments from interfering with abortion coverage in private health insurance.
- The Senate bill (S. 1021) was introduced on March 25, 2021, by Sen. Tammy Duckworth (D-IL) with 24 original co-sponsors; it now has 28 co-sponsors plus Ms. Duckworth.
- The House bill (H.R.561) was introduced on January 26, 2023, by Rep. Barbara Lee (D-CA-12) with 168 original co-sponsors.
The right to have an abortion is useless if it’s unaffordable. The EACH Act is an enormous step toward meaningful access for all.