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We need to strengthen Medicaid. With a new administration and Congress moving on key legislative priorities, now is the time. Strengthening Medicaid means increasing access to abortion and reproductive care. Abortion access is often an afterthought among the health advocacy community, but without abortion access, Medicaid coverage cannot ensure the overall well-being of people that may become pregnant.

Advocates for strengthening the Medicaid program must also advocate for the Ensuring Abortion Coverage in Health Insurance (EACH) Act. The EACH Act would restore abortion coverage to people who receive health care or insurance through the federal government Passing the EACH Act will repeal the Hyde Amendment, and every person that relies on Medicaid for health coverage would have access to abortion care.

Since its introduction in 1976, the Hyde Amendment has served as a threat to people’s health. The Hyde Amendment prohibits the use of federal funds for abortion care in Medicaid (except in very narrow circumstances), leaving millions of people without access to life-saving reproductive care. If not for the Hyde Amendment, 13.9 million reproductive-age people enrolled in Medicaid could have received federal support for abortion coverage in 2019.

The Hyde Amendment disproportionately harms Black, Indigenous, and people of color (BIPOC), because they are more likely to have lower incomes, and subsequently be insured by Medicaid, due to systemic racism and economic injustice. Yet, access to abortion care for BIPOC people is even more critical when considering the pervasive health disparities they face when compared to their white counterparts, especially when pregnant. Black women are three times more