Restrictive Federal Funding for Abortion is Economically Burdensome to the Individual and the Nation.

Executive Summary: The Hyde Amendment (Hyde) hinders abortion access to people who can become pregnant (we will refer to this cohort henceforth as “women” and recognize that not all people who can become pregnant identify as such) whose health insurance is funded by the national government. This disproportionately affects marginalized women. The Conservative party passed incremental laws to restrict abortion access, including but not limited to, gestational age and specific procedure limitations, waiting periods, parental consent, and Targeted Regulation of Abortion Providers (TRAP) laws. To uphold reproductive rights, a counter approach is needed to mitigate disparities in women most affected by Hyde. Now, more than ever, it is essential that funding is not a barrier to care in the states which continue to protect abortion rights.

Key Messages:

• Hyde withholds federal funds from covering abortion services in nearly all circumstances except rape, incest, or life endangerment.
• The lack of financial support engendered by Hyde prompts individuals to raise their own funds for abortion or carry a pregnancy to term.
• The long-term impacts of Hyde on the national economy and welfare system are greater than the acute cost of covering abortions.
• Some states are noncompliant with the minimal federal requirements set forth by Hyde and must be held accountable to the law to ensure equitable access to abortion care (Figure 1).
• We propose permanently ending the renewal of the Hyde Amendment through the passage of the EACH Act. This will counteract the increasingly restrictive encroachment of abortion rights.

Figure 1: Map of the United States depicting state limits to abortion coverage due to Hyde and how it impacts women covered by Medicaid. Source: KFF.org

Impoverished women on federal assistance programs such as Medicaid and Children’s Health Insurance Program are often highlighted in abortion debates. However, Hyde impacts people from many walks of life which is often understated. This includes federal employees, Washington D.C. residents, Native Americans on Indian Health Service funding, federal prisoners, Medicare beneficiaries, and Peace Corps volunteers.

Hyde has Repercussions on both the Private Citizen and the Public Economy

Abortions are financially burdensome. The average price of an early abortion at 10 weeks gestation is $500 and doubles at 20 weeks of gestation, at a median price of $1,195.90. Women marginalized by Hyde are prone to late gestation abortions. This is driven by factors which increase the likelihood of a second-trimester abortion which include dropping out of high school, relying on financial assistance to pay for the procedure, and living more than 25 miles from a provider. For example, Peace Corps volunteers, a group supported by federal insurance, must travel back to the U.S. to pay out of pocket for abortion care, all while receiving a meager $ 250–300/month stipend. For women that do receive abortions, approximately 75% of them are low-income. For these impoverished women, nearly one third of their monthly income must be diverted from paying for rent or food to cover abortion costs. Women who can’t access abortion are at four times greater odds of living below the federal poverty level. With the current funding limitations imposed by Hyde, marginalized women must sacrifice their upward mobility and choose between caring for a child or paying for an abortion, both of which they can’t afford.

The restrictions imposed by Hyde cause a ripple effect on the country as a whole. 505,000 more women could be in the labor force in a hypothetical situation with zero state-level abortion restrictions. An estimated $105 billion is lost each year per state secondary to the reductions in labor force with current abortion restrictions. The national GDP would rise by an estimated 0.5% if all restrictions were lifted . Collectively, the financial burden of abortions to both women and country is far less than childbirth. Compared to the one time cost of an abortion, the Medicaid price for maternal and newborn care for a vaginal and cesarean section birth averages $29,800 and $50,373, respectively. The cost to social support programs to care for both mother and child is also significant, as children comprise the largest percentage of welfare beneficiaries at 41%

Not all states are compliant with Hyde’s minimum federal requirements and some states interpreted how to execute federal laws. South Dakota (S.D.) is a key example, which provides Medicaid coverage for abortions only in cases of life endangerment but not for cases of rape or incest. S.D. violates federal law without any legal repercussions from federal oversight, including the Centers for Medicare & Medicaid Service (CMS). Only 16 states choose to allot their own funds for medical and surgical abortions outside of the situations detailed by Hyde. While 37 states report they specifically cover medication-induced abortions, only 13 of these states actually requested a reimbursement for the medication. This may be due to a state’s preference of abortion procedure, or may suggest the presence of informal, undocumented barriers to access (Figure 1). Countless women will continue to experience obscure obstacles to care unless something changes.

Policy Options

Ensure States Abide by the Minimum Federal Regulations

• Federal organizations such as CMS have identified violations to Hyde and can take legal action against these states.

Expand existing Global Abortion Policies Database (GAPD) to identify barriers to abortion and create an action arm of the GAPD to assure access to care.

• The GAPD is a comprehensive database detailing global abortion policies and guidelines. We call for collaboration with GAPD to expand an American arm of their database to include a form where women can report informal barriers to care they are experiencing. The action arm of the GAPD will comprise third-party members representing the federal government to advocate for women. They can address the identified delays in care through the proper channels and expedite the process.

Endorse the EACH act (S.1021/H.R.2234 introduced March 2021) and permanently repeal Hyde which will reduce the financial barriers to abortion care.

• If Hyde were permanently repealed, 7.7 million women of reproductive age in 33 states and Washington, D.C. would receive government financial support for abortions. The EACH act will reverse Hyde to permanently provide coverage for abortions to anyone with federal insurance. Expanding abortion coverage will improve existing disparities in abortion access and enable marginalized women to exercise their reproductive freedoms without financial barriers.

*Please note: this policy brief was written prior to the recent Dobbs V. Jackson ruling.