December 12, 2020 Liz Borkowski, MPH 0Comment

For more than four decades, each spending bill Congress passes has contained a discriminatory and harmful rider: the Hyde Amendment, which prohibits the use of federal funds to pay for abortions except in cases of rape, incest, or life-endangering pregnancies. This means people with Medicaid coverage can’t use their insurance to pay for abortions, unless they live in one of the 16 states that use their own funds to cover abortions for Medicaid beneficiaries. The systemic racism that has denied equitable opportunities to Black and Hispanic women leaves them more likely to have low incomes, and therefore more likely to be enrolled in Medicaid and subject to the Hyde Amendment’s discriminatory impacts.

In a historic hearing on December 8, 2020, the House Appropriations Committee’s Subcommittee on The Departments of Labor, Health and Human Services, Education, and Related Agencies considered “The Impact on Women Seeking an Abortion but are Denied Because of an Inability to Pay.”

Opening Statements

Representative Rosa DeLauro (D-CT), who will lead the Appropriations Committee in the next Congress, opened the hearing by saying “The Hyde Amendment is a discriminatory policy.” She pledged, “While the Labor, HHS, Education bill has carried the Hyde amendment every year since 1976, this is the last year … Now is the time to empower all women to be able to make deeply personal life decisions without politicians inserting themselves into the doctor’s office.”

DeLauro referred to several important pieces of evidence about the harmful effects of denying pregnant people the ability to access abortions, including the landmark Turnaway Study led by Diana Greene-Foster of the University of California San Francisco. DeLauro summarized some of that study’s key findings:

For women denied an abortion despite wanting one because it was the right decision for themselves and their families, women being forced to carry an unwanted pregnancy to term are four times more likely to live below the Federal Poverty Level.  Women are more likely to experience serious complications at the end of their unwanted pregnancy including eclampsia and death – contributing to the maternal mortality rate in this country that should be embarrassing and unacceptable to everyone participating today. These women denied an abortion are more likely to stay with an abusive partner. These women who were denied a safe and legal medical procedure are more likely to suffer anxiety, loss of self-esteem, and less likely to have aspirational plans for their futures after being denied an abortion. Finally, the Turnaway Study found that being denied has serious implications for the existing children in the family.

Representative Nita Lowey (D-NY), chair of the Appropriations Committee, also gave opening remarks, stating, “The Hyde Amendment has created two sets of rules: One for those with resources, and one for those without. After more than 40 years, it continues to impose judgment and bully low-income women, with a disproportionate impact on women of color.”

Witnesses

The Democrats’ three witnesses painted a more detailed picture of the harms of the Hyde Amendment and made forceful cases for repealing it.

Herminia Palacio, President and CEO of the Guttmacher Institute, told the committee, “The Hyde Amendment is a racist policy.” She cited Guttmacher research conducted in April and May that found Black and Hispanic women were more likely than non-Hispanic White women to say they would be delaying pregnancies or having fewer children because of COVID-19, but they were also more likely to experience delays in getting sexual and reproductive healthcare or obtaining contraception because of the pandemic.

Palacio also explained the link between abortion restrictions and maternal mortality: “Forcing someone who wants an abortion to continue a pregnancy is a violation of their reproductive autonomy. Moreover, it is tantamount to requiring them, against their wishes, to accept the risks of pregnancy- and labor-related complications, including preeclampsia, infections and death.” After noting the shamefully high U.S. maternal mortality rate and the fact that Black and Indigenous women are 2-3 times more likely to die from pregnancy or its complications than White women, she continued: “I ask you to reflect on these overlapping and perverse indignities: The Hyde Amendment disproportionately withholds abortion coverage from communities of color, a potential consequence of which is being forced to continue a pregnancy in a system in which Black and Indigenous people are astonishingly more likely to die.”

Jamila Perritt, President and CEO of Physicians for Reproductive Health, grounded her testimony in her experience of caring for patients in Washington, DC. “The patients I care for share something in common: They’re all making thoughtful, sometimes difficult, decisions about their health and wellbeing, and they all deserve high-quality care.” She noted that the American College of Obstetricians and Gynecologists has identified abortion as a health service that requires timely access to care, and pointed out that as a form of healthcare, abortion should receive the same kind of insurance coverage as similar forms of care.

Perritt also highlighted some problems that are unique to the District of Columbia: Despite the fact that our local government has decided to use our own revenue to cover Medicaid recipients’ abortion care, Congress prohibits us from doing so. The many federal employees who live in DC also can’t use their government health insurance for abortions. “I took an oath to provide compassionate care,” she told the committee. “Coverage bans like the Hyde Amendment stand in the way.”

