The Hyde Amendment denies Medicaid funding for poor women seeking abortion, except in rare circumstances. Forty years ago, and every year since, the U.S. Congress has passed it as a budget rider. As a social experiment, the Hyde Amendment has been a singular failure: It codifies social injustice, harms the most vulnerable among us and drives up costs to society. About 7 million Medicaid-eligible women of reproductive age live in the 32 states that do not cover abortion. Regrettably, North Carolina is one of these.
The amendment’s sponsor, the late Republican Rep. Henry Hyde of Illinois, opposed reproductive rights. Since the U.S. Supreme Court had ruled in 1973 that abortion was a constitutionally protected civil right, Hyde could attack abortion only through the power of the purse. An elderly, affluent and white man, Hyde was candid about his strategy, “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.” By default, he targeted poor women, the most vulnerable among us.
The Hyde Amendment was a legislative hat trick: sexist, classist and racist all in one bill. First, no operation unique to men has a similar funding restriction. Second, according to the Guttmacher Institute, 75 percent of women having abortions are poor or low-income. Because of persistent inequities, poor women have unintended pregnancy rates five times higher than do affluent women. Similarly, poor women have abortion rates six times higher than those well off. Third, the Hyde Amendment discriminates against women of color. Poverty and race are inextricably related, and women of color disproportionately depend on Medicaid, especially in southern states. African-American women have abortion rates three times that of white women.
Financial difficulties are a major reason for 73 percent of women seeking an abortion. They report being unable to afford another child; most are already mothers. Despite the lack of Medicaid funding, most women of limited means seeking an abortion manage to scrape together the funds. For impoverished families, this often means choosing between health care and basic needs. Women report diverting money from rent (14 percent), food (16 percent) and utility and other bills (30 percent) to pay for their care. That citizens in the world’s richest country are forced to choose between health care and basic sustenance is grotesque.
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Scraping together money for an abortion often delays women to later stages of pregnancy, when the cost is higher. About 1 woman in 4 fails to obtain the desired abortion and then bears a child she does not want and cannot adequately provide for. Follow-up studies of women denied abortion confirm that the denial plunges some into unemployment, poverty and dependence upon social services.
The Hyde Amendment codified an untenable two-class system of health care for American women. Because of its discriminatory nature, the amendment was challenged in court. However, in the 1980 U.S. Supreme Court decision of Harris v. McRae, the conservative court ruled that the amendment “places no governmental obstacle in the path of a woman who chooses to terminate her pregnancy, but rather, by means of unequal subsidization of abortion” discourages a woman from exercising her civil rights. For many poor women, “unequal subsidization” translates into an insurmountable, government-imposed, financial obstacle. In his stinging dissent, Justice Thurgood Marshall complained that the Hyde Amendment “represents a cruel blow to the most powerless members of society. I do not believe that a Constitution committed to the equal protection of the laws can tolerate this result.”
Momentum is now building in Congress to overturn the Hyde Amendment. The Equal Access to Abortion Coverage in Health Insurance Act, introduced in Congress last year, holds that government should not be meddling in private decisions between a woman and her physician. Most U.S. citizens, regardless of their views on abortion, agree that women should not be denied medical care solely because they are poor. As Martin Luther King once noted, “The time is always right to do what is right.” Now is the time to undo 40 years of injustice caused by the Hyde Amendment.
David Grimes, M.D., lives in Carolina Beach.