February 10, 2011
The Honorable Jerrold Nadler, Ranking Member
Judiciary Subcommittee on the Constitution
U.S. House of Representatives
Washington, DC 20515
Dear Congressman Nadler:
Thank you for the opportunity to submit this statement on behalf of the Guttmacher Institute in
opposition to H.R. 3, the No Taxpayer Funding for Abortion Act, on which a hearing was held
before the Subcommittee on the Constitution on February 8, 2011.
Through its work as an independent, not-for-profit organization focusing on reproductive health
research, policy analysis and public education in the United States and internationally, the
Guttmacher Institute has developed and analyzed a great deal of information on public- and
private-sector abortion insurance coverage, the implications for the health and well-being of
women and their families of insurance coverage or the lack thereof, and the relationship between
insurance coverage and abortion incidence. Many of the Institute’s research findings, along with
key research findings of other experts in the field, are addressed in two articles directly relevant to
H.R. 3 from the Guttmacher Policy Review that are summarized below and attached for inclusion
in the record.
A primary purpose of H.R. 3 is to write into permanent law an annually imposed policy, commonly
referred to as the Hyde amendment, that sharply limits abortion coverage (currently to cases of life
endangerment, rape and incest) under Medicaid, the joint federal-state health insurance program for
the nation’s lowest-income citizens. H.R. 3 would also make permanent the Hyde amendment’s socalled
progeny, a series of policies that similarly restrict abortion coverage or services for other
groups of women dependent on the government for their health insurance or health care, ranging
from women in federal prisons to women in the U.S. armed forces.
As discussed in “The Heart of the Matter: Public Funding of Abortion for Poor Women in the
United States” (Winter 2007), a number of studies conducted over the last three decades have
assessed the impact of the Hyde amendment’s near-ban on Medicaid insurance coverage of
abortion. A review of these studies published by the Institute in 2009 concluded that some three in
four poor women seeking an abortion manage to obtain one notwithstanding the lack of coverage.
This may be a testament to their determination not to bear a child they feel unprepared to care for,
but their doing so also may come at a considerable price to themselves and their families. Various
studies indicate that many Medicaid enrollees denied abortion coverage are forced to divert money
meant for rent, utility bills, or food or clothing for themselves and their children as they scrape
together the funds to pay for the procedure. This is especially problematic because both the cost
and the risk of an abortion increase as a pregnancy continues. In 2009, the average charge for an
abortion was $451 at 10 weeks’ gestation, but it jumped to $1,500 at 20 weeks. And the risk of
death from abortion, although exceedingly small at any point, increases exponentially with
gestational age. Thus, a poor woman seeking an abortion in the absence of Medicaid coverage is
Guttmacher Institute 2 February 10, 2011
often caught in a vicious cycle: the longer it takes for her to obtain the procedure, the harder it is
for her to afford it, even as the risk to her health is increased. And, of course, one in four Medicaid
enrollees who would have an abortion if Medicaid coverage were available is unable to do so and
carries her unwanted pregnancy to term.
I would like to address a point on which Guttmacher research is frequently invoked and
misrepresented. It simply does not follow that because one in four Medicaid enrollees who would
have an abortion if it were covered under Medicaid is unable to do so in the absence of such
coverage, restoration of federal Medicaid coverage would result in a significant increase in the
incidence of abortion nationwide. As discussed in “Insurance Coverage and Abortion Incidence:
Information and Misinformation” (Fall 2010), this is because only a small proportion of women are
enrolled in Medicaid in any state, and because 17 states, including several of the nation’s most
populous, are among those that use their own money to pay for abortion services for poor women.
Accordingly, lifting the Medicaid restrictions would translate into an estimated 5% rise in the total
number of abortions in the group of states in which funding is currently restricted—and a 2.5%
increase in the total number of abortions performed nationwide.
In conclusion, the Hyde amendment endangers poor women’s reproductive health and violates their
reproductive and human rights. Even the five-member majority opinion in the 1980 Supreme Court
decision upholding Congress’ ability to impose the Hyde amendment took pains to stress that the
Court was not passing judgment on the merits of the funding restriction by deciding “whether the
balance of competing interests reflected in the Hyde Amendment is wise social policy.” On the
contrary, said the Court, “if that were our mission, not every Justice who has subscribed to the
judgment of the Court today could have done so.” Indeed, the Hyde amendment is not wise social
policy. Instead of enshrining the Hyde amendment in permanent federal law, Congress should be
acting to repeal it—as it should be acting to repeal its progeny, the range of restrictive policies that
similarly deny abortion coverage or services to various groups of women who are dependent on the
federal government for their health insurance or health care.
Finally, it should go without saying that Congress should not be extending the harms of the Hyde
amendment and its progeny further by seeking, as H.R. 3 does under the disingenuous “no taxpayer
funding” label, to eliminate abortion coverage in what heretofore has always been considered the
private insurance market by redefining “taxpayer funding” to encompass the standard tax treatment
currently afforded to individual or employer-based health insurance plans should those plans
include abortion coverage. Abortion is a legal, constitutionally protected and medically appropriate
health care service that fully merits health insurance coverage, both in private-sector plans and in
plans for those dependent on the federal government.
Thank you for the opportunity to provide these comments.
Cory L. Richards
Executive Vice President and Vice President for Public Policy