Amanda Beatriz Williams, Executive Director of the Lilith Fund for Reproductive Equity (the oldest abortion fund in Texas) and an abortion storyteller with We Testify, shared her own personal story of obtaining an abortion at age 19 and also conveyed the kinds of challenges that Lilith Fund clients face when seeking abortions in one of the states with the most barriers to abortion. “Across the country, the Hyde Amendment has had devastating impacts for people unable to make ends meet — who are more likely to be women of color, LGBTQ people, immigrants, and young people,” she told the committee. In 2019, 68% of Lilith Fund clients were people of color, and they traveled an average of 158 miles to reach abortion care in a state whose many restrictions compound the challenges of getting abortion care. “For too many, coverage bans like the Hyde Amendment can act as de facto bans on abortion altogether,” she explained. She concluded her testimony with the story of Rosie Jimenez:

I also want to leave you with the story of another Texan, Rosie Jimenez, whose legacy we continue to honor in our work every day. Rosie was a beloved mother of a young child, student, and young Chicana living in McAllen, Texas in the 1970’s. Rosie was enrolled in Medicaid, but Medicaid did not cover an abortion at a clinic in her hometown, due to the recently passed Hyde Amendment. Instead she sought a cheaper, unsafe procedure and ultimately died due to complications. Rosie became the first known person to die as a result of the Hyde Amendment. To be clear: Rosie died because of Hyde.

 Committee Members

 Many of the statements and questions from Democratic committee members picked up on the inequities the witnesses identified and gave them opportunities to expand on these topics. A few highlights:

  • Representative Barbara Lee (D-CA), a lead sponsor of the EACH Woman Act to end the Hyde Amendment, told her colleagues, “The history of how we got to this point is so important, because sometimes systemic racism is overt, sometimes it’s subtle and covert.” She thanked All* Above All for everything they’ve done to push for an end to the Hyde Amendment.
  • Representative Mark Pocan (D-MD) highlighted one of the key problems with policies like the Hyde Amendment, noting that as “a White man who makes the salary of a member of Congress, I’m unlikely to personally intersect with the Hyde Amendment in my life, although largely it is people like me who’ve made the decisions for everyone in the country.”
  • Representative Katherine Clark (D-MA) stressed that there’s no way to achieve racial and economic justice in this country with the restrictions of the Hyde Amendment still in place.
  • Representative Lois Frankel (D-FL) explained, “Systemic racism arises when hierarchy and privileges get baked into the systems and institutions that govern daily life … We’ve got to clean up a lot of injustice.”
  • Representative Bonnie Watson Coleman (D-NJ) asked questions that are at the heart of the discussion: “Do you respect a woman’s right to make those decisions, and if she is insured under some federal program, should she not be entitled to the same healthcare that a very wealthy woman is?”

Some of the witnesses’ responses to questions are particularly noteworthy. In response to Pocan’s question about restrictions to other forms of healthcare based on income, Palacio recalled her time working with people with HIV/AIDS in San Francisco at the height of the AIDS epidemic. “We have a history of stigmatizing people of color and refusing pay for their care,” she noted – and pointed out that it’s not just people with HIV, but those with substance use disorders and other mental health conditions. “Women who seek an abortion are being systematically characterized as ‘other,’” just as some groups of people seeking other types of care are. Perritt added that access to fertility care and certain kinds of contraception is also restricted based on income and employer.

In response to a question from Representative Lee about the constitutional right to abortion, Williams stated, “There is no right without access.” Roe v. Wade is important, but it’s not enough.

In response to a question from Lowey about the compounding effects of racism, Palacio explained, “There’s a direct line from reprehensible policies of our past like forced sterilization and to policies like the Hyde Amendment.” She noted that enslaved people couldn’t parent and that “Black bodies have been experimented on.” But, she emphasized, “You cannot remedy a racist history by continuing racist policies in the current time and into the future.” We have a racist history, and “it’s time to remedy the past by taking this bold step for the future” of eliminating the Hyde Amendment.

Palacio also stated: “The issue here today is about justice. Abortion should be accessible to people who are poor the same way that it is to people who are wealthy. It should be accessible to people who are Black, Brown, and Indigenous the same way it is to people who are White.”

DeLauro closed the hearing by exhorting members of the committee to look at the results of their policies. “Look at the consequences that have been discussed here today, and who are the people that these consequences have affected? It’s women of color, communities of color … the Hyde Amendment has failed women, women of color, and communities of color in being able to access the healthcare, the reproductive healthcare, that they need.”

In response to her Republican colleagues who indicated resistance to getting rid of the Hyde Amendment, she urged, “Whatever your views are on abortion, our public policy decisions and their effect on the people we represent, that is where our responsibility lies.”

I hope that Congress takes the important step toward equity and justice of repealing the Hyde Amendment.

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