Abortion Access: Restrictions on Public Funding and Insurance Coverage

03.05.09 - Access to abortion in the U.S. is undermined not only by restrictive legislation, but also by bans on the use of public funds, facilities and employees for abortions, and by restrictions on insurance coverage for abortions. These restrictions patently discriminate against women and pose significant obstacles for women – particularly low-income women – seeking to exercise their constitutional right to have an abortion.

Bans on Public Funding for Abortion

When abortion was first legalized in 1973, federal Medicaid funds could be used to pay for medically necessary abortions just as they could be used to pay for any other health care service needed by a low-income recipient of Medicaid benefits. However, in 1977, Representative Henry Hyde (Rep-IL) sponsored a budget amendment that prohibited the use of any federal funds to pay for abortion except when necessary to save a woman's life.

In 1980, the Supreme Court upheld this amendment – commonly known as the "Hyde Amendment" – against a challenge that it violates women's right to abortion and denies equal protection to low-income women. Renewed annually by Congress, the Hyde Amendment has since 1993 permitted federal funding for abortions only where the pregnancy results from rape or incest, or where necessary to save a woman's life when it is endangered by a physical disorder, injury or illness.

Similar restrictions limit access to abortion for Medicare enrollees, federal employees and their dependents, military personnel and their dependents, Native American women who receive health care through the Indian Health Service, Peace Corps volunteers, women in federal prisons, and low-income women in the District of Columbia.

State Funding for Abortion

The Hyde Amendment does not affect a state's authority to fund abortions with its own Medicaid funds. Four states voluntarily provide abortion funding beyond the exceptions contained in the Hyde Amendment, and an additional 13 states provide such finding as a result of court challenges brought by the Center and other advocates.

The Center for Reproductive Rights has successfully challenged a number of state bans on Medicaid funding for abortion. Our factsheet Portrait of Injustice: Abortion Coverage under the Medicaid Program describe funding for abortion in detail.

Restrictions on Public Facilities & Public Employees

Another barrier to abortion access comes in the form of state laws prohibiting the performance of abortions at public medical facilities, a critical source of health care for low-income women and women of color. For example, in many states, abortions cannot be performed in public hospitals, or by public employees, except in cases of rape or incest, or where the woman's life is endangered by the pregnancy. In addition, some states also prohibit state employees and employees of social service agencies receiving state funds from providing even counseling or referrals for abortion services. 

Bans on Insurance Coverage for Abortion

To date, five states – Idaho, Kentucky, Missouri, North Dakota, and Oklahoma – have passed laws that restrict private health insurance plans from covering abortions. Under those states' laws, insurance coverage for abortion is available only in cases where the woman's life is endangered (and, in Oklahoma, where the pregnancy resulted from rape or incest), unless policyholders pay an additional premium to cover a separate policy rider.

Twelve states impose similar restrictions on abortion coverage in health insurance plans for public employees. These states' policies range from outright bans on insurance coverage for abortion services to polices that limit coverage for abortions to instances in which the abortion is necessary to preserve the woman’s health or life or in cases of rape, incest, or fetal abnormality.