Orange County, NC Commissioners Resolution

On October 20, 2020 the Orange County Board of Commissioners unanimously adopted Resolution 65, introduced by Chair Penny Rich. More than 23% of North Carolinians of reproductive age are impacted by coverage bans in the state. Currently, NC Medicaid and insurance plans sold on the Exchange are prohibited from covering abortion with limited exceptions — that along with a host of other restrictions in state and federal law effectively ban the use of insurance to cover the cost of abortion.

Recognizing that no one should be denied access to abortion just because they are struggling financially, the Orange County Board of Commissioners called for the repeal of the Hyde Amendment and urged the governor to support measures that promote access to the full range of reproductive health care for North Carolinians.

 

The Hyde Amendment: FAQ

How does the Hyde Amendment restrict insurance coverage of abortion care?

Issued September 2020

  • The Hyde Amendment is a policy that bans the use of federal funds to pay for abortion care except when a pregnancy endangers the life of the pregnant person, or when it results from rape or incest.1 Since 1976 Congress has inserted the Hyde language in the annual appropriations. 1
  • This restriction on federal funding has been expanded to a number of federally funded health insurance programs, including Medicaid, Medicare, the Children’s Health Insurance Program, the Federal Employee’s Health Benefits Program, and the Indian Health. 1
  • US states may elect to use state-based funding to pay for the abortion care that the Hyde Amendment prohibits for individuals enrolled in Medicaid; however, as of April 2020 only 16 states do.2

Who is affected by coverage bans on abortion?

  •  Abortion is a common and safe procedure with very few risks.3 In 2017, 18.4% of all pregnancies in the United States ended in abortion.4 In the same year, the US abortion rate was 13.5 abortions per 1,000 women of reproductive age.4
  • In the United States, most women who have an abortion are struggling financially and already face significant barriers to health care. A majority pay out-of-pocket for their care.5
  • Among US women aged 15-49, 19% were covered by Medicaid and one percent by Medicare in 2018. Both programs ban abortion coverage and Medicare recipients cannot have their abortion care covered by state funds because it is fully funded by federal dollars.6 Medicaid coverage is disproportionately higher among women living below the Federal Poverty Level (FPL), women of color, single parents, and women with lower educational attainment.7  In 2018, 14% of nonelderly adult women in the United States had incomes at or below the FPL.8
  • Sixty-seven percent of all women enrolled in Medicaid were of reproductive age.7 Over half of women of reproductive age who were enrolled in Medicaid in 2018 lived in states that apply the Hyde restrictions to their state funds. 1
  • Data on the number of women of reproductive age who rely solely on the Indian Health Service for their sexual and reproductive health care are not available. However, in 2018, there were 700,940 American Indian and Alaska Native women 15-50 years of age in the United States.9
  • Most women who obtain abortion care are parents; 29% report that caring for their existing family is a primary reason for obtaining an abortion.10

How do abortion coverage bans impact pregnant people?

  • Pregnant people may be unable to find a local abortion provider. The number of abortion-providing facilities in the United States decreased five percent between 2014 and 2017.4 Thirty-eight percent of reproductive-age women in the United States live in a county that lacks an abortion provider.4 A recent analysis of disparities in access to abortion care found that although the median distance to an abortion provider in the United States is 10.79 miles, 20% of US residents may have to travel up to 42.54 miles or farther to reach a provider.11
  • Pregnant people may struggle to afford abortion. Pregnant people residing in 33 states and the District of Columbia are unable to use their Medicaid health insurance to cover the cost of abortion care unless their pregnancy results from rape or incest, or is life-endangering.2 Such a time-sensitive and unanticipated out-of-pocket expense can mean forgoing food, rent, or household bills for pregnant people whose insurance will not cover the cost of an abortion.12,13 Over half of the women in one study of abortion patients said such costs amounted to more than one-third of their personal monthly income.13 Individuals seeking abortion after 20 weeks in a pregnancy faced costs nearing two-thirds of their income per month.13
  • Pregnant people may be forced to delay care. Even for those who are able to afford care, a lack of available or accessible care may result in additional delays. Many pregnant people are not able to obtain abortion care as early as they would like and attribute delays to the time it took to discover their pregnancy, arrange care, and to decide whether or not to continue the pregnancy.14

What are the impacts of being denied a wanted abortion?

  • Women who do not obtain a wanted abortion are more likely to subsequently live in poverty.15Women unable to obtain a wanted abortion may be more likely to be unemployed and less likely to have the financial resources to afford household essentials such as food and the cost of housing.15 The negative financial impacts of abortion denial have been found to persist for up to several years.16
  • Pregnant people can face risk of violence. Carrying an unwanted pregnancy to term can slow a woman’s separation from the man involved in the pregnancy.18 For women experiencing intimate partner violence, this can mean they and their children are at continued risk of violence from that partner.19

References

  1. Salganicoff A, Sobel L, Ramaswamy The Hyde Amendment and coverage for abortion services: Kaiser Family Foundation; 2020.
  2. Guttmacher State funding of abortion under Medicaid. 2020; https://www.guttmacher.org/state-

policy/explore/state-funding-abortion-under-medicaid. Accessed April 29, 2020.

