Printable
version of this fact sheet (PDF file, 28K)
Authorized in 1965, Medicaid is a joint
federal-state program that provides the nation's low-income
population with basic health and long-term care coverage.
Medicaid is the largest health care program in the
United States, and covers more than 50 million people.1 Under
Medicaid states receive federal matching funds to provide
health care for low-income individuals.
Medicaid coverage is critical to the
health care of millions of women. More than 16 million
women receive their basic health and long-term coverage
through Medicaid.2 In 2003,
Medicaid covered one in ten women and one in five low-income
women.3 In 2003, 11.5%
of women of reproductive age were covered by Medicaid.4
Currently, all state Medicaid programs
must cover pregnant women who meet the federal income
requirements. Many states have elected to cover women
with incomes that are higher than the federal requirements.
However, this coverage is not without limits, and abortion
services are among the provisions that are most stringently
regulated.
Medicaid is the largest form of aid to
the states from the federal government, comprising
43% of all federal grants.5 As
the national economy has worsened, state tax revenue
has lessened and health care costs have continued to
rise. This resulted in more people eligible for Medicaid.6 This
has placed pressure on states to control Medicaid costs,
typically the second-largest budget expenditure.7 The
federal government is also looking at scaling back
Medicaid funding, and the Bush administration has proposed
to reduce Medicaid spending by $35 billion over the
next ten years. These cuts will especially impact women.
After Roe
v. Wade decriminalized abortion
in 1973, Medicaid covered abortion care without restriction.
In 1976, Representative Henry Hyde (R-IL) introduced
an amendment that later passed to limit federal funding
for abortion care. Effective in 1977, this provision,
known as the Hyde Amendment, specifies what abortion
services are covered under Medicaid.
Over the past two decades, Congress has
debated the limited circumstances under which federal
funding for abortion should be allowed. For a brief
period of time, coverage included cases of rape, incest,
life endangerment, and physical health damage to the
woman. However, beginning in 1979, the physical health
exception was excluded, and in 1981 rape and incest
exceptions were also excluded.
In September 1993, Congress rewrote the
provision to include Medicaid funding for abortions
in cases where the pregnancy resulted from rape or
incest. The present version of the Hyde Amendment requires
coverage of abortion in cases of rape, incest, and
life endangerment.
The first challenges to the Hyde Amendment
came shortly after its implementation. The Supreme
Court has held that the Hyde Amendment restrictions
are constitutional8 and
that states participating in Medicaid are only required
to cover abortion services for which they receive federal
funding rather than all medically necessary abortions.9 Challenges
under state constitutions have been more successful.
Several lawsuits have been brought in individual states
arguing that state constitutions afford greater protection
for privacy and equal protection than the federal Constitution.10
The Hyde Amendment affects only federal
spending. States are free to use their own funds to
cover additional abortion services. For example, Hawaii,
New York, and Washington have enacted laws funding
abortions for health reasons. Other states, such as
Maryland, cover abortions for women whose pregnancies
are affected by fetal abnormalities or present serious
health risks. These expansions are important steps
toward ensuring equal access to health care for all
women.
Prior to the 1993 expansion of the Hyde
Amendment, thirty states chose not to use their own
Medicaid funds to cover abortions for pregnancies resulting
from rape or incest.11 Initially,
a number of states expressed resistance to comply with
the expanded Hyde Amendment, and presently thirteen
states are under court orders to comply and cover rape
and incest in addition to life endangerment.12 Every
court that has considered the Hyde Amendment's application
to a state's Medicaid program since 1993 has held that
states continuing to participate in the Medicaid program
must cover abortions resulting from rape or incest
in order to be compliant with the Hyde Amendment, regardless
of state laws that may be more restrictive.
|
|
Funding
under Hyde Amendment Only: Alabama,
Arkansas, Colorado, Delaware,
District of Columbia, Florida,
Georgia, Idaho, Kansas, Kentucky,
Louisiana, Maine, Michigan,
Missouri, Nebraska, Nevada,
New Hampshire, North Carolina, North Dakota,
Ohio, Oklahoma, Pennsylvania,
Rhode Island, South Carolina,
Tennessee, Texas, and
Wyoming.
Hyde
Amendment and Additional Health
Circumstances: Indiana
(physical health), Iowa (fetal
abnormality), Mississippi
(fetal abnormality), Utah
(physical health and fetal
abnormality), Virginia (fetal
abnormality), and Wisconsin
(physical health).
