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As the new Congress settles in, feminist groups are gearing up for another push to repeal the Hyde Amendment, a rider on congressional appropriations that prohibits federal money from paying for abortions except in cases of rape, incest, or life endangerment. The EACH Woman Act, introduced in previous sessions by California representative Barbara Lee, would restore federal funding of abortions. Currently, women who rely on Medicaid, as well as veterans, Peace Corps members, those in the military, and those covered by the Indian Health Service have to scramble to come up with $500 for a private-pay abortion. That price tag can triple if their pregnancy progresses to the second trimester. As a result, many are forced to bear children against their will. Repealing the Hyde Amendment would remove an enormous roadblock to abortion access for low-waged and unemployed women. But feminists should be thinking bigger. Medicaid is a means-tested program that excludes many who need it. Winning full reproductive rights will require winning Medicare for All.

How Hyde Happened The Hyde Amendment emerged from the backlash to the 1973 Roe v. Wade decision that legalized abortion. The amendment was a bipartisan effort, introduced by Republican Henry Hyde of Illinois and passed in 1976, 207 to 167, with 113 Democrats in support. Republican president Gerald Ford refused to green light the amendment, but Jimmy Carter obliged when he took office and the Supreme Court gave its approval: Those who could afford abortions could get them, while those who couldn’t would be forced to bear a child. When asked by reporter Judy Woodruff whether this seemed fair, Carter responded, “Well, as you know, there are many things in life that are not fair, that wealthy people can afford and poor people can’t.” Medicaid had been covering three hundred thousand abortions a year. After Hyde it covered only a few. And that’s where the policy has stood for forty years, with a handful of states covering Medicaid abortions using their own funds. How many women are being compelled to give birth? Researchers found that one in four women who would have had Medicaid-funded abortions instead brought their pregnancy to term. But even that is an underestimate: it doesn’t account for all the people that Medicaid doesn’t cover who still can’t afford to pay for an abortion out-of-pocket. According to a recent study, more than half of Americans can’t come up with an emergency sum of $500 without borrowing or selling something. Hyde has been lethal. In 1977, Rosie Jimenez, a twenty-seven-year old in McAllen, Texas lost her life after receiving an illegal abortion — the first woman known to have died due to the Hyde Amendment’s restrictions. Jimenez had previously obtained an abortion through Medicaid, but when she became pregnant again, Medicaid no longer funded the procedure. So she went to a local quack. Jimenez left “a five-year-old daughter and an uncashed scholarship check,” the New York Times reported. The Democratic Party response to more than forty years of coerced births has amounted to a collective shrug. Every Congress, both Democratic and Republican, has approved Hyde restrictions and every president, from Reagan to Obama, has allowed them. That began to change in 2016, when Hillary Clinton had to face Bernie Sanders, a lifelong opponent of Hyde, in the Democratic presidential primary. At the party convention, the Democratic establishment conceded to anti-Hyde language in its official platform. But even then, the party concealed its earlier silence on the issue with clever wording, stating “We will continue to oppose — and seek to overturn — federal and state laws and policies that impede a woman’s access to abortion, including by repealing the Hyde Amendment.”

Prioritizing Hyde For decades, feminists — led by reproductive justice advocates and women of color organizations — have made ending Hyde a priority because it’s the biggest obstacle to abortion access, especially for women of color. Organizing against Hyde is also proactive — it would expand abortion access rather than just forestall further restrictions. But there’s reason to doubt this strategy. Suppose we were able to put enough pressure on Congress to scrap Hyde and a future president were to agree. Many states would then demand the right to decide whether to use Medicaid dollars for abortions. Legal challenges would follow. The Supreme Court would likely side with the intransigent states, as they did with the Affordable Care Act. Since the bluest big states (New York and California) already cover abortion through Medicaid, the number of women who would actually gain abortion coverage would be disappointingly small. I’ve actively opposed Hyde my whole adult life, but I think it’s time for feminists to try a couple of additional routes to achieve our goal of expanding abortion access. One avenue is to make abortions cheaper and easier to obtain. A first trimester pill abortion costs over $500, and the pills aren’t available in retail pharmacies, so most practitioners can’t provide them. That’s no accident — when the Food and Drug Administration approved the pill in 2000, the agency made sure it would be just as expensive and difficult to obtain as a surgical abortion. However, the pill combination that clinics use for 30 percent of abortions — first mifepristone, then misoprostol — is available on grey market websites for between $110 and $360. (The feminist website Plan C maintains a “report card” on internet pill purveyors.) The second pill, misoprostol (brand name Cytotec), is available for other uses in the United States by prescription and over the counter in Latin America. Used alone, it causes abortion in 85 to 90 percent of cases. The dosage when used on its own, without mifepristone, is twelve pills, which you can buy for $50 total in Mexico. Pharmacies along the border are apparently doing a brisk business. In making demands for cheaper and more widely available pill abortions — demanding that they be over the counter, even — the movement would be following the lead of women who are already bringing the price of their abortions down by obtaining pills in other countries, on the internet, or from a feminist pill underground. Second, and perhaps even more importantly, feminists and reproductive rights advocates should throw their efforts into the growing movement for Medicare for All — which, if we fight for it, could include full abortion and birth control coverage for everyone. Winning Medicare for All would be a resounding victory for feminism. Because of job discrimination, women tend to have worse health coverage and often have to depend on a spouse for health care (especially if they leave the paid workforce to do unpaid care work). Guaranteeing health insurance to all would enhance women’s economic independence because health care would no longer depend on employment or marital status. The current for-profit system also relies heavily on the unpaid work of women caring for family members, who are discharged “quicker and sicker” by an insurance system that exists only to make shareholders money. Long-term care, such as is paid for by national health systems in other countries, here is provided by family members, mostly women, many ruining their own health in the process. Finally, a Medicare-for-All system in which the federal government paid for abortion and birth control would likely be less vulnerable to legal challenges than Medicaid or the Affordable Care Act, because states would not be funding or administering it. While feminists would still need to win the argument for full abortion and birth control coverage, we’d be in a much better position to achieve our goals — especially if every feminist group is in there fighting for reproductive rights.