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EACH Person’s Right: The Importance of Federal Abortion Care Funding to Health Care Reform

Published online by Cambridge University Press:  30 January 2023

Cassandra LaRose  and
Michael S. Sinha
Cassandra LaRose
Affiliation:
1Northeastern University School of Law, Boston, MA, USA 2Northeastern University Bouvé College of Health Sciences, Boston, MA, USA
Michael S. Sinha*
Affiliation:
3Center for Health Law Studies, Saint Louis University School of Law, St. Louis, MO, USA
*
*Corresponding author. Email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

The United States has a long and controversial history with abortion that did not end with Roe v. Wade. Almost immediately thereafter, anti-choice politicians commenced a decades-long effort to restrict access to abortion, recently culminating in the Dobbs decision that overturned Roe. One successful attempt to restrict access immediately following Roe was the Hyde Amendment. With more Americans covered by federally funded health insurance than ever, the Hyde Amendment creates an insurmountable barrier to abortion care for those who lack other sources of financing.

Despite the impacts of the Hyde Amendment, support for discontinuing the amendment has been weak. For the first time in over forty years, the United States is in a position to change its abortion funding policy. Beyond ending Hyde, the EACH Act has been introduced in Congress to ensure permanent funding for abortion through all federally funded insurance programs. To secure funding for abortion and reduce barriers to access, advocates must press the federal government to pass legislation such as the EACH Act.

Type
Articles
Information
American Journal of Law & Medicine , Volume 48 , Issue 2-3 , July 2022 , pp. 266 - 274
Copyright
© 2023 The Author(s)

Introduction

As the United States considers options for health care reform, it is crucial that advocates and policymakers address the laws and policies that create barriers to health care. Some of the greatest barriers to care in the United States are those to reproductive health care. Not only is reproductive health care treated as a political issue, with several states attempting to outright ban access to care, but there are also several state and federal laws that block the funding of abortion.Footnote 1 At the federal level, almost all use of federal funding for abortion care is blocked by what is known as the Hyde Amendment.Footnote 2

Although the Hyde Amendment blocks nearly all federal funding for abortion care and has done so for over forty years,Footnote 3 it is not a permanent law.Footnote 4 Instead, the Hyde Amendment is a rider to the Department of Health and Human Services’ (“HHS”) appropriations bill that has been renewed yearly as part of Congress’ annual budgeting since 1977.Footnote 5 In its current language, the Hyde Amendment prevents the use of federal funds for abortion care services except for when the pregnancy is a product of rape or incest, or when the pregnant person’s life is endangered by the pregnancy.Footnote 6 This results in an insurmountable barrier to abortion care for those covered by federally funded programs such as the Indian Health Service, Medicare and CHIP, as well as Medicaid in states that do not opt to use state funding to provide coverage for abortions.Footnote 7

Concern about the Hyde Amendment’s impact arose during debate over U.S. health care reform efforts like the Patient Protection and Affordable Care Act of 2010 (“ACA”).Footnote 8 Under the ACA’s Medicaid expansion, many more people capable of becoming pregnant became eligible for Medicaid coverage, vastly improving their overall access to health care. By 2020, 16% of non-elderly adult women in the United States were covered by Medicaid.Footnote 9 The Hyde Amendment, however, leaves a gap in that coverage by blocking the use of federal funds for abortion, an issue that activists rallied around at the time of the ACA’s passing.Footnote 10

Current progressive pushes to expand federally funded health insurance would vastly improve most health care access, but the Hyde Amendment would continue to block coverage of abortion. For example, the Biden administration has indicated a desire to lower the Medicare eligibility age to sixty years old, with some in Congress pushing for an even lower eligibility age.Footnote 11 If universal health care coverage is achieved through a progressive stepwise lowering of the Medicare eligibility age, more people who become pregnant will be denied coverage for abortion care. In such a scenario, as Medicare eligibility reaches persons of childbearing age, those individuals would become subject to a public insurance scheme that excludes abortion care. In fact, for those who live in states where state funding is used to cover abortions under Medicaid, replacing Medicaid coverage with Medicare coverage would take abortion funding away.

