In 1973, the Supreme Court legalized abortion with its landmark ruling in Roe v. Wade. Three years later, the pro-life movement fought back hard — and struck a blow to abortion access in the United States that has lasted for 40 years.
That blow was the Hyde Amendment, which first passed Congress in 1976. It bans all federal funding for abortion, except in cases of rape or incest, or to save a pregnant woman’s life. Douglas Johnson, legislative director for the National Right to Life Committee, says the Hyde Amendment “has proven itself to be the greatest domestic abortion reduction law ever enacted by Congress.”
It’s hard to overstate the impact of Hyde, even compared with the slew of state restrictions that have crippled access to abortion in just the past five years. Those restrictions closed abortion clinics by the dozen, and otherwise made it a lot harder for women to get the procedure. But the Hyde Amendment is even more sweeping: It makes abortion completely unaffordable for millions of women, and it’s been doing that for 40 years.
Yet somewhere along the line, Hyde became a point of consensus between pro-choice and pro-life politicians — a sort of third rail in abortion politics that neither side would touch. It became status quo to consider abortion so controversial that, at the very least, there should be “no taxpayer funding” for it. Even pro-choice lawmakers, when fighting against efforts to defund Planned Parenthood, will quickly point out that the organization can’t use tax dollars for abortion because Hyde is “the law of the land.”
But 40 years later, that consensus is starting to change. For the first time in 2016, the Democratic Party platform included a call to repeal the Hyde Amendment. For the first time in 2015, a bill to repeal Hyde was introduced in Congress. And Hillary Clinton has made getting rid of Hyde a major campaign promise.
What caused this change? Why, all of a sudden, are Democrats now willing to touch that third rail?
It didn’t happen by accident. It’s the result of deliberate, focused organizing led by women of color, who have worked to shift the conversation around Hyde from being about tax dollars and shame to being about basic fairness and dignity.
How women of color convinced the broader pro-choice movement, and many Democrats, to make public abortion funding a priority
The pro-choice movement scored a huge victory this year when the Supreme Court overturned two Texas laws that forced about half of the state’s abortion clinics to close. That decision promises to block copycat laws in other states, and may even lead to a much broader range of anti-abortion laws being struck down.
But the Hyde Amendment is “probably one of the harshest remaining barriers to abortion,” said Destiny Lopez, co-director of the anti-Hyde campaign All Above All. “There are a lot of bad laws on the books, but this, to me, is the most fundamentally unfair of all of them. If you have ‘access’ to abortion but can’t afford it, the right is meaningless.”
The Hyde Amendment bans abortion coverage for basically anyone who gets their health insurance through the federal government. That includes people who are insured through Medicaid, as well as federal employees, military service members, incarcerated people, and Native Americans who use Indian health service facilities.
The Medicaid ban in particular means that abortion is disproportionately unaffordable for poor women, young women, and women of color — all of whom are more likely to need abortions in the first place.
About one in six women of reproductive age rely on Medicaid for their health insurance. Currently, 17 states have a policy to use their own state Medicaid funds to pay for abortion services — but 60 percent of women on Medicaid don’t live in those states, so they can’t get any insurance coverage for abortion at all. More than half of those women who can’t get any coverage are women of color.
Women of color who advocate for abortion rights have been pushing against the Hyde Amendment for decades, arguing that it was a racial and economic justice issue. They said that abortion rights need to be seen as a holistic, intersectional “reproductive justice” issue, not just a question of “choice.”
But for decades, this was a fringe position in the broader abortion rights movement. Pro-choicers were busy playing defense and fending off new restrictions. They tended to defer to the moral sensibilities of abortion opponents by arguing that abortion should be “safe, legal, and rare” — even though abortion is very common (about a quarter to a third of women will have an abortion in their lifetime).
That started to change in 2010. First, insurance coverage for abortion suffered yet another blow when the Affordable Care Act allowed states to exclude abortion coverage from their insurance exchanges. Half of all states did just that.
Soon thereafter, state legislatures started passing a barrage of new laws aimed at restricting abortion — which closed clinics in droves, imposed even more new funding bans and other restrictions, and ultimately created the greatest crisis in abortion access since Roe.
All of this was a devastating onslaught for the abortion rights movement. But it was also a wake-up call.
Leaders from the National Network of Abortion Funds and the National Latina Institute for Reproductive Health got together and decided that enough was enough. It was time to go on offense and craft a proactive vision of what real reproductive justice should look like. And it was hard to imagine a bigger, bolder, more proactive change than abolishing the Hyde Amendment.
