This fact sheet was written by Krystal Leaphart. It was edited by Ian Lague.
Abortion is essential health care that should be accessible and affordable for all, but in reality, US abortion access has long been shaped by profound inequities. In 1976, just three years after the landmark Roe v. Wade decision, Congress passed the Hyde Amendment, which prohibits federal funds from covering abortion services for people enrolled in Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP), except in cases of life endangerment, rape or incest. The Hyde Amendment also impacts people who obtain their health care or coverage through the federal government in other ways, including federal employees and their dependents; military personnel and their dependents; veterans; Peace Corps volunteers; American Indians and Alaska Natives; and people held in federal prisons or detention centers.
The Hyde Amendment disproportionately impacts Black, Brown, and Indigenous communities and creates barriers to care, even in states where abortion is legal. In response to bans and limitations on insurance coverage for abortion, communities have long organized assistance like abortion funds and practical support networks to address financial barriers created by the Hyde Amendment and other restrictive policies.
Since Medicaid is a joint federal–state program, states can utilize their own Medicaid funds to provide this critical coverage. Currently, 20 states without total abortion bans allow state Medicaid funds to be used to cover abortion care beyond the limitations of the Hyde Amendment. By contrast, more than half of states plus the District of Columbia restrict Medicaid coverage in accordance with the Hyde Amendment, with some variation on additional exceptions, such as physical health or fetal condition. These and other limitations too often ensure that abortion access, regardless of its legal status, remains unequal, unaffordable and stigmatized.