What Is the Hyde Amendment?

A History, Its Impacts, and How It Might Shape Future Healthcare Reform

Illinois Rep. Henry Hyde.

Getty Images/David Hume Kennerly

The Hyde Amendment effectively prevents federal funding from being used to pay for abortions—with very limited exceptions—via any programs that are administered by the Department of Health and Human Services (HHS).

The amendment, sponsored by Rep. Henry Hyde (R, Illinois), was enacted in 1976, and although it has never become a permanent law, Congress has renewed it annually for the last four decades, attaching it as a rider to HHS appropriations bills.

The only exceptions under the Hyde Amendment are cases involving rape or incest, or when the mother's life is in danger.

Whose Coverage Is Impacted?

The amendment primarily affects women who are covered by Medicaid, but it also extends to the Children's Health Insurance Program, Indian Health Services, and Medicare (roughly a million women of child-bearing age are covered under Medicare, as the program covers those with disabilities in addition to the elderly).

And similar provisions have been enacted over the years that apply to coverage provided to women in the military (TRICARE), federal workers who get their coverage via the Federal Employee Health Benefits Program, and women who are serving in the Peace Corps.

The ban on abortion coverage for Peace Corps volunteers and women serving in the military actually went beyond the requirements of the Hyde Amendment, from 1979 through 2014 for Peace Corps Volunteers, and from 1981 to 2013 for women in the military.

The 1979 Peace Corps appropriations bill included a total ban on abortion coverage for volunteers, regardless of rape, incest, or danger to the woman's health. That ban remained in place until 2014, when a new appropriations bill extended abortion coverage to Peace Corps Volunteers in cases of rape or incest, or when the woman's life would be endangered by carrying the pregnancy to term. Since then, Peace Corps volunteers have had abortion coverage equivalent to what the Hyde Amendment provides. That's to say, it's almost never covered, but in cases of rape, incest, or danger to the mother's life, it is.

Starting in 1981, for women serving in the military, abortion was only covered if the woman's life was in danger of continuing the pregnancy. But in 2013, military coverage was extended to include coverage for abortions in cases of rape or incest, bringing it into line with the Hyde Amendment.

Medicaid Coverage of Abortions

Because of the Hyde Amendment, federal Medicaid funds (which flow through HHS) cannot be used to pay for abortions except in cases of rape, incest, or a danger to the mother's life.

Thanks in part to the Affordable Care Act's expansion of Medicaid, two out of every 10 American women of reproductive age are covered by Medicaid. And roughly two-thirds of adult women who are covered by Medicaid are between the ages of 19 and 49.

And abortions are disproportionately obtained by women who are low-income. Nearly half of the abortions performed in 2014 were for women with income below the poverty level, and a full three-quarters of abortions are obtained by women with income below 200% of the poverty level. Under the Affordable Care Act (ACA), everyone with income up to 138% of the poverty level would have access to Medicaid, but there are still 14 states that refused to expand Medicaid, and in 13 of them, there's a coverage gap. So some women with income below the poverty level have no realistic option for health insurance. Many of the rest have Medicaid, although the Hyde Amendment blocks federal Medicaid funding for abortions in most cases.

But Medicaid is jointly funded by the state and federal governments. And 16 states use state Medicaid funds to cover abortions in circumstances other than just rape, incest, or a danger to the mother's life:

  • Alaska
  • California
  • Connecticut
  • Hawaii
  • Illinois
  • Maine
  • Maryland
  • Massachusetts
  • Minnesota
  • Montana
  • New Jersey
  • New Mexico
  • New York
  • Oregon
  • Vermont
  • Washington

More than half of these states provide additional state-funded Medicaid coverage for abortions as a result of a court order. Arizona is also subject to a similar court order but continues—in violation of the court order—to only provide Medicaid funding for abortions in cases of rape, incest, or danger to the mother's life.

What About the Health Insurance Exchanges?

The Hyde Amendment does play a role in how coverage is provided and funded in each state's health insurance exchange (most of which are run by the federal government via HealthCare.gov).

All individual market plans sold since 2014—including those for sale in the exchanges—must include coverage for the 10 essential benefits defined by the Affordable Care Act (ACA). Although well-woman care, contraceptives, and maternity coverage are all required benefits, abortion is not. But federal rules do not prohibit ACA-compliant health plans from covering abortions.

States can implement their own rules in terms of whether health plans for sale on the exchange can provide coverage for abortions. As of 2019, there were 34 states that had implemented their own regulations to restrict access to abortion services on plans sold through the exchange. Most of them provided exceptions that align with the Hyde Amendment (ie, cases of rape, incest, or danger to the mother's life). And in another eight states, no plans sold through the exchange included abortion services as of 2019, even though the state had not implemented a ban. 

