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I am a mother of four and I do the best that I can for my kids. I work part-time and get some government benefits, but we can still barely pay the rent. Last month my 16-year old got pregnant. We both decided she wasn’t ready to have a child. But my caseworker said Medicaid doesn’t cover abortion in South Carolina. The clinic told me it will cost $350, and we have to pay up-front. How will we find the money?
-Gladys, age 34*
The U.S. Congress passed the Hyde Amendment in 1976, prohibiting Medicaid from paying for abortion services. The only exceptions to this federal funding ban are in cases of rape, incest, and danger to the life of the woman. Over 30 states have also banned the use of state Medicaid funds to pay for abortion. These funding restrictions have had a devastating impact on the daily lives of women and families.
Women on Medicaid have very low incomes and cannot afford to pay for their health care, including abortion, so the Hyde Amendment and state funding bans effectively restrict their right to control their health and lives. The average cost of a first-trimester abortion in the U.S. is $468, which is more than one-third of what a poverty-level family lives on in a month (the poverty level is defined as $16,600 yearly for a family of three). With no Medicaid coverage and without other means to pay for care, many low-income women cannot obtain abortions at all.
A study of women on Medicaid in North Carolina found that one in three women who would have had an abortion if funding had been available instead carried their pregnancies to term. Other low-income women are forced to pay for abortion care with money they need for rent, utilities, and food for their families. Because abortions after 12 weeks of pregnancy can cost over $1,000, lower-income women often find themselves in a vicious cycle. By the time they raise enough money for a first-trimester abortion, they may be in the beginning of the second trimester and in need of even more money.
The Hyde Amendment and state funding bans have a disproportionate impact on women of color and on immigrant women. African Americans comprised nearly one-quarter of all Medicaid recipients in 2004, despite making up only 12% of the total U.S. population. Over two-thirds of Laotians and Hmong and nearly half of Cambodians in the U.S. live in poverty and depend on Medicaid. Latinas similarly make up over one-fifth of Medicaid recipients, while comprising only 12.5 percent of the general population. Access is often out of reach for immigrant women, even in the seventeen states that do offer abortion coverage. Under current law, immigrants who entered the U.S. after August 1996 are barred from receiving Medicaid benefits for five years.
I am a member of the Hopi Nation and I live near Albuquerque. I was studying with a classmate at my college when he raped me. As if this wasn’t horrible enough, I became pregnant. When I went to Indian Health Services, they said “the government won’t allow us to provide abortions.” But I talked to my aunt who is a nurse and she said that because I was raped, they are supposed to help me get an abortion. When I called them back, they told me I would have to find a clinic myself and pay up front, and maybe they could reimburse me.
-Cheryl, age 19
Like Medicaid, the federally-funded health program for Native Americans known as Indian Health Services is supposed to cover abortion in cases of rape, incest, and when the woman’s life is in danger. However, a 2002 survey conducted by the Native American Women’s Health Education Research Center found that over 60 percent of IHS facilities provide neither abortion services nor funding even in eligible cases. This is especially horrifying given that there is a higher incidence of rape among Native American women than any other U.S. racial or ethnic group.
Women on Medicaid are also routinely refused assistance in cases of rape or incest. Medicaid officials sometimes claim that they never cover abortion, either because they do not understand that there is a rape/incest exception or because of personal opposition to the procedure. When proper information is given, the arduous paperwork that Medicaid requires of the woman, the police, and/or the doctor means that payment is never made—or does not come in time. In some cases, the reimbursement from the state is so low that clinics are simply unwilling to seek repayment at all. In a disturbing continuation of past coercive and racist policies, IHS and Medicaid refuse to cover abortion even when legal exceptions apply, but they consistently pay most of the costs for sterilization.
My husband is in the army and is currently deployed in Iraq. I live in rural California, supporting our five kids on my husband’s military pay of $800 per month. When I found out I was pregnant again, I knew we couldn’t have another child. My cousin helped me—she knew what clinic to go to because she had an abortion and [state] Medicaid covered it. But when I talked to the clinic, they said that my husband’s military insurance is forbidden to pay for abortion.
-Jessica, age 23
Funding bans also strip military service members and families of their right to full reproductive health services. During the decade following the Hyde Amendment, Congress severely restricted abortion coverage in virtually every federal program, denying coverage to military personnel and their families, federal employees (including the Peace Corps), people on disability insurance, teenagers enrolled in the State Children’s Health Insurance Program, and women in the federal prison system. Women in prison face particular obstacles because they have no opportunities to earn income and little control over their access to health care.
The Hyde Amendment and other funding bans have meant that for the last thirty years, abortion, although legal, is largely out of reach for millions of women. If you are moved by these women’s stories, please join us in saying “Hyde – 30 Years is Enough!”
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Sarah Horsley is Communications and Campaigns Director at the National Network of Abortion Funds, a teacher of political economy at Springfield College School of Human Services, and a long-time advocate for low-income women and families.
* Women’s names and specifics of their stories have been changed to protect confidentiality. The stories in this article are based on the experiences of women helped by the National Network of Abortion Funds, a network of local groups that raise funds to help low-income women and girls access abortion care. Some story sections are borrowed from Susan Schewel, “The Hyde Amendment’s Prohibition of Federal Funding for Abortion – 30 Years is Enough!” in The Women’s Health Activist, National Women’s Health Network, September/October 2006.