For the first time in nearly 30 years, a US president has released a budget that doesn’t ban federal funding for abortion.
On Friday Joe Biden released his full budget proposal for fiscal year 2022, and in keeping with his campaign promise on abortion access, Biden did not include the Hyde amendment, an annual budget rider that bans federal Medicaid money from being used for almost all abortions. (There are exceptions for pregnancies resulting from rape or incest or that would threaten the pregnant person’s life.)
Hyde dramatically limits abortion coverage for millions of people with low incomes enrolled in the federal health insurance program, creating a two-tiered system of access. Advocates and lawmakers have called Hyde discriminatory, harmful and racist. But for years, Democratic and Republican administrations upheld the ban because of voter support and anti-abortion stigma.
“We are thrilled that President Biden kept his campaign promise and submitted a budget without the Hyde amendment,” said Destiny Lopez, the co-president of All* Above All, a reproductive justice organization that has led the effort to repeal abortion coverage bans. “The Hyde amendment has, for more than 40 years, denied insurance coverage of abortion for people working to make ends meet and today will mark the first time in literal decades that our president has submitted a budget without the Hyde amendment.”
Reproductive rights and justice advocates have long noted that a right to abortion without access is a right in name only, and restrictions like Hyde can place often insurmountable barriers to access abortion, while perpetuating racial and economic inequality – two issues Biden campaigned on. Black, Latino and LGBTQ people are disproportionately likely to have low incomes and get insurance through Medicaid, thereby facing the coverage ban.
Abortion at 10 weeks of pregnancy costs an average of $550, and costs increase as the pregnancy progresses. People face other costs including taking unpaid time off work, childcare as most people seeking abortions are already parents, and travel costs. People with low incomes may need time to gather funds because their insurance doesn’t cover abortion and they can get caught in a cruel cycle as the procedure just gets more expensive, or even approach the gestational limit in their state.
Taken together, Hyde functions as a de facto abortion ban for many. A 2009 literature review estimated that one in four women with restricted Medicaid would have an abortion if their insurance covered it but instead are forced to carry the pregnancy to term. A 2019 study in Louisiana came to a similar conclusion. Women denied a wanted abortion are more likely to experience poverty both six months and four years later than are those who receive an abortion, per a 2018 study.
A 2019 poll commissioned by All* Above All found that six in 10 registered voters believe Medicaid should cover abortion services just like it covers other pregnancy-related care. And Lopez said ending Hyde fits squarely within Biden’s stated priorities of racial equity and economic security. “The president and the administration understand that the same folks who are bearing the brunt of this pandemic, and the brunt of this national reckoning on racial justice, are the ones who have been harmed by Hyde,” she said.
Friday’s budget is historic, said Yamani Hernandez, executive director of the National Network of Abortion Funds, a membership organization for mutual aid groups that help people pay for abortion expenses and coordinate travel. “For years, Black, Indigenous and people of color have organized to highlight abortion injustices that have disproportionately weighed on their shoulders, and today they have finally been heard,” Hernandez.
While 16 states use their own funds to cover abortion for Medicaid enrollees, in 2019, 7.7 million reproductive-age women with Medicaid lived in the 34 states and Washington DC that ban abortion coverage. Of the women subject to the bans, 51% are women of color. The move will have less effect in the 12 states that still have not expanded Medicaid because without higher income thresholds, it’s harder for low-income adults without children to qualify for the program.
Biden’s budget also removes a ban on abortion coverage for low-income residents of Washington DC. It was not clear at press time if the budget included other restrictions similar to Hyde that limit coverage for people with disabilities insured through Medicare, as well as for federal employees, military personnel, Native Americans using the Indian Health Service (IHS), Peace Corps volunteers, people incarcerated in federal prisons, and. In fiscal year 2015, federal funds covered just 160 abortions.
Hyde has been passed every year since 1976 and not since 1993 has a president released a budget without Hyde, though that effort from President Bill Clinton failed in the House. Repealing Hyde was in the Democratic party platform for the first time in 2016 and in the 2020 cycle, Biden was the last Democratic presidential candidate to support its repeal. Following criticism in June 2019, Biden reversed his long-held support and said, “I can’t justify leaving millions of women without access to the care they need and the ability to … exercise their constitutionally protected right.”
Proponents of repealing Hyde were worried that Biden might not follow through with his campaign promise, especially since he has yet to even say the word “abortion”. Advocates say it is an important show of support at a critical time: Last week, the supreme court agreed to hear a case regarding a Mississippi 15-week ban that directly challenges Roe v Wade, the 1973 case that legalized abortion.
Biden’s move may be largely symbolic, though an important act to advocates. The president’s budget proposal is non-binding, and it’s up to Congress to write and pass the final version that gets sent to his desk. The House appropriations committee chair, Rosa DeLauro, has vowed not to include Hyde in future House spending bills, a move that the House speaker, Nancy Pelosi, supports. If the budget passes the House, it will face a 50-50 Senate, with several centrist Democratic senators who support Hyde. Senators Joe Manchin of West Virginia, Bob Casey of Pennsylvania and Tim Kaine of Virginia all voted to include Hyde in the Covid-19 relief bill passed in March, but the effort ultimately failed.
“As with many progressive issues, the Senate is more challenging,” Lopez said, adding: “We will get there. It’s important to put down these markers of support, for the leader of our party to put down a marker that he supports abortion justice, that he supports lifting of abortion coverage bans.”
Separately, the House has introduced legislation known as the Each Act that would permanently repeal the Hyde amendment, removing it from the annual budget process. Vice-President Kamala Harris co-sponsored the bill when it was first introduced in 2019.