All
or Most Health Circumstances: Alaska,
Arizona, California, Connecticut,
Hawaii, Illinois, Maryland,
Massachusetts, Minnesota, Montana,
New Jersey, New Mexico, New
York, Oregon, Vermont, Washington,
and West Virginia.
Noncompliant
with the Hyde Amendment: South
Dakota (life endangerment only). |
Unique barriers face low-income women
accessing comprehensive reproductive health care. Barriers
to abortion access such as the lack of providers, state
laws delaying women from receiving timely care, and
funding restrictions like the Hyde Amendment fall disproportionately
on low-income women who have limited resources with
which to overcome these obstacles. The Guttmacher
Institute has found that 20-35% of Medicaid-eligible
women who would choose abortion carry their pregnancies
to term when public funds are not available.13 Additionally,
lack of public funding results in women waiting while
they raise funds, postponing their abortions until
later in their pregnancies when the costs and health
risks can be higher. For women who are struggling to
make ends meet and who do not have insurance that covers
abortion care, the legal right to have an abortion
does not guarantee access.
The restrictions imposed by the Hyde
Amendment unfairly jeopardize the health and well-being
of low-income women and their families. Women who do
not have the ability to pay for abortion services may
resort to self-inducing an abortion or obtaining unsafe,
illegal abortions from untrained practitioners. Also,
the Hyde Amendment harms women's health by denying
coverage for abortion services in cases where women
have serious physical or mental health concerns.
The Hyde Amendment marginalizes and stigmatizes
abortion care rather than recognizing it as an essential
component of women's health, and denies low-income
women basic reproductive health care. The Hyde Amendment
is reauthorized each year under appropriations bills
for the Department of Labor and the Department of Health
and Human Services. The current restrictive version
of the Hyde Amendment does not provide coverage for
abortions in cases of fetal abnormalities, or health
exceptions apart from life-threatening conditions.
Removing funding restrictions for abortion care is
an integral step in ensuring that abortion remains
safe, legal, and accessible. American women have had
the legal right to choose abortion for more than thirty
years. To achieve reproductive equality for all women,
restrictive barriers such as the Hyde Amendment must
be removed.
- The Henry J. Kaiser
Family Foundation, "The
Medicaid Program at a Glance," Key
Facts (January 2005).
- The Henry J. Kaiser
Foundation, "Medicaid's
Role for Women," Issue Briefs: An
Update on Women's Health Policy (November
2004).
- Id.
- The Henry J. Kaiser
Family Foundation and the Alan Guttmacher
Institute, "Medicaid:
A Critical Source of Support for Family
Planning in the United States," Issue
Briefs: An Update on Women's Health
Policy (April 2005).
- The Henry J. Kaiser
Family Foundation, "State
Fiscal Conditions and Medicaid," Medicaid
Facts (November 2005).
- Id.
- Id.
- See Beal
v. Doe, 432
U.S. 438 (1977) and Maher
v. Roe,
423 U.S. 464 (1977)
- 448 U.S. 297 (1980).
- Advocates bringing
lawsuits have ensured state Medicaid
coverage for abortions in all or most
circumstances in Alaska, Arizona,
California, Connecticut, Illinois,
Massachusetts, Minnesota, Montana,
New Jersey, New Mexico, Oregon, Vermont,
and West Virginia. Courts in Florida,
Idaho, Kentucky, Michigan, North Carolina,
Pennsylvania, and Texas have upheld
funding restrictions under their respective
state constitutions. Center for Reproductive
Rights, "Portrait
of Injustice: Abortion Coverage Under
the Medicaid Program".
- Bruce Alpert, "Fight
Brews as Clinton Backs Medicaid Abortions," New
Orleans Times-Picayune, December 30,
1993, at B1.
- The Guttmacher
Institute, "State
Funding of Abortion Under Medicaid," State
Policies in Brief (June 1, 2005).
- Heather Boonstra and
Adam Sonfield, "Rights
Without Access: Revisiting Public
Funding of Abortion for Poor Women," The
Guttmacher Report on Public Policy vol.3(2) (April 2000).
For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.
For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. - 8:00 P.M.
Saturdays: Noon - 5:00 P.M.
National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881
Copyright© 2006,
National Abortion Federation
|