Another popular proposal for universal health care coverage comes from the Medicare for All bill championed by Senator Bernie Sanders (I-VT).Footnote 12 Senator Sanders’ bill includes a provision which would make the Hyde Amendment inapplicable to the Medicare for All system.Footnote 13 However, if the reproductive health care provision were to be negotiated out of the bill, the Hyde Amendment would apply, effectively denying government funding of abortion coverage across the board.

Background

The history of the hyde amendment

The Hyde Amendment was a direct response to the Supreme Court’s 1973 landmark decision in Roe v. Wade, which acknowledged a constitutional right to abortion.Footnote 14 It was first introduced as part of the 1977 HHS appropriations bill;Footnote 15 its name comes from Henry Hyde (R-IL), the anti-choice Congressman who first introduced it.Footnote 16 Congressman Hyde believed that the best approach to preventing abortion was to target poor women through Medicaid coverage. Hyde was quoted about the Hyde Amendment as saying, “I would certainly like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle class woman, or a poor woman. Unfortunately, the only vehicle available is the [Medicaid] bill.”Footnote 17

Hyde’s attempt to bar abortion care access for Medicaid recipients, who were also disproportionately people of color,Footnote 18 was hotly contested. The Hyde Amendment was so controversial that it held up the passage of HHS’s appropriations bills several times in the 1970s, with debates hinging on the appropriate scope of funding allowances for abortion.Footnote 19 The Amendment as introduced by Congressman Hyde was more stringent than the current iteration—it had no exceptions.Footnote 20 The exceptions to the funding ban were seen as a compromise, with the language of such provisions changing multiple times in the 1970s and 1980s.Footnote 21 The language debate appears to have quieted down, with the current exceptions for cases of rape, incest, and life endangerment in place since 1993.Footnote 22

Government interests in hyde

The Hyde Amendment was not just debated in Congress; it was also challenged in court. One such challenge reached the Supreme Court in the 1980 case Harris v. McRae—a five-to-four decision that upheld the validity of the Hyde Amendment.Footnote 23 The majority in Harris held that the Hyde Amendment did not pose a barrier to the right to abortion recognized by Roe v. Wade because it “places no governmental obstacle in the path of a woman who chooses to terminate her pregnancy.”Footnote 24 The majority opinion further argued that, since poverty is not a suspect classification under the Fourteenth Amendment, the freedom to choose to have an abortion does not “carr[y] with it a constitutional entitlement to the financial resources to avail herself of the full range of protected choices.”Footnote 25 The Court found that the Hyde Amendment upholds the government’s interest in protecting fetal life and encouraging alternatives to abortion care, permitting the federal government to favor childbirth through financial incentives like the Hyde Amendment.Footnote 26 Justice Thurgood Marshall’s dissenting opinion in Harris labeled the Hyde Amendment as a direct attack on the right to abortion. Marshall pointed to the “undeniable fact” that “denial of a Medicaid-funded abortion is equivalent to denial of legal abortion altogether.”Footnote 27

Impact of abortion care access or lack thereof

Before the Hyde Amendment took effect, around 300,000 abortions were financed using federal Medicaid funds per year.Footnote 28 In comparison, though Medicaid funded over 157,000 abortions in 2015, the overwhelming share of funding was state-based—federal funding financed that abortion care in only 160 instances.Footnote 29 Lack of access to abortion has severe consequences for both the health and wellbeing of people who become pregnant. These health impacts of the Hyde Amendment are especially egregious when considering the demographics of Medicaid recipients. Due to systemic and institutionalized racism and histories of marginalization, twenty percent of non-elderly Medicaid recipients are Black (compared to about thirteen percent of the U.S. population) and twenty-nine percent of Medicaid recipients are Hispanic or Latino (compared to about nineteen percent of the U.S. population).Footnote 30

While legal abortions are safe, being denied abortion care can be extremely detrimental to a pregnant person’s health in the short- and long-term. Continuing a pregnancy exposes pregnant individuals to the health complications associated with pregnancy and childbirth, which can be life-threatening and include eclampsia and postpartum hemorrhage.Footnote 31 In the long-term, those who are denied an abortion are also more likely to suffer from chronic pain and other chronic conditions five years later.Footnote 32