  1. National Academies of Sciences Engineering and The safety and quality of abortion care in the United States: National Academies Press;2018.
  2. Jones R, Witwer E, Jerman Abortion incidence and service availability in the United States, 2017. New York: Guttmacher Institute;2019.
  3. Jerman J, Jones R, Onda Characteristics of US abortion patients in 2014 and changes since 2008. New York: Guttmacher Institute;2016.
  4. Kaiser Family Foundation. Health insurance coverage of women ages 15-49, 2018. https://wkff.org/other/state-indicator/health-insurance-coverage-of-women-ages-15-49/? currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed April 30, 2020.
  5. Kaiser Family Medicaid’s role for women. 2019; https://www.kff.org/womens-health-policy/ fact-sheet/medicaids-role-for-women/.
  6. Kaiser Family Nonelderly adult poverty rate by gender estimates based on the Census Bureau’s American Community Survey, 2009-2018.
  1. United States Census Bureau. American Community Survey 1-Year Estimates Selected Population Profiles: American Indian and Alaska Native.
  2. Biggs M, Gould H, Foster Understanding why women seek abortions in the US. BMC women’s health. 2013;13(1):29.
  1. Bearak J, Burke K, Jones Disparities and change over time in distance women would need to travel to have an abortion in the USA: a spatial analysis. The Lancet Public Health. 2017;2(11):e493-500.
  2. All* Above All and Ibis Reproductive Health. Research brief: The impact of out-of-pocket costs on abortion care access. 2016; https://wibisreproductivehealth.org/publications/research-brief-impact- out-pocket-costs-abortion-care-access.
  3. Roberts S, Gould H, Kimport K, Weitz T, Foster Out-of-pocket costs and insurance coverage for abortion in the United States. Women’s Health Issues. 2014;24(2):e211-218.
  4. Finer L, Frohwirth L, Dauphinee L, Singh S, Moore Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception. 2006;74(4):334-344.
  1. Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States. American journal of public health. Mar 2018;108(3):407-413.
  2. Miller S, Wherry L, Foster The economic consequences of being denied an abortion: National Bureau of Economic Research; January 2020.
  3. Foster DG, Raifman SE, Gipson JD, Rocca CH, Biggs Effects of carrying an unwanted pregnancy to term on women’s existing children. J Pediatr. Feb 2019;205:183-189 e181.
  4. Mauldon J, Foster D, Roberts Effect of abortion vs. carrying to term on a woman’s relationship with the man involved in the pregnancy. Perspectives on Sexual and Reproductive Health. 2015;47(1):11-18.
  5. Roberts S, Biggs M, Chibber K, Gould H, Rocca C, Foster Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion. BMC Medicine. 2014(12):144.

Fact Sheet: About the Hyde Amendment

The Hyde Amendment is language in the yearly Labor, Health and Human Services, Education and Related Agencies (often shortened to Labor-H or LHHS) appropriations legislation that bars programs in these agencies from covering abortion. This restriction primarily withholds abortion coverage from those qualified and enrolled in the Medicaid health insurance program for low-income people, except in the limited cases of rape, incest, and life endangerment.

The Hyde Amendment is designed to deprive poor and minority women of the constitutional right to choose abortion.”

-Supreme Court Justice Thurgood Marshall (1980)

THE HYDE AMENDMENT PAVED THE WAY FOR OTHER FEDERAL ABORTION COVERAGE RESTRICTIONS

Since the Hyde Amendment passed in 1976, anti-choice politicians have added abortion coverage and funding bans to appropriations language  that restricts: Medicaid, Medicare and Children’s Health Insurance Program enrollees; Federal employees and their dependents; Peace Corps volunteers; Native Americans; women in federal prisons and  detention centers, including those detained for immigration purposes; women who receive health care from community health centers; survivors of human trafficking; and low-income women in the District of Columbia.

Click here for more on state laws related to insurance coverage of abortion.

REAL WORLD IMPACT OF THE HYDE AMENDMENT

  • Medicaid coverage can mean the difference between getting abortion care or being denied. Studies show that when policymakers place severe restrictions on Medicaid coverage of abortion, it forces one in four poor women seeking an abortion to carry an unwanted pregnancy to term.1
  • When a woman is living paycheck to paycheck, denying coverage for an abortion can push her deeper into poverty. Indeed, studies show that a woman who seeks an abortion but is denied is more likely to fall into poverty than one who is able to get an abortion.2
  • According to the most recent data, 58% of women of reproductive age enrolled in Medicaid or CHIP live in states that ban Medicaid coverage for abortion except in limited circumstances. 51% of these enrollees are women of color.3
  • The Hyde Amendment creates an often insurmountable barrier to abortion for women across the country already struggling to get affordable health care, and disproportionately affects those who are low-income, people of color, young, immigrants, or live in rural communities.

