In a long-sought concession to the principle of home rule, legislation passed by Congress and signed by President Obama on December 16 restores the ability of the District of Columbia—for the first time in over a decade—to use its own, locally raised revenue to pay for abortions for its Medicaid recipients. Under the so-called Hyde Amendment, federal contributions to the joint federal-state Medicaid program may be used to pay for abortions only in cases of rape, incest and to save the life of the mother. States, however, may use their own funds to subsidize abortions on broader grounds, and 17 states currently do so. The District is expected to rejoin that group shortly, providing much-needed assistance to low-income women severely limited by current restrictions and helping to correct a longstanding inequity in access to abortion services.

The issue of Medicaid funding goes to the heart of who has access to abortion in the United States and under what circumstances. Numerous studies have demonstrated the negative impact that Hyde Amendment restrictions can have on poor women facing an unwanted pregnancy. Lacking Medicaid coverage, some require a considerable amount of time to come up with the money to pay for an abortion on their own, often pulling resources from other family necessities, such as food or rent. As the cost of the procedure increases with gestation, low-income women may become trapped in a vicious cycle of scrambling to raise enough money before the cost increases further. Still, in a testament to their determination to control their own childbearing and act in their best interest and that of their families, some women do manage to obtain the abortion under these circumstances.

Other women, however, are left with no recourse but to carry an unwanted pregnancy to term. According to a 2009 report by the Guttmacher Institute and Ibis Reproductive Health, based on an extensive review of the literature, approximately one in four women who would obtain a Medicaid-funded abortion if given the option instead have to continue their pregnancy.

The omnibus FY 2010 appropriations bill allowing the District to pay for medically necessary abortions using local funds is an important step in the right direction because it can help lessen the disproportionate barriers poor women encounter in seeking access to a safe abortion procedure. Rather than trying to reduce women’s recourse to abortion through coercive measures, U.S. policy—even as it guarantees access to those women who need an abortion—should focus on reducing unintended pregnancy, the underlying cause of almost all abortions, by actively promoting contraceptive use and ensuring universal access to family planning services.

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The impact of restricting Medicaid funding for abortion

How politics distorts facts on the impact of abortion coverage

A historic look at the Hyde Amendment

Current state policies on funding of abortion under Medicaid