At the Planned Parenthood health center in Washington, D.C.—where I work as a physician—a counselor and I reviewed the files of patients I was to see that day. One individual, who I’ll call Lucy, was a very young patient there for an abortion, accompanied by her parents. All three were in agreement that continuing her pregnancy was not an option for physical, mental and emotional reasons.
During her ultrasound, we discovered Lucy was much later in her pregnancy than previously thought, so we would not be able to perform her procedure—but instead would refer her to a hospital for care.
As I began a discussion with Lucy and her parents explaining the need for hospital care, all three began to cry. Lucy’s mother told me that they did not have money to be seen anywhere else, especially not a hospital. Her mother told me that the family had Medicaid, but I knew that because of restrictions imposed by a federal law called the Hyde Amendment, their insurance would not cover Lucy’s abortion care.
Without insurance or the money to pay out-of-pocket for the procedure, it was likely that Lucy would have no option but to carry the pregnancy to term.
Her father turned to me with tears in his eyes and asked if there was anything I could do to help them. As I sat there with this family, I felt intensely empathetic with their situation, devastated at my inability to help Lucy, and angry and frustrated at the law that was coming between my patient and the care she needed.
I became an obstetrician-gynecologist over 15 years ago because I want to provide quality care, including abortion care, to anyone in need who comes through my doors. But the Hyde Amendment often prevents me from being able to do so.
For over 40 years, the Hyde Amendment has blocked federal insurance from covering abortion care outside of the exceptions of rape, incest, or life endangerment. And, unlike other states or jurisdictions, the District of Columbia is further prohibited by Congress from using its own money to provide abortion coverage to its residents. Lucy is only one of over 55,000 reproductive-age women in D.C. enrolled in Medicaid who is affected by these restrictions.
One in four women will access an abortion over the course of their reproductive lives. Yet, Hyde intentionally deprives many of my patients—often people with low incomes who hail from communities of color, those most likely to use Medicaid as their health insurance—from being able to afford this crucial type of healthcare.
This policy has real-life impacts. My patients have had to make life-altering health decisions based on financial constraints. Many have been forced to choose between buying food for their families and receiving critical health care.
The Hyde Amendment not only restricts abortion coverage under Medicaid in D.C. and across the country, but also under the Indian Health Service, Medicare and the Children’s Health Insurance Program. Over the years, its language has been incorporated into a range of other federal programs so that abortion care is also restricted for federal employees and their dependents, military service members, Peace Corps volunteers, immigrants, incarcerated individuals, Native Americans and residents of Washington, D.C.
So, in addition to the policy denying coverage to Lucy, it also denies coverage to many of my other patients. Helen, a federal employee, suffered serious complications with her previous pregnancy, and she and her family worried the same would happen in this pregnancy. Helen’s federally-funded insurance would not pay for her abortion, so she had to pay for it out-of-pocket. In addition to that cost, she also incurred the costs of taking time off of work, paying for childcare and for transportation.
While I recognize that individuals may have complicated feelings about abortion, when people like Lucy and Helen need to end their pregnancies, it is imperative they have access to affordable, quality medical care. Their access should not depend on how much money their families earn or where they live.
We need to understand the real-life impact of the Hyde Amendment. Health insurance should cover all healthcare needs, and any healthcare program that respects and upholds reproductive health must cover abortion care. This kind of reality for health care is not impossible; right now, our policymakers have the ability to pass a bill called the EACH Woman Act, which would leave health decisions with patients—those most equipped to make them. It would eliminate many restrictions to abortion care, including the Hyde Amendment.
Removing bans placed by the Hyde Amendment is critical to ensuring abortion care is not a luxury afforded by a few, but instead is healthcare that can be accessed by anyone who needs it. My patients deserve nothing less.
