The current Republican temper tantrum over health care — you know, the one where they forced a shut-down of the entire government because they don’t want the American public to have health care coverage — is just the logical conclusion of a long line of GOP healthcare shenanigans. But usually, they’re targeting poor people, and poor women in particular. In my Guardian column this week, I’m writing about how this all goes back to the Hyde Amendment:
Thirty-seven years ago this week, the Hyde amendment was first attached to an appropriations bill. It banned any federal funding of abortion by outlawing it in the Medicaid program. Since 1976, Hyde has been reauthorized again and again. Women’s health groups routinely oppose it, even bringing and losing a Supreme Court case over it.
President Clinton managed to get an exception for rape and incest into the amendment in the 1990s. But today, outside of the civil liberties organizations and women’s advocacy groups that are still pointing out the harms wrought by Hyde, there’s little mainstream political will to seriously challenge the law, even within the Democratic party. That Democrats so easily backed down on the Hyde amendment is a real shame, because that cowardice handed the GOP an effective road map for denying healthcare coverage for people or procedures they dislike.
Medicaid and Medicare provide healthcare to low-income, elderly and vulnerable Americans, and are some of the most popular social welfare programs in the United States. They passed thanks to liberal control of Congress in the mid-1960s. But after the Supreme Court decided Roe v Wade – initially to little fanfare – in 1973, extending the right to abortion to all American women, conservatives adopted an anti-abortion position as part of its efforts to solidify a base of segregationists, newly politicized religious Christians, and other traditionalists increasingly wary of rapidly-shifting social mores around race and gender.
Enter Henry Hyde, a right-wing senator from the suburbs of Chicago, Illinois for whom abortion was a personal obsession. Realizing he couldn’t deny the right to abortion to all American women, Hyde targeted the ones he could: low-income women relying on Medicaid. The initial iteration of the Hyde amendment barred Medicaid funding for any abortion, including cases of rape or incest, even to save the pregnant woman’s life. In the years following, more progressive lawmakers managed to add in rape, incest and threat-to-life exceptions, and some individual states decided to pay for abortion care with their own funds. But Democrats were never able to do away with the amendment itself, and today it’s far from the top of the party’s priority list.
Today reproductive healthcare for low-income women is in crisis. The US has one of the highest unintended pregnancy rates among developed nations, and one of the highest maternal mortality rates. Women are more likely to die during childbirth in Republican-dominated states than in more liberal ones, and poor women are particularly vulnerable. Many pregnant women find themselves pawning their valuables in order to pay for an abortion, or begging family and friends for money.
Barriers to abortion access – Hyde premiere among them – mean that low-income women often end up having abortions later in the pregnancy than they otherwise would have, which means the procedure is more expensive and more difficult to obtain. Organizations like the National Network of Abortion Funds have sprung up to fill the gap, but they can’t meet 100% of the need.
Hyde also means that some low-income women who want to terminate their pregnancies aren’t able to get abortions at all. Those women, of course, adjust to their life circumstances as all of us do, but they are much more likely to suffer negative health and financial consequences than similarly-situated women who were able to terminate. Even when previous financial differences are taken into account, women who sought to have abortions but couldn’t are three times as likely to fall below the federal poverty line two years after giving birth.
The takeaway from Hyde should be that denying low-income people healthcare is a public health disaster, and no one should be refused a necessary and legal medical procedure because of their income. But, the GOP learned that Democrats will fold on basic rights if it only impacts poor women, and if they can isolate particular aspects of medical care that a large enough segment of the population feels morally superior about. One in three American women will have an abortion in her life, but the GOP managed to turn terminating a pregnancy into a divisive issue where half the American public thinks the government should have control.
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