Many public officials espouse the view that patients and their doctors, not government officials from Washington D.C., should make health care decisions. They are right. But, if these officials want their words to be more than just empty rhetoric, they need to act quickly to remove a four-decade old barrier to health care for women who live in poverty.
Forty years ago this month, Congress passed the Hyde Amendment (named for the late Illinois Congressman Henry Hyde), which bans Medicaid coverage for abortion except in cases of rape, incest, or to save the life of the pregnant woman. In other words, Congress decided to limit health care for women struggling to make ends meet.
Nearly one in five women of reproductive age in Illinois relies on Medicaid for health insurance coverage. These women, like each of us, should be able to take care of their health and well-being by accessing a full range of legal medical procedures. Bans on insurance coverage for abortion are heavy-handed intrusions into a decision that is best left to a woman and her family. However we feel about a woman’s decision to have an abortion, politicians shouldn’t deny her health coverage because of how much money she makes.
Illinois is one of 17 states that recognizes that federal Hyde restrictions treat women unequally by denying them access to medically necessary health care, and that therefore takes steps to fill the gap in abortion coverage through state Medicaid funding. The American Civil Liberties Union of Illinois was instrumental in securing this coverage for women; our lawsuit challenging these restrictions in Illinois resulted in a 1994 court order requiring the state to cover all medically necessary abortions for women insured through the state’s medical assistance programs.
In practice, however, providers in Illinois encounter confusing instructions, conflicting paperwork requirements, and other needless obstacles to coverage. The Guttmacher Institute recently found that Illinois now provides so little coverage for medically necessary abortions through state Medicaid that it is likely in violation of our longstanding court order.
Moreover, thousands of other women in Illinois face similar obstacles based solely on the source of their insurance. State and federal politicians have passed restrictions on insurance coverage that prevent a woman from accessing abortion coverage if she works for the government, serves in the military, volunteers for the Peace Corps, is serving time in federal prison or is a Native American woman who utilize Indian Health Services.
Low-income women who cannot access coverage for abortion care through Medicaid or other insurance often delay their procedures as they attempt to come up with the money to pay for them. Making abortion coverage straightforward, transparent, and accessible better ensures that a woman will be able to see a licensed, quality health provider in a timely manner. As Justice Ruth Bader Ginsburg recently wrote in Whole Women’s Health v. Hellerstedt, “When a State severely limits access to safe and legal procedures, women in desperate circumstances may resort to unlicensed rogue practitioners . . . at great risk to their health and safety.”
Last year, the Cook County Board of Commissioners adopted a resolution calling for an end to the Hyde Amendment and other unfair limitations on insurance coverage of abortion. In doing so, Cook County joined a growing number of communities around the country that are standing up and voicing support for comprehensive reproductive health coverage that meets the real needs of women and families.
No woman should have to choose between paying rent or the water bill and getting the health care she needs. For 40 years, the Hyde Amendment has harmed women struggling to make ends meet. It’s time to bring an end to federal and state policies that limit a woman’s access to care based solely on the source of her insurance coverage. Forty years is long enough.
Amy Meek is a staff attorney with the Women’s and Reproductive Rights Project at the ACLU of Illinois