Last October, abortion advocate Brittany Mostiller spoke at a virtual rally hosted by then-vice presidential candidate Kamala D. Harris. In hopes that the Biden administration would advocate for Congress to repeal the Hyde Amendment, a provision in the federal budget that bars Medicaid from covering the cost of abortion in most cases, Mostiller told her abortion story.

“When I was 22, I was a mama to three daughters and holding down a part-time job at a grocery store, and I realized I was pregnant again. I couldn’t afford another child then — physically, emotionally or financially,” Mostiller told Harris. “The decision to have the abortion was the easy part, but I couldn’t afford it.”

Because Medicaid did not cover abortion care, Mostiller said, she had to come up with $900 to pay for her abortion out-of-pocket. The average cost of an abortion can vary from $500 to more than $3,000, depending on the trimester.

Earlier this year, Illinois became one of 17 states to expand Medicaid to cover abortion care, but in 2007 — when Mostiller needed an abortion — it did not. “The Hyde Amendment stood in the way of me having access to the care I wanted and needed,” Mostiller recently told The Lily. She ultimately got support from the Chicago Abortion Fund, where she ended up volunteering and then working as a reproductive justice advocate; she’d later serve as the executive director of the fund.

Antiabortion advocates have long argued that the amendment helps antiabortion taxpayers avoid involuntarily funding abortion care. “For more than four decades, the Hyde family of pro-life policies has kept American taxpayers out of the abortion business, with the Hyde Amendment itself saving nearly 2.5 million lives,” Marjorie Dannenfelser, president of the antiabortion advocacy group Susan B. Anthony List, said in a statement.

Last week, when President Biden released his proposed 2022 budget, it did not include the Hyde Amendment, which has been policy since 1976. The budget proposal makes Biden the first president to omit the amendment from his budget since Bill Clinton attempted to repeal it in 1993. Although the budget is unlikely to pass the 50-50 Senate intact, reproductive health advocates are celebrating the symbolism, at least, of the exclusion of Hyde — Biden had supported it for years.

“Women of color in particular, within the reproductive health, rights and justice movement, have been leading on this work for decades,” said Destiny Lopez, co-president of the abortion rights organization All Above All.

Just three years after the Supreme Court ruled in Roe v. Wade in 1973, legalizing abortion in the United States, Congress enacted the Hyde Amendment to prevent Medicaid from paying for abortion care. Reproductive health advocates argue that the amendment disproportionately impacts low-income women of color, who are more likely to receive health insurance through Medicaid.

Republicans and antiabortion advocates, meanwhile, are decrying Biden’s decision to omit it from the budget. Mallory Quigley, vice president of communications at the Susan B. Anthony List, said: “Peer-reviewed studies show the impact of abortion is nearly four times higher for the Black community. By eliminating the Hyde Amendment from their proposed budget, the Biden-Harris administration endangers the lives of minorities.”

Republican lawmakers like Rep. Andy Biggs (Ariz.) and Sen. Marsha Blackburn (Tenn.) voiced their disapproval of Biden’s budget on Twitter, echoing fears that it would force taxpayers to pay for abortions. Democrats like Rep. Barbara Lee (Calif.) applauded the choice, saying it would advance the “fight to end this racist & discriminatory policy once and for all.”

Lee, who in 2016 introduced legislation into Congress to repeal Hyde, was working as a congressional staffer when the amendment passed in 1976.

“I was one of only a handful of women, especially African-American women, working on Capitol Hill, and women’s rights weren’t exactly on the agenda,” she wrote in a 2016 op-ed. “You can imagine my frustration with the Hyde Amendment, which made the legal right to abortion essentially meaningless for poor women and women of color by stripping it out of their insurance coverage.”

Today, reproductive justice advocates of color are still leading the push to repeal Hyde.

All Above All, which is led by women of color, was founded in 2013 with the specific aim of restoring public insurance coverage of abortion. Since then, 130 organizations have joined All Above All’s campaign — which has included expanding Medicaid coverage at the state level and introducing the Each Woman Act into Congress, which would lift the Hyde Amendment.

Lopez said her team knew they needed to change the public narrative around the amendment — but that it would be difficult to rally support for low-income women of color when abortion was already such a hotly debated subject. In recent years, however, they’ve seen Democratic congressional sponsors increasingly sign onto the Each Woman Act and Democratic candidates voice their support for repealing Hyde in the 2020 election.

Central to All Above All’s work, Lopez says, is a reproductive justice framework. The term, coined in 1994 by a group of Black women called Women of African Descent for Reproductive Justice, seeks to make reproductive health care accessible for all women. Lopez says a reproductive justice lens allowed her team to consider how income, immigration status, race and sexual orientation might impact a person’s access to abortion care.

Attorney Jessica Mason Pieklo, senior vice president and executive editor of Rewire News Group, said it’s important to remember the political context from which Roe and Hyde emerged: the civil rights movement. Racial justice was always bound up in reproductive justice, she said. In 1980, the Supreme Court upheld the Hyde Amendment in Harris v. McRae; it found that a woman’s freedom of choice did not carry with it “a constitutional entitlement to the financial resources to avail herself of the full range of protected choices.” But in a dissent, Justice Thurgood Marshall argued that the amendment was “designed to deprive poor and minority women of the constitutional right to choose abortion.”

“I think what we’ve seen in the U.S. is income disparities have grown,” said Amy Hagstrom Miller, founder and chief executive of Whole Woman’s Health, a network of gynecology clinics that provide abortion care across the country. This has created “a disproportionate effect on young people, people of color, rural people,” Hagstrom argued, and “we see these barriers to access to abortion have a really disproportionate effect on those communities.”

Given that Biden’s budget is not likely to pass Congress with Hyde omitted, Lopez says All Above All will continue its campaign for the Each Woman Act, but is also broadening its mission to expand abortion access beyond solely focusing on insurance coverage.

“How do we realize the promise of medication abortion care for communities of color and folks looking to make ends meet with a more expansive vision of abortion access that goes beyond just codifying Roe? Because Roe was really never sufficient for our community because of Hyde,” Lopez said. One of those next steps, she said, is raising public and political awareness of the other congressional provisions that limit federal funding for abortions.

Hyde has also inspired similar policies to bar federal funding for abortion. Native Americans who receive health insurance through the Indian Health Service (IHS), for example, can face restricted access to abortion care. Marinah Farrell, an Indigenous Mexican midwife and executive director of the Changing Woman Initiative, said that Native Americans already face significant barriers to accessing health care through the IHS because of long wait times, shuttered clinics and large distances between facilities. But she’s hopeful that Biden’s budget proposal is symbolic of “the rising up of Native birth workers, and the reclamation that’s happening around body sovereignty.”

In a statement, an IHS spokesperson said, “The IHS is committed to ensuring that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indians and Alaska Natives.” The spokesperson added, “Many factors contribute to limited access to high quality maternal health services in rural communities, including workforce shortages and challenges arising from the social determinants of health which have contributed to disparities in maternal health care for women and their babies in rural communities.”

Mostiller, for her part, was thrilled when she heard Biden’s budget left out Hyde, her words echoing early reproductive justice advocates of color who called for “the right to have a child; the right not to have a child; and the right to parent the children we have.” She said she was moved by “the thought of pregnant people who enrolled in government-funded health insurance having the opportunity to create the families they want, when and if they want to.”

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