Thursday, January 22, 2009

Blog for Choice: Repeal the Hyde Amendment

For Blog for Choice Day, bloggers have been asked: What is your top pro-choice hope for President Obama and/or the new Congress? Mine is Medicaid coverage for abortion services.

Cost remains one of the biggest barriers to accessing abortion. Abortion is expensive - on top of the time one needs to take off from work, and the added time and expense caused by state restrictions such as waiting periods and the sparsity of providers in many parts of the country. Even when women can scrape the money together, doing so requires precious time. Such waits can make it harder to find a willing and competent provider, and can also increase the cost further.

Coverage of abortion services is generally excluded by Medicaid under what's known as the Hyde Amendment. Twenty-eight years ago, the Supreme Court upheld that general exclusion, saying in part:

The financial constraints that restrict an indigent woman's ability to enjoy the full range of constitutionally protected freedom of choice are the product not of governmental restrictions on access to abortions, but rather of her indigency. Although Congress has opted to subsidize medically necessary services generally, but not certain medically necessary abortions, the fact remains that the Hyde Amendment leaves an indigent woman with at least the same range of choice in deciding whether to obtain a medically necessary abortion as she would have had if Congress had chosen to subsidize no health care costs at all. ...

Although the liberty protected by the Due Process Clause affords protection against unwarranted government interference with freedom of choice in the context of certain personal decisions, it does not confer an entitlement to such funds as may be necessary to realize all the advantages of that freedom.

Harris v. McRae (1980). There are several possible objections to this ruling. One is that the above reflects an impoverished conception of the right to bodily self-determination. Another, perhaps stronger under current juriprudence, is that singling out abortion services, when health care services for men are generally covered, is a form of invidious discrimination against women.

Constitutional doctrine aside, both points are highly relevant to President Obama's promise of guaranteeing health care for all. "Health care for all" has to mean more than access to an insurance plan. It has to mean access to comprehensive health care, without arbitrary and discriminatory exclusions such as the Hyde Amendment. Or, for that matter, exclusions of life-saving preventive care, or of contraceptives, or services related to gender transition. Opposing these exclusions is not only just, it is sound public health policy.

I know that repealing the Hyde Amendment is not a top priority for Obama or for Democrats in Congress, as it is more controversial than some other pro-choice measures. But so long as individuals lack health insurance coverage for abortion, the promise of "health care for all" will not be fully realized.

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