September 27, 2016 — In a Rewire commentary, Lin-Fan Wang, "a family doctor working in an underserved community," calls for an end to the Hyde Amendment by highlighting the disparate access to abortion care in New York, which allows state funding for abortion care, to Pennsylvania, which does not.
She explains that the Hyde Amendment bars the use of federal funding for abortion care outside of cases of rape, incest or life endangerment. However, Wang writes that "states can individually decide whether state funds can be used to cover abortion care for Medicaid recipients." According to Wang, "more than half of the 50 U.S. states prohibit state funding of abortion beyond the Hyde exceptions."
Wang writes, "At the start of my practice in New York state, it was easy to make available comprehensive health care to all of my patients regardless of their income" because the state, despite the ban on federal funding, "permit[s] state Medicaid funds to cover abortion care." Wang notes, "When my New York patients using Medicaid as their health-care coverage came to see me and decided that abortion was the best decision, I was able to provide the care they needed without my patients worrying about the cost."
In contrast, after Wang began working in Pennsylvania, her "interactions with patients seeking an abortion completely changed." Reflecting on her first abortion consultation with a patient on Medicaid in the state, Wang writes, "Just as I was about to discuss her medical history as part of the exam, she asked how much the abortion would cost, since Pennsylvania doesn't permit state funds to be used for abortion care." Wang states, "Instead of providing my patient with the abortion she needed without delay, I had to help her figure out whether she could afford to receive care."
Wang spotlights some of the other challenges facing Pennsylvania women covered through Medicaid who are seeking abortion care. She writes, "Patients who qualify for Medicaid but who are unable to receive abortion coverage often have to concern themselves with taking an unpaid day off from work -- because many of them work jobs that don't offer paid leave -- and finding and affording extra child care." She states, "The funding restriction means that patients are forced to delay care in order to find the money needed to get a service that is covered financially by Medicaid just one state over."
Calling for an end to Hyde, Wang writes, "Health insurance should not be based on which state you live in. The timetable for health care should not depend on whether you have Medicaid or whether you are fortunate enough to have private insurance." She continues, "No longer should my patients reliant on Medicaid be forced into the vulnerable position of scraping together funds for their abortion care." Wang concludes, "As a doctor, I want to focus on helping patients with their medical decisions, not on whether or not they can afford the health care they need" (Wang, Rewire, 9/26).