That’s how the All Above All campaign, which is now a coalition of more than 100 organizations, got started. “We realized that we needed a dedicated effort solely focused on lifting abortion coverage bans,” Lopez said. “We knew that if we were going to do something about it, we needed a multi-pronged campaign just dedicated to this issue. Because at that point, we were essentially undoing 34 years of bad policy.”
All Above All officially launched three years ago, and got to work on lobbying pro-choice members of Congress and conducting polls to prove that repealing Hyde wasn’t really the poison pill that so many people assumed it was.
All Above All’s polling, conducted by Hart Research, is striking. Large majorities of voters, even Republicans, in battleground states agree with the statement, “However we feel about abortion, politicians should not be allowed to deny a woman's health coverage for it just because she's poor.” Black voters are by far the most supportive of this sentiment. And a majority of those polled, 54 percent, say they would support a law requiring Medicaid to cover abortions.
It’s been a major effort, Lopez said. Not only did the members of All Above All have to educate the public and members of Congress, but they also had to work to convince their allies in the pro-choice movement that this was a good, important strategy.
Now all the big names in the abortion rights movement, like Planned Parenthood and NARAL Pro-Choice America, have embraced not just anti-Hyde activism but also the more intersectional “reproductive justice” lens. They’ve started talking more about issues of economic and racial justice, not just the usual points about bodily autonomy or access to health care.
“The groundswell you’re seeing now and the broad-based support [to repeal Hyde] is definitely not accidental,” said Yamani Hernandez, executive director of the National Network of Abortion Funds. “It’s been a specific strategy of the campaign to make inroads across movements, [especially] the economic justice movement. There’s been a parallel groundswell on fair wages, the realization of what poverty really means for people. And that’s raised the consciousness of the public and our lawmakers that it’s no longer just a question of keeping abortion legal.”
Until All Above All started doing their work, Lopez said, there really wasn’t much public dialogue about the issue. Some polls showed opposition to public funding for abortion. But nobody was out there making the case for what “no taxpayer funding for abortion” actually meant to women in practice, and why it was unfair.
And that frame of fairness, Lopez said, has been key to the movement’s success. When you explain the human consequences of the Hyde Amendment, many people — especially young people and people of color, she said — intuitively understand that the status quo is unjust and needs to change.
The Hyde Amendment leaves many poor women with no “choice” at all
The Hyde Amendment is more of a tradition than a law, a rider that gets added to the federal budget every year. Every year without fail, Congress passes it again. And every year without fail, America effectively makes a choice: to try to reduce the number of abortions by making it harder for poor women, specifically, to get them.
The policy’s original sponsor, Rep. Henry Hyde of Illinois, had no illusions about this goal. “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,” Hyde said. “Unfortunately, the only vehicle available is the ... Medicaid bill.”
But while Hyde would probably be pleased that the overall rates of abortion in America have decreased dramatically since 1990, it’s not because poor women have been blocked from accessing abortions. The abortion rate has gone down because women and girls have gotten better access to contraception and better education about how to prevent pregnancy.
However, many lower-income women still lack the health care access they need to prevent unintended pregnancy. Abortion patients were much more likely to be poor in 2014 than they were in 2008, and three-quarters of abortion patients now live either below the federal poverty line or close to it.
The Hyde Amendment makes it incredibly difficult, if not impossible, for a low-income woman to actually exercise her right to an abortion. Hyde means that women on Medicaid have to pay a median out-of-pocket cost of $575 for an abortion — which is about a third of monthly income for most of these women.
“Of the women who report that Medicaid isn’t paying for their abortion, most are already food- or housing-insecure,” said Sarah Roberts, a public health social scientist at Advancing New Standards in Reproductive Health (ANSIRH). “They skip meals, or they’re unable to pay their rent or mortgage.”
“Women will go to great lengths to get an abortion,” said Diane Horvath-Cosper, an abortion provider and an advocacy fellow with Physicians for Reproductive Health. “But you can’t get blood from a stone. If somebody doesn’t have the money, they don’t have the money.”
That’s why many advocates see the Hyde Amendment as “discrimination, pure and simple,” Horvath-Cosper said. “It’s discrimination against women who are poor, against people who are already struggling to survive and make ends meet.”