The exchange is the only place where premium subsidies are available, and advocates for reproductive rights have noted that in those 34 states, there is no access to affordable health insurance with abortion coverage.

But on the other side of the debate, advocates note that in states where abortion coverage in the exchanges is allowed, it can be difficult for pro-life enrollees to determine which plans cover abortions and which don't. As of 2020, there are five states—California, Oregon, Washington, New York, and Maine—where all of the plans sold in the exchange are required to provide coverage for abortion, creating an ethical dilemma for enrollees with a philosophical opposition to abortion.

Health insurance plans sold through the exchanges are partially funded via the ACA's premium subsidies. So compliance with the Hyde Amendment requires health insurers in the exchanges that offer abortion coverage—beyond the narrow exceptions in the Hyde Amendment—to collect two separate premium payments and keep them in separate accounts. That's how they ensure that subsidies are only used to offset the cost of coverage for services not related to abortions.

From the consumer's perspective, that hasn't been complicated thus far, as regulations have allowed the full premium to be paid with a single payment, with the carrier separating out the amounts after receiving the payment. But as of mid-2020, that will change. Under the terms of regulations finalized by the Trump administration in late 2019, insurers that offer non-Hyde abortion services will have to send two separate bills to enrollees—one for abortion services and one for the rest of the services the plan covers—and will have to instruct enrollees to pay the two bills with separate transactions. 

Advocates for reproductive rights have noted that this change is likely to make insurers stop offering non-Hyde abortion services altogether, due to the administrative cost of sending and processing separate invoices.

An Obstacle to Single-Payer Health Coverage

Although it was resoundingly defeated by Colorado voters in the 2016 election, single-payer advocates attempted to introduce ColoradoCare, a health coverage system that would have taken effect in 2019. The proposal was, unsurprisingly, rejected by conservatives. But it was also rejected by some progressive groups, who would normally be in favor of a single-payer healthcare proposal. One of the problems for progressive advocates had to do with abortion funding.

NARAL Pro-Choice Colorado opposed ColoradoCare on the grounds that it would eliminate coverage for abortions in the state. Their concern was that the Colorado Constitution has, since 1984, prevented the use of state funds to pay for abortion "except when necessary to prevent the death of the woman or unborn child where every reasonable effort is made to preserve the life of each."

ColoradoCare would have been funded via a combination of state and federal funds under an Affordable Care Act 1332 Innovation waiver. Although the ColoradoCare information that was put forth prior to the election didn't mention abortion at all, pro-choice advocates felt that there was no way the plan would have been able to fund abortion, and they worried that the women in Colorado who already had abortion coverage via private insurance would have lost access to coverage for abortions under ColoradoCare.

Similar concerns have been noted regarding the "Medicare for All" approach called for by Senator Bernie Sanders (D, Vermont). Since Sanders' plan would largely eliminate private plans (where abortion coverage is widely available) and replace them with federally-funded health insurance overseen by HHS (and thus subject to the Hyde Amendment) millions of women would potentially lose health insurance coverage for abortion. But Sanders has clarified that his health care reform proposal includes the repeal of the Hyde Amendment. If that were successful, abortion coverage would no longer be restricted under federally-run health programs.

Will the Hyde Amendment Be Codified into Law? Or Repealed?

While Democrats have called for repealing the Hyde Amendment altogether, the Republican Party's 2016 Platform called for codifying it into law.

In September 2016, Donald Trump—who won the presidential election later that fall—wrote a letter in which he doubled down on his opposition to abortion, including his plans to appoint anti-abortion justices to the Supreme Court, and his desire to make the Hyde Amendment a permanent law (Trump has appointed two justices to the Supreme Court as of 2020).

And the House of Representatives passed legislation in 2017 that would have made the Hyde Amendment permanent (as opposed to a rider that has to be continually reauthorized by Congress), but it didn't pass in the Senate.

But as noted above, Sen. Bernie Sanders, who is running for the Democratic presidential nomination in 2020, has proposed a "Medicare for All" program that would involve repealing the Hyde Amendment altogether. And several other top contenders for the Democratic nomination have expressed support for repealing the Hyde Amendment. But the spending bill passed by the House of Representatives in 2019 included the Hyde Amendment, despite the fact that Democrats now have a majority in the House. 

The Hyde Amendment remains a political hot potato. It remains to be seen whether it will become permanent, be repealed, or continue to be added to future spending bills.

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