How Health Care Reform Means More Access to Abortion, Not Less

Photo by Mark Ralston/AFP/Getty Images.

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No one seems to have much noticed, but the health care bills winding their way through Congress will do more to expand abortion access in low-income communities than any single step since the Supreme Court’s 1973 ruling in Roe v. Wade. That’s not what you’ve been hearing as the fight over the Stupak amendment rages. But as the bills are written, it’s true.

The bill passed by the House last month would extend Medicaid coverage to Americans with incomes of up to 150 percent of the federal poverty line, or about $16,000 for a single person, by 2013. The Senate package is slightly less generous: It would apply to those with incomes of up to 133 percent of the federal poverty line, or about $14,000 for a single person, and it wouldn’t kick in until 2014. Still, the Congressional Budget Office estimated that either bill would add 15 million people covered by Medicaid over the course of the next decade.

That in itself won’t increase abortion access, because the Hyde amendment, passed by Congress in 1976, bars the federal government from reimbursing states for abortion-related Medicaid expenses (with exceptions for rape and incest, as well as abortions that are necessary to protect the life of the mother). But importantly, Medicaid is a joint federal-state program. And in 13 states, courts have ordered state governments to use their own money to fund abortions for women who receive Medicaid—of whom there will be millions more, post-health care reform.

The states administer Medicaid, and the federal government reimburses the states for somewhere between 50 cents and 84 cents of every Medicaid dollar that they spend. The Hyde amendment prevents the federal government from reimbursing the state’s abortion expenses, but it doesn’t stop the states from paying for abortion on their own. In 1981 in Massachusetts, a Medicaid recipient who went by the pseudonym “Mary Moe” joined several other plaintiffs and sued the state to pay for abortions. In 1981, the state’s highest court ruled that Massachusetts could not discriminate between women who choose to terminate their pregnancies and women who choose to carry to term. If the state paid the medical bills of the latter, it had to pay for the former as well.