The human costs of banning public abortion funding can be devastating
Horvath-Cosper provides abortions in both Maryland, where Medicaid can cover abortions, and the District of Columbia, where it can’t. The difference between the two, she says, is “night and day.”
“A lot of people don’t even know,” she said. “They’re shocked, they’re floored, to find out that Medicaid doesn’t cover abortion. Because it covers everything else, and their friends in Maryland can use their Medicaid. They’re blown away.”
Sometimes women delay the procedure in order to have enough time to scrape the money together. But if they delay long enough, they might need to have a more expensive and riskier procedure. “From a purely public health perspective, it makes sense to help women get the abortion as early as possible,” said Dan Grossman, director of ANSIRH. “Funding restrictions can end up having a negative health impact.”
And women who become pregnant by an abusive partner and can’t get an abortion will often find themselves even further trapped in the cycle of abuse.
So it’s no wonder that not being able to afford the procedure might drive some women to desperation, including trying to give themselves an abortion at home. When researchers interview women who have tried to self-induce an abortion, many of them mention cost as a reason for doing so.
That’s why shortly after the Hyde Amendment passed, grassroots abortion rights advocates started creating abortion funds — organizations that raise funds, give rides, watch children (60 percent of women who have abortions are already mothers), and provide other services for women who need abortions but can’t afford them. Today, 70 of these groups in 38 states are organized under the banner of the National Network of Abortion Funds (NNAF).
But abortion funds, while they provide a lifeline for many women in need, can’t come close to filling the funding gap. NNAF gets about 100,000 calls a year from women seeking financial assistance for an abortion, executive director Yamani Hernandez said — and can only fulfill about a third of those requests, with an average grant of $200 per woman. Meanwhile, there are 29 million women who are subject to Hyde and other funding restrictions in America.
“Thank goodness abortion access funds are there, but they’ve got limited resources and they’re unable to help all the clients who call them,” Horvath-Cosper said. “We shouldn’t have to crowdfund somebody’s medical care. That shouldn’t be a thing.”
Low-income women aren’t the only ones who suffer from Hyde, Horvath-Cosper said. She provides abortions in a hospital, and several times a week she sees patients who have “devastating” prenatal diagnoses, where the pregnancy is wanted but the fetus will likely not survive — and where insurance won’t cover a termination because of the Hyde Amendment. These tend to be later procedures, which can cost $10,000 to $15,000. Abortion funding organizations usually can’t cover expenses that high.
Some of these patients are attorneys or analysts who have good-paying government jobs — but because they are federal employees, Hyde affects them. “These are people who have fantastic insurance, or so they thought,” Horvath-Cosper said. “And they come in and say, ‘Well, what do you mean, my insurance won't cover this? My baby will die, are they saying I just have to continue the pregnancy and wait for that to happen?’ And I have to say, yeah, that's exactly what that means. It feels heartless. It feels uncaring.
“To put somebody through a doomed pregnancy when they don't want to continue it, and worry about the baby being born and experiencing pain — it's devastating for everybody involved. And it makes you feel really angry at the people in the offices who are making these laws, who don't sit with these families and know what it feels like.”
There are exceptions to the Hyde Amendment, but they are extremely limited and don’t cover fetal anomalies. They also don’t cover risks to a woman’s health that fall short of death — and that puts doctors in a terrible position.
“How do you decide when someone is close enough to death to say that they deserve to have a pregnancy termination?” Horvath-Cosper said. “From a clinician’s point of view, there’s no ‘death checklist,’ where we say, well, if you have this and this but not this, then you're not close enough. ... To have to purposely allow someone’s health to get so bad they might die in order to have it paid for by insurance — it runs counter to everything you want to do when you go into medicine. You want to catch things before things get really bad and someone is at death’s door.”
All of this — the health impacts, the economic impacts, the social justice impacts — is why All Above All has been pushing so hard to repeal Hyde. And while the campaign still has a long way to go, it’s been remarkably successful in a short time.
In the three years since the campaign has gone public, repealing Hyde has gone from a taboo subject to a mainstream pro-choice position that has been officially embraced by the Democratic Party.
But the biggest issue wasn’t really convincing people that repealing Hyde was the right thing to do, advocates say. It was educating people on what Hyde is and what it does, and introducing the idea that there is a better way.
“For many years, women of color were the only ones talking about the Hyde Amendment,” Hernandez said. “For a long time it was considered a fringe issue, unwinnable. And that day has just passed. I don’t think we'll ever go back to a time when people don't understand what Hyde is.”