Studies comparing those who have had access to abortion care to those who were denied an abortion show that being denied an abortion also has negative psychological, social, and economic impacts. The mental health impacts of being denied an abortion are immediate, with many pregnant people experiencing increased anxiety and low self-esteem.Footnote 33 As compared to those who are able to access abortion care, individuals who are unable to terminate an unwanted pregnancy are more likely to remain tied to an abusive partner after having a child.Footnote 34 Those who are able to access abortion care, however, reduce their exposure to intimate partner violence,Footnote 35 achieve their short and long-term aspirational goals,Footnote 36 and can even rise above the poverty line.Footnote 37 Conversely being denied an abortion pushes people further into poverty by limiting one’s availability to work and increasing household costs while raising a child.Footnote 38 For these reasons, the American Psychological Association has expressed opposition to the Hyde Amendment and even signed onto an amicus brief in Harris v. McRae in support of the plaintiffs.Footnote 39

State funding of abortion care under hyde

Although the Hyde Amendment creates a barrier to abortion care funding using federal dollars, it is still possible for abortions to be covered by Medicaid. This is because Medicaid is a jointly funded program, meaning that the money for health insurance under Medicaid comes from both federal and state funding sources.Footnote 40 Under this scheme, states can—but are not required toFootnote 41—use state funding sources to finance abortion care for Medicaid recipients. Although the duality of Medicaid funding provides an important opportunity to fund abortion for Medicaid recipients despite the federal ban, it also creates and exacerbates health disparities between states.

Currently, only sixteen states use state funds to cover abortion care beyond the limited exceptions under the Hyde Amendment.Footnote 42 Some of these states do so as a matter of policy choice while others do so under court order.Footnote 43 Meanwhile, thirty-four states and Washington, D.C. do not provide funding to supplement abortion services for Medicaid recipients.Footnote 44 The states that finance abortion care using state funds are mostly concentrated in the Northeast and on the West Coast, with the entirety of the South only funding abortions for Medicaid recipients under the same limitations imposed by Hyde.Footnote 45

The disparities in state funding of abortion care correlates with a state’s overall health outcomes for pregnant people, as well as with the state’s overall access to reproductive health services. For example, Massachusetts chooses to use state funds to finance abortion care services for Medicaid recipients, whereas Texas only funds abortion care for Medicaid recipients under the limitations imposed by the Hyde Amendment.Footnote 46 Massachusetts has far superior access to reproductive health care services than Texas does along multiple measures. In 2017, for example, there were forty-seven abortion care providers in Massachusetts while there were only thirty-five in Texas,Footnote 47 despite Texas being a much larger state geographically and having a population almost five times larger than Massachusetts.Footnote 48 In Massachusetts, only nine percent of women between the ages of fifteen and forty-four lived in a county without an abortion provider in 2014, compared to forty percent of women in the same age group in Texas.Footnote 49 Now that abortion is banned in Texas, there are currently no abortion clinics in the state.Footnote 50 In addition, women in Massachusetts are more likely to have access to and use contraception than women in Texas.Footnote 51 These provider disparities exacerbate funding disparities by making abortion care even more difficult to obtain, even when Medicaid recipients may be able to gain access to funds to cover abortion care.

States that do not provide funding for abortion care also have overall worse pregnancy and maternal health outcomes. While the United States already has a maternal mortality rate that is much higher than other high-income countries,Footnote 52 the maternal mortality rate is often higher in states that do not supplement abortion coverage for Medicaid recipients compared to those that do.Footnote 53 Similar trends can be seen for infant mortality. In 2019, Mississippi’s infant mortality rate was 8.71 deaths per 1,000 live births while Massachusetts’ was 3.8 deaths per 1,000 live births.Footnote 54 Unlike Massachusetts, Mississippi does not use state funds to finance abortion.Footnote 55

Political landscape of the hyde amendment

Though abortion care is a health care issue that should be treated similarly to the funding of other essential health care services, it is as politically contentious today as it was in the 1970s. Generally speaking, champions for the right to abortion care strongly oppose the Hyde Amendment while antichoice politicians are staunch supporters of the Hyde Amendment. Historically, political moderates also tend to support the Hyde Amendment, which explains its long duration of annual renewal.Footnote 56

Support (or lack thereof) for the Hyde Amendment generally falls along political party lines, with the exception of some moderate Democrats. Progressive Democrats wish to see the Hyde Amendment removed but have struggled to garner enough support to do so.Footnote 57 Other reasons for weakened support from Democrats for ending the Hyde Amendment include a desire to stay in office and the need to compromise to get an appropriations bill through Congress without causing a government shutdown.Footnote 58 In 2020, many Democrats did not push strongly to remove the Hyde Amendment from the HHS appropriations bill due to fears of targeted political ads from Republican opponents.Footnote 59 Republicans strongly oppose ending the Hyde Amendment—many have pledged not to support any appropriations bill that does not include the funding ban.Footnote 60 This makes repealing the Hyde Amendment even more politically difficult, as a progressive Democratic majority will likely be necessary.

