Revisiting public funding of abortion for poor women.

Declarations made this year in the course of the presidential campaign have given new hope to advocates who have long been frustrated in their attempts to ensure that women at all income levels have the ability to exercise their constitutional right to choose abortion. These advocates decry the practical impact of the so-called Hyde Amendment, measured both in the sacrifices of women who struggle to find another source of funds for an abortion and in the births to those unable to do so. This impact is only compounded, they say, by the meager and diminishing level of government support for low-income mothers in the post-welfare reform era.

After years languishing on the political back burner, the issue of public funding of abortion for poor women was brought into focus this winter by debates between the Democratic presidential hopefuls. Seeking to reconcile his prior opposition to Medicaid funding except in the rarest and most extreme circumstances with statements that he has "always been prochoice," Vice President Al Gore explained his antifunding stance during the late 1970s and early 1980s as consistent with the majority opinion in Congress to "keep the government completely out of it" in deference to taxpayers opposed to abortion. Over time, he said, he came to realize that prohibitions on abortion funding carried "an inequitable result" and denied poor women "the practical ability" to exercise their right to abortion.

Vice President Gore's explicit acknowledgment that to be fully prochoice means working both to guarantee the legal right to abortion and to secure women's real-world ability to access abortion services is heartening to advocates of poor women's reproductive rights and health. Fully aware of the uphill nature of the battle, key groups are embarking on a renewed campaign for poor women's abortion rights and reproductive equity.

Two Decades of Restrictions

The political debate over Medicaid funding has been waged with varying intensity for a quarter of a century. The first version of the Hyde Amendment, named after Rep. Henry Hyde (R-IL), went into effect in August 1977. It forbade the expenditure of federal funds for abortion services, except in cases where the continuation of the pregnancy threatened the woman's life, under all programs administered by the Department of Health, Education and Welfare (now the Department of Health and Human Services). The measure primarily affected Medicaid (Title XIX of the Social Security Act), the program under which the federal and state governments share the cost of necessary medical and surgical care for many of the poorest Americans, in particular women who receive welfare benefits on behalf of their children.

Congress has renewed the Hyde Amendment every year since, albeit with some modifications. In the early years, the annual debates were protracted and intense. In 1978, the standard was liberalized somewhat to include exceptions for "promptly reported" rape and incest and "severe and long-lasting physical health damage" confirmed by two physicians--a health exception far narrower than the standard set in 1973 by the U.S. Supreme Court in Doe v. Bolton, which clarified that in the context of abortion, "health" must be broadly defined to include both physical and mental health concerns. In 1979, the limited physical health exception was dropped, and the rape and incest exceptions were eliminated during the first year of the Reagan administration in 1981. While these policy changes did have some practical effect, federal funding of abortion under each of these policies was a mere fraction of the funding from pre-Hyde years.

It was not until the Clinton administration came to power that debate over the Hyde Amendment once again was joined. Even then, the restrictions were eased only slightly to allow funding for abortion in cases of rape and incest, as well as for life endangerment. And even that minor liberalization was short-lived. The current version of the Hyde Amendment, enacted in 1997, tightens the life exception to permit payment only when the woman's life is threatened by "a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself." It also provides that these restrictions be included in any Medicaid managed care benefits package funded with federal dollars; states funding abortions in circumstances beyond those allowed by the Hyde Amendment must contract separately with their participating managed care plans for such services.