 

The Hyde Amendment is not permanent law. Congress has the opportunity to lift the Hyde Amendment each year. Tell them to take action now.

 

Sources:
1 Henshaw SK et al., Restrictions on Medicaid Funding for Abortions: A Literature Review, Guttmacher Institute, 2009. Available at http://bit.ly/1IK5XcF.
2 Foster DG, Roberts SCM and Mauldon J, Socioeconomic consequences of abortion compared to unwanted birth, abstract presented at the annual meeting of the American Public Health
Association, San Francisco, Oct. 27–31, 2012. Available at http://bit.ly/1PvNd4w.
3 Donovan, M., In Real life: Federal Restrictions on Abortion Coverage and the Women They Impact, Guttmacher Institute. Guttmacher Policy Review. Vol. 20. 2017. Available. At http://bit.ly/2j6Ec3W.

City of Easthampton, MA Council Resolution

A resolution supporting the ROE Act and full access to abortion.

City of Greenfield, MA Council Resolution

A resolution supporting full access for abortion, the ROE Act, and reproductive justice.

Town of Amherst, MA Resolution

A resolution affirming support for access to safe and legal abortion in the Commonwealth of Massachusetts and across the United States.

 

 

City of Northampton Council Resolution

A resolution affirming support for access to safe and legal abortion in the Commonwealth of Massachusetts and across the United States.

 

City of Somerville Council Resolution

A resolution supporting full access to abortion and reproductive justice.

Sample Letters to the Editor

Dear Editor,

While abortion has been legal the U.S. thanks to the Roe v. Wade Supreme Court decision, abortion care remains effectively out of reach for too many people. The reason? The Hyde Amendment, first passed in 1976, bans coverage of abortion for women enrolled in Medicaid health insurance. And, the Trump administration and his friends in Congress have already tried three times this year to make it harder for those with private health insurance to get coverage for an abortion.

This interferes with one of the most important decisions anyone can make—whether or not to become a parent. However we feel about abortion, no one should be denied insurance coverage for it just because she’s poor.

The EACH Woman Act will ensure each of us has abortion coverage, however much money we make, wherever we live, or however we get our health insurance.

And, the Trump administration is currently considering rules that would it harder for women with private health insurance to get coverage for an abortion.

We don’t have to imagine what it looks like when abortion is pushed out of reach. Restricting Medicaid coverage of abortion forces one in four poor women seeking abortion to carry an unwanted pregnancy to term. In fact, women who are denied abortion care are more likely to fall into poverty.

It’s time Congress pass the EACH Woman Act now to ensure extremist politicians no longer interfere with a woman’s decision whether or not to have an abortion and so that every woman will have insurance coverage for abortion, however much money she makes.

 

Dear Editor,

When a woman decides to end her pregnancy, it is important that she has access to safe, affordable medical care. And the best way to do this is by providing insurance coverage – whether public or private – so she can see a licensed, quality health provider and make the best decisions for herself and her family.

Each of us faces different circumstances, and whatever our personal experience, we should be able to get the care we need without politically-motivated interference. It is imperative that we safeguard women’s health and well-being by ensuring that everyone has insurance coverage for the pregnancy care they need, including abortion care, without potentially harmful delay or interference.

When it comes to the most important decisions in life, such as whether to become a parent, it is vital that a woman is able to consider all the options available to her, however she receives her health coverage.

Passing the EACH Woman Act gets us one step closer.

 

Dear Editor,

Lack of insurance coverage for abortion for poor women is one of the main barriers to reproductive health equity in this country. That’s why passing the EACH Woman Act to ensure every woman has insurance coverage for abortion is long overdue.

When it comes to the most important decisions in life, such as whether to become parent, it is vital that a woman is able to consider all the options available to her, however much money she makes. It’s not our place to interfere with her decision by withholding coverage. Decisions like these are best left to a woman, her family, and her health care provider.

We simply can’t always know a woman’s unique circumstances, therefore it is not our place to judge her experience or decisions.

I urge my [U.S. representative/U.S. senator NAME] to support the EACH Woman Act and for politicians to stop interfering with a woman’s ability to make her own important health care decisions by imposing restrictions on abortion coverage.

St. Louis, MO Board of Alderman Resolution

On February 1, 2019, the St. Louis Board of Alderman passed Resolution 225, introduced by Alderman Annie Rice. Currently, MO HealthNet, the state’s Medicaid program, restricts the coverage of abortion for the more than 10,000 women enrolled in Medicare across St. Louis, and a series of other restrictions in state and federal law effectively ban the use of insurance to cover abortion costs in Missouri. This resolution called for the passage of policies, including the EACH Woman Act, which would allow all women access to the full range of pregnancy-related health care, including abortion, regardless of their public or private insurance. It also called on other state and federal officials to end bans on abortion coverage for women in public insurance programs.