The battle over abortion funding is so politically charged that the ability to pass an appropriations bill that does not include a version of the Hyde Amendment is difficult to do without presidential support. Most U.S. Presidents since 1977 have supported the Hyde Amendment, and none have vetoed an appropriations bill that includes it, as evidenced by the consistent inclusion of the Hyde Amendment for over 40 years.Footnote 61 Some Presidents, and most recently Donald Trump, have gone further than simply signing off on the Hyde Amendment by supporting policy to make the provision permanent.Footnote 62 Meanwhile, even Democratic Presidents have failed to show strong support for ending the Hyde Amendment. President Joe Biden has shown the most support for ending the Hyde Amendment by publicly denouncing it in recent speeches.Footnote 63 However, he supported the Hyde Amendment as recently as 2019.Footnote 64 Though the Biden Administration has expressed support for expanding abortion care access through ending the Hyde Amendment, more political pressure and continued support will be required to garner support in Congress.

Proposed solutions

Ending the hyde amendment

Reproductive rights and justice advocates have been pushing to end the Hyde Amendment since its inception in 1977. A recent campaign to do so comes from All Above All Catalysts for Abortion Justice’s “Be Bold. End Hyde.” campaign.Footnote 65 At the same time, many abortion rights groups are currently overwhelmed battling an onslaught of state anti-abortion bills, restrictive laws, and all-out bans.Footnote 66 Indeed, the Supreme Court recently overturned Roe v. Wade in Dobbs v. Jackson Women’s Health Organization, upholding Mississippi’s fifteen week abortion ban.Footnote 67 According to the Guttmacher Institute, 2021 was the worst year for abortion legislation in recent history, with 108 restrictions having been enacted across nineteen states.Footnote 68 With the Dobbs decision and its ripple effect on state laws governing abortion, 2022 has already been a considerably worse year for reproductive rights.

Meanwhile, the federal government has never been in a better political position to repeal the Hyde Amendment, despite fears of political backlash. As of July 2022, Democrats hold a majority in the House, there is a very slight Democratic majority in the Senate, and the President is a Democrat who has recently expressed support for repealing the Hyde Amendment.Footnote 69 In addition, health care has a larger focus than ever, with several proposed polices to expand federal health insurance coverage amid the COVID-19 pandemic. Importantly, these policy proposals unmask the glaring holes in the U.S. health care system, not to mention the deep racial and class divides that are made worse by unequal access to health care, including abortion care.Footnote 70

It will still take enormous and consistent political pressure to convince enough moderate Democrats to support an appropriations bill that does not include the Hyde Amendment. Further, simply removing the Hyde Amendment from next year’s HHS appropriations bill does not go far enough. As the federal budget is changed, debated, and passed yearly, the Hyde Amendment may always be added back in a subsequent year. Further, repealing the Hyde Amendment simply removes the federal ban on funding—it does not affirmatively guarantee adequate federal coverage of or access to abortion care.Footnote 71 Ensuring federal funding of the full spectrum of abortion related care would require guidance as to the scope of services and an affirmative provision of funding for such services.

The each act

One solution to avoid the possibility of reinstating the Hyde Amendment after repealing it or a constant flip-flop from year to year is to pass a permanent law to provide and protect funding for abortion care. The Ensure Affordable Abortion Coverage and Care for Every Person (“EACH”) Act was introduced in March 2021 in both the House and the Senate.Footnote 72 The Act is a comprehensive piece of legislation which would ensure the coverage of abortion care services in programs funded by the federal government. It also prohibits restrictions on private health insurance coverage of abortion care.

Unlike a simple repeal of the Hyde Amendment, the EACH Act, first introduced in 2015, would provide positive protections for abortion care coverage using congressional Commerce Clause powers.Footnote 73 The bill aligns with the principle that all people should have access to abortion care services, and that income level or type of insurance should not prevent anyone from accessing abortion care.Footnote 74 The introduction to the bill recognizes the health disparities inherent in denying Medicaid funding for abortion care because Medicaid recipients are disproportionately Black, Hispanic, certain Asian ethnic subgroups, Indigenous, and members of the LGBTQ community.Footnote 75 Importantly, there is also a block on federal funding of abortion care through the Indian Health Service, which furthers harm to Indigenous pregnant people.Footnote 76

Coverage requirements in the EACH Act are expansive, encompassing the entirety of services “related to, and provided in conjunction with, an abortion.”Footnote 77 The health care programs subject to this provision are all current and future federally funded health care programs.

For those with government funded health insurance, the Act has provisions ensuring both abortion care financing and access to services. This goes beyond the Hyde Amendment by ensuring access to abortion care services through government medical care facilities and facilities with which the government-funded health care programs contract. The provision of the Act ensuring access to abortion related services, however, is not clear as to the definition of “access,” and could do more to define what services must be provided at these facilities and how the EACH Act will intersect with state-level abortion care restrictions. The bill may also face opposition in Congress, particularly if the filibuster is invoked. Even if passed, a future Congress can always vote to overturn the law—though as the Affordable Care Act has demonstrated, repealing a law is no simple task. States will also continue to chip away at abortion rights, which may undermine the impact of the EACH Act, even if signed into law.

Overall, the EACH Act provides an essential federal commitment to the funding of abortion care and accomplishes much more than not renewing the Hyde Amendment in the next HHS appropriations bill. In December 2021, Congress authorized a short-term spending bill to fund the federal government through mid-February 2022.Footnote 78 After two more continuing resolutions extending through March 15, 2022, President Biden signed the Fiscal Year 2022 omnibus appropriations bill, with Hyde Amendment funding restrictions on abortion still in place.Footnote 79

So far, the EACH Act has relatively strong support in both the House of Representatives and Senate, but not enough to successfully pass the bill. The Senate bill was introduced by Senator Tammy Duckworth (D-IL) and currently has twenty-eight co-sponsors,Footnote 80 while the House bill was introduced by Congresswoman Barbara Lee (D-CA) and has 187 cosponsors.Footnote 81 All of the cosponsors are Democrats except for Senator Bernie Sanders (I-VT), but the large number of cosponsors points to a strong coalition of progressive lawmakers dedicated to going beyond ending the Hyde Amendment. Passage of the EACH Act will still require a large advocacy push, including support from moderate Democrats and the Biden Administration.

To garner such support, a large and strong coalition of advocates will be necessary across the nation. As this bill has implications for government funded health insurance and future health reforms, coalition building should happen between and among health reform organizations and reproductive justice organizations, with reproductive justice organizations that are well-versed in this issue, such as All Above All, taking the lead. At a time when abortion access is being ferociously attacked state-by-state, dismantling barriers to abortion care while improving access at the federal level has never been more important.

Conclusion

Though essential, codifying the right to abortion care in the United States will not be sufficient. The Hyde Amendment is a long-standing barrier to health care access for low-income people that must be repealed. Further, funding for and access to abortion care services must be ensured by federal law through a bill such as the EACH Act. Blocking access to abortion care disproportionately impacts marginalized communities and can harm a pregnant person’s mental health, physical health, socioeconomic status, and ability to achieve life goals. Advocates can and must work push federal lawmakers to stop renewing the Hyde Amendment and to pass legislation to fund the full spectrum of reproductive health care services, including abortion care.

References

1 Restrictions on Public Funding of Abortion, The Po’y Surveillance Program (Oct. 1, 2021), http://lawatlas.org/datasets/restrictions-on-public-funding-of-abortion [https://perma.cc/C62Q-AUEH].

2 Alina Salganicoff et al., The Hyde Amendment and Coverage for Abortion Services, Kaiser Fam. Found. (Mar. 5, 2021), https://www.kff.org/womens-health-policy/issue-brief/the-hyde-amendment-and-coverage-for-abortion-services/ [https://perma.cc/TR7F-REME].

3 Access Denied: Origins of the Hyde Amendment and Other Restrictions on Public Funding for Abortion, ACLU [hereinafter Access Denied], https://www.aclu.org/other/access-denied-origins-hyde-amendment-and-other-restrictions-public-funding-abortion [https://perma.cc/9XTC-5GDW] (last visited Apr. 9, 2022).

4 See Salganicoff et al., supra note 2.

5 See Access Denied, supra note 3.

6 See Salganicoff et al., supra note 2.

7 Id.

8 Cynthia Soohoo, Hyde-Care for All: The Expansion of Abortion-Funding Restrictions Under Health Care Reform, 15 CUNY L. Rev. 391, 416-19 (2012).

9 Women’s Health Insurance Coverage, Kaiser Fam. Found. (Nov. 8, 2021), https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage/ [https://perma.cc/8ZHH-98KV].

10 Soohoo, supra note 8, at 416-18.

11 Press Release, U.S. Senator Elizabeth Warren, Warren at Hearing: Lowering Medicare Eligibility Age to 55 Could Cover Tens of Millions of Americans, We Can’t Waste This Opportunity to Expand Coverage and Lower Costs (Apr. 15, 2021), https://www.warren.senate.gov/newsroom/press-releases/at-hearing-lowering-medicare-eligibility-age-to-55-could-cover-tens-of-millions-of-americans-we-cant-waste-this-opportunity-to-expand-coverage-and-lower-costs [https://perma.cc/9L88-AEMT] (When questioning Chiquita Brooks-LaSure, then-nominee to be Administrator of the Centers for Medicare and Medicaid Services, Senator Warren commented, “I know President Biden has talked about dropping the Medicare age from 65 to 60, but frankly I think we should go even further.”).

12 Medicare for All Act of 2019, S. 1129, 116th Cong. (2019).

13 Id. at § 701(b)(3).

14 Roe v. Wade, 410 U.S. 113 (1973).

15 See Access Denied, supra note 3.

16 Heather D. Boonstra, The Heart of the Matter: Public Funding Of Abortion for Poor Women in the United States, 10 Guttmacher Pol’y Rev. 12, 12 (2007).

17 Id.

18 Karen Davis et al., Health Care of Black Americans: The Public Sector Role, 65 Milbank Q. (Supplement 1, Part 1) 213, 223 (1987).

19 See Access Denied, supra note 3.

20 Julie Rovner, Abortion Funding Ban Has Evolved Over the Years, NPR (Dec. 14, 2009, 6:00 AM), https://www.npr.org/templates/story/story.php?storyId=121402281 [https://perma.cc/8MWU-AWFE].

21 See Boonstra, supra note 16, at 12-13.

22 Pub. L. No. 103-112, § 509, 107 Stat. 1082, 1113 (1993) (making appropriations for the Departments of Labor, Health and Human Services, and Education, and other related agencies). It should be noted, though, that newer state laws banning or restricting access to abortion care are increasingly being proposed and passed without any exceptions.

23 Harris v. McRae, 448 U.S. 297, 299, 326 (1980).

24 Id. at 315.

25 Id. at 316.

26 Id. at 325.

27 Id. at 338.

28 See Access Denied, supra note 3.

29 Medicaid Coverage of Abortion, Guttmacher Inst. (Feb. 2021), https://www.guttmacher.org/evidence-you-can-use/medicaid-coverage-abortion [https://perma.cc/KPP5-R87J].

30 Distribution of the Nonelderly with Medicaid by Race/Ethnicity, Kaiser Fam. Found., https://www.kff.org/medicaid/state-indicator/medicaid-distribution-nonelderly-by-raceethnicity [https://perma.cc/CY7S-ELMF] (last visited June 5, 2022); QuickFacts United States, U.S. Census Bureau (2019), https://www.census.gov/quickfacts/fact/table/US/PST045219 [https://perma.cc/7XYS-VYUD] (choose “Race and Hispanic Origin” from “All Topics” dropdown).

31 Caitlin Gerdts et al., Side Effects, Physical Health Consequences, and Mortality Associated with Abortion and Birth After an Unwanted Pregnancy, 26 Women’s Health Issues 55, 57 (2016).

32 Jamie Ducharme, Women Who Are Denied Abortions May Face Long-Lasting Health Problems, Study Says, Time (June 10, 2019; 5:00 PM), https://time.com/5603194/denied-abortions-physical-health/ [https://perma.cc/XZ3U-UAB4].

33 M. Antonia Biggs et al., Women’s Mental Health and Well-Being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study, 72 JAMA Psychiatry 169, 174 (2017).

34 Sarah C.M. Roberts et al., Risk of Violence from the Man Involved in the Pregnancy After Receiving or Being Denied an Abortion, 12 BMC Med., Sept. 29, 2014, at 5.

35 See id.

36 Ushma D. Upadhyay et al., The Effect of Abortion on Having and Achieving Aspirational One-Year Plans, 15 BMC Women’s Health, Nov. 11, 2015, at 6-9.

37 Diana Greene Foster et al., Socioeconomic Consequences of Abortion Compared to Unwanted Birth (Oct. 30, 2012) (presentation), https://apha.confex.com/apha/140am/webprogram/Paper263858.html [https://perma.cc/6JPY-KPR3] (presentation at the 140th American Public Health Association Annual Meeting and Expo, October 27-31, 2012, in San Francisco).

38 Id.

39 Brief for the American Psychological Association et al. as Amicus Curiae in Support of Petitions for Rehearing, Harris v. McRae, 448 U.S. 917 (1980) (Nos. 79-1268, 79-4, 79-491).

40 Financial Management, Ctrs. for Medicare & Medicaid Servs., https://www.medicaid.gov/medicaid/financial-management/index.html [https://perma.cc/PG94-NE9E] (last visited June 5, 2022).

41 See Maher v. Roe, 432 U.S. 464, 464, 470, 480 (1977) (holding that state restrictions on Medicaid abortion care coverage do not violate the equal protection clause of the Fourteenth Amendment).

42 State Funding of Abortion Under Medicaid, Guttmacher Inst. [hereinafter Guttmacher: State Funding of Abortion] (June 1, 2022), https://www.guttmacher.org/state-policy/explore/state-funding-abortion-under-medicaid [https://perma.cc/RH2X-Q7PY].

43 Id.

44 Id.

45 State Funding of Abortions Under Medicaid, Kaiser Fam. Found. [hereinafter Kaiser: State Funding of Abortion] (May 1, 2022), https://www.kff.org/medicaid/state-indicator/abortion-under-medicaid [https://perma.cc/WA92-3Z2X].

46 See id.

47 Data Center, Guttmacher Inst., [hereinafter Data Center], https://data.guttmacher.org/states/table?state=MA+TX&topics=282+71+73&dataset=data [https://perma.cc/DYN8-38U3] (last visited June 5, 2022).

48 QuickFacts United States, U.S. Census Bureau, supra note 30 (To compare state populations, search “Texas” in the search field and press “Enter”; then search “Massachusetts” in the search field and press “Enter.”).

49 See Data Center, supra note 47.

50 Abortion in the U.S. Dashboard, Kaiser Fam. Found., [hereinafter Abortion in the U.S. Dashboard] https://www.kff.org/womens-health-policy/dashboard/abortion-in-the-u-s-dashboard/ [https://perma.cc/VGH3-JE6T] (last updated Oct. 13, 2022).

51 See Data Center, supra note 47.

52 Roosa Tikkanen et al., Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries, Commonwealth Fund (Nov. 18, 2020), https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries [https://perma.cc/3HK3-FLMN].

53 Amirhossein Moaddab et al., Health Care Disparity and Pregnancy-Related Mortality in the United States, 2005-2014, 131 Obstetrics & Gynecology 707, 707-12 (2018).

54 Infant Mortality Rates by State, CDC (Mar. 3, 2022), https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm [https://perma.cc/4J4S-3GL4] (choose “2019” from dropdown).

55 See Kaiser: State Funding of Abortion, supra note 45 (Mississippi follows federal standards funding abortions only in instances of rape, incest, life endangerment, and fetal impairment).

56 During the passage of the most recent budget-reconciliation bill, Democratic senators Joe Manchin, Bob Casey, and Tim Kaine, joined Republicans in support of the Hyde Amendment. See John McCormack, Manchin Says He’ll Support the Hyde Amendment in ‘Every Way Possible,’ Nat’l Rev. (June 11, 2021, 1:47 PM), https://www.nationalreview.com/corner/manchin-says-hell-support-the-hyde-amendment-in-every-way-possible/ [https://perma.cc/D3VF-HUWK].

57 Sarah Ferris & Heather Caygle, Democrats Dodge Abortion Fight with Plan to Keep Hyde Amendment, Politico (July 2, 2020, 6:52 PM), https://www.politico.com/news/2020/07/02/hyde-amendment-abortion-democrats-348272 [https://perma.cc/G2Q7-67V5].

58 Id.

59 Id.

60 Letter from Representative Jim Banks, Chairman, Republican Study Comm. and Steve Scalise, House Republican Whip to Nancy Pelosi, Speaker of the House of Represenatives, Chuck Schumer, Majority Leader, Kevin McCarthy, Republican Leader, and Mitch McConnell, Minority Leader, (Jan. 26, 2021).

61 See Salganicoff et al., supra note 2.

62 Eliza Collins, Trump Announces ‘Pro-Life Coalition,’ Supports Making Hyde Amendment Permanent, USA Today (Sep. 16, 2016, 6:02 AM), https://www.usatoday.com/story/news/politics/onpolitics/2016/09/16/trump-marjorie-dannenfelser-anti-abortion-rights/90431388/ [https://perma.cc/5A37-X7T7].

63 Katie Glueck, Joe Biden Denounces Hyde Amendment, Reversing His Position, NY Times (June 6, 2019), https://www.nytimes.com/2019/06/06/us/politics/joe-biden-hyde-amendment.html [https://perma.cc/8WGG-V6YW].

64 Heidi Przybyla, Joe Biden’s Long Evolution on Abortion Rights Still Holds Surprises, NBC News (June 5, 2019, 5:01 AM), https://www.nbcnews.com/politics/2020-election/biden-s-long-evolution-abortion-rights-still-holds-surprises-n1013846 [https://perma.cc/GG3N-MF2R].

65 Be Bold. End Hyde., AllAboveAll, https://allaboveall.org/abortion-coverage-2/ [https://perma.cc/H23H-A4B7] (last visited June 5, 2022).

66 See Abortion in the U.S. Dashboard, supra note 50.

67 Dobbs v. Jackson Women’s Health Org., 141 S.Ct. 2619, 2619-20 (2021) (mem.) (granting certiorari to review of a Mississippi statute prohibiting abortion after 15 weeks of gestation).

68 Elizabeth Nash, State Policy Trends 2021: The Worst Year for Abortion Rights in Almost Half a Century, Guttmacher Inst. (Jan. 5, 2022), https://www.guttmacher.org/article/2021/12/state-policy-trends-2021-worst-year-abortion-rights-almost-half-century [https://perma.cc/6PN4-AFHA].

69 Party Breakdown: 117th Congress House Lineup, U.S. House of Representatives, https://pressgallery.house.gov/member-data/party-breakdown [https://perma.cc/4B8R-25GA] (last visited June 8, 2022); 117th Congress (2021–2023), U.S. Senate, Party Div., https://www.senate.gov/history/partydiv.htm [https://perma.cc/7NMP-WR6P] (last visited June 8, 2022).

70 Jaime S. King, Covid-19 and the Need for Health Care Reform, 382 N. Eng. J. Med. 104 (2020).

71 See Salganicoff et al., supra note 2.

72 The Equal Access to Abortion Coverage in Health Insurance Act of 2021 [hereinafter EACH Act], S. 1021, 117th Cong. (2021) & H.R. 2234, 117th Cong. (2021).

73 EACH Act § 2.

74 Id.

75 Id.

76 See Shaye B. Arnold, Reproductive Rights Denied: The Hyde Amendment and Access to Abortion for Native American Women Using Indian Health Service Facilities, 104 Am. J. Pub. Health 1892, 1892 (2014).

77 EACH Act § 3.

78 Further Extending Government Funding Act of 2021, Pub. L. No. 117-70, 135 Stat. 1499.

79 Consolidated Appropriations Act, 2022, Public Law No: 117-103 (2022).

80 S.1021 - EACH Act of 2021, U.S. Congress, https://www.congress.gov/bill/117th-congress/senate-bill/1021/cosponsors [https://perma.cc/426R-TZY8] (last visited June 8, 2022).

81 H.R.2234 - EACH Act of 2021, U.S. Congress, https://www.congress.gov/bill/117th-congress/house-bill/2234/cosponsors?q=%7B%22search%22%3A%5B%22HR+2234%22%2C%22HR%22%2C%222234%22%5D%7D&r=1&s=1 [https://perma.cc/5SAT-ER8V] (last visited June 8, 2022).