Since 1977, the Hyde Amendment has prohibited use of federal Medicaid funds to pay for abortion, with the rare exceptions of rape, incest and life endangerment. On the recent anniversary of Roe v. Wade, the House of Representatives passed H.R. 7, the "No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2015." This mean-spirited bill would permanently codify the Hyde Amendment; until now, it has been a rider attached to budget bills. In addition, H.R. 7 would limit women's ability to buy private insurance and, for political purposes, restrict small businesses from some tax credits.
The Hyde Amendment and H.R. 7 punish America's poor. "Medicaid and race are inextricably linked." The median household wealth of white families in 2013 was 13 times that of African-American families, and 10 times that of Hispanic households. African-Americans and Hispanics are disproportionately poor, and, thus, more dependent on Medicaid health benefits.
In 2011, African-Americans comprised 20 percent of Medicaid recipients, but represented only 14 percent of the population. In the South, the racial disparities are even greater: in Louisiana, 57 percent of Medicaid beneficiaries are African-American; in Mississippi, the figure is 67 percent.
Access to safe abortion is essential for women to achieve their fertility goals. African-American women have the highest rate of unintended pregnancy among all racial and ethnic groups. Poor women have rates of unintended pregnancy five times higher than the most affluent women. Because of unintended pregnancies, African-American and Hispanic women rely on abortion more than white women do. Similarly, poor women have abortion rates six times that of affluent women.
Unintended pregnancies ending in the birth of a child are increasing in the U.S. Unintended births occur disproportionately among poor minority women with limited educational attainment -- women in greatest need of family planning and abortion services. As noted by the Centers for Disease Control and Prevention, unintended pregnancies are associated with a range of adverse outcomes for the mother and her child, including premature birth and low birth weight.
Coping with the Hyde Amendment:
About one in four female recipients of Medicaid is unable to obtain a desired abortion. That three out of four poor women manage to scrape together the necessary funds speaks to their determination to prevent an unwanted birth. This often entails further sacrifice for an already impoverished family by diverting money intended for rent (14 percent), food (16 percent) or utility and other bills (30 percent).
If a poor woman cannot find the money for an abortion, her default option is rearing a child -- the costs of which are dramatically higher. Forced childbearing can plunge a poor family deeper into poverty. That women in the richest country in the world today are forced to choose between food for their families and health care is inexcusable.
Separate and unequal:
The Hyde Amendment established a two-tier system: those who can afford to exercise their constitutional right to abortion, and those who cannot. Supreme Court Justice Thurgood Marshall wrote an impassioned dissent to Harris v. McRae (which in 1980 ruled the Amendment constitutional albeit not necessarily good social policy).
He warned that the Hyde Amendment is a:
...Form of discrimination repugnant to the equal protection of the laws guaranteed by the Constitution... and 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.
More enlightened states:
Paying for abortions requested by Medicaid recipients is both a good social and economic policy. Every dollar invested in publicly-funded abortions saves more than four dollars in later costs to society. Currently, 17 states pay for such abortions through state funds; four of these do so voluntarily* and 13 do so to comply with a court order:
- New Jersey
- New Mexico
- New York*
- West Virginia
Toward racial equality:
Should H.R.7 pass both houses, the president has vowed to veto this bill, since "The federal government should not be injecting itself into decisions best made between women, their families and their doctors." Momentum is growing to overturn the Hyde Amendment as well.
The Hyde Amendment and H.R.7 target poor women who are disproportionately African-American or Hispanic. They establish a two-class system of medical care, a concept deemed unconstitutional for public education. The ethical principles of beneficence, autonomy and justice should guide health care in our nation. Depriving large numbers of citizens equal access to constitutionally-protected health care violates the principle of justice. This blatant discrimination must be rejected, not codified in law. As Martin Luther King observed: "The time is always right to do what is right." The time is right to remedy this festering sore on the body politic.