When We Talk About Medicare, We Need to Talk About the Hyde Amendment

Medicare for All has been a fiercely debated topic throughout the Democratic debates—but little attention has been given to the current harmful Medicare restrictions on abortion access.

Restrictions on abortion are pushing care out of reach for many, and these laws fall especially hard on people of color, low-income people and young people. Roe v. Wade may uphold the legal right to abortion, but access to abortion in the United States depends on the state you live in and how much money you have.

That’s a big deal: Research has consistently shown that policies that ensure abortion is covered by insurance and is accessible to people regardless of income, promote people’s rights to make decisions about their reproductive lives and protects their health and well-being, an research has also shown that those who did not receive a wanted abortion were more likely to be living in poverty four years later and faced greater overall economic hardship than those who did receive a wanted abortion.

In New York, policy makers affirmed the right to abortion by codifying it into law and expanding the provision of care. To help ensure that Roe is a reality for all people in Massachusetts, lawmakers and advocates are similarly working to pass a bill that would expand and improve access to abortion for uninsured individuals in the Commonwealth.

The ROE Act would establish insurance coverage for abortion for individuals not able to enroll in MassHealth—coverage that already exists for all other pregnancy-related care—and expand abortion services to those seeking care after 24 weeks in cases of fatal fetal diagnosis, eliminate the onerous judicial bypass process for minors and the mandatory 24-hour waiting period and revise medically inaccurate and inflammatory language that effectively establishes fetal personhood and marginalizes the lives of pregnant people. 

In sharp contrast, Alabama this year enacted legislation that bans abortion in the state completely, except in cases where the mother’s life is in danger, and Georgia, Kentucky, Louisiana, Mississippi and Ohio passed bans on abortion after just six weeks of pregnancy, before most people even know they’re pregnant.

Nationally, anti-abortion policies are expanding: The Trump administration enacted new restrictions on Title X funding that amounted to a domestic gag rule. And for the past four decades, Congress has renewed the Hyde Amendment—a law that denies Medicaid enrollees affordable abortion care and has made safe and legal abortion care inaccessible for low income people across the country since 1977. 

Massachusetts is one of only 16 states use their own state funds to pay for all or most abortions. In the District of Columbia or any of the 34 states that impose the Hyde Amendment, patients seeking abortion care could instead be forced to pay hundreds of dollars out-of-pocket. (One recent study found that patients paid $575 out-of-pocket on average because Medicaid would not cover their abortion.)

Even in Massachusetts—where the majority of residents have health insurance, and MassHealth covers abortion services—one Ibis study found that for residents not able to enroll or stay enrolled, the cost of abortion care continued to be a significant hardship. 

The cost of an abortion is further compounded by logistical expenses—traveling out of state for care, finding accommodations for multi-day procedures, arranging for child care and missing school or work. These mounting expenses can lead to delays in care or force the continuation of an unwanted pregnancy

Restrictive policies like the Hyde Amendment exacerbate already challenging financial situations and rob people of their ability to exercise autonomy in decisions about family planning. Everyone should be able to get safe, affordable, quality abortion care, free from political interference and unnecessary regulations.

That’s why we must ensure abortion laws are grounded in rigorous research and designed to improve the health and lives of all people. Armed with powerful evidence, together we can advance policies that support reproductive rights and justice.


Samantha Ruggiero is a Research Assistant at Ibis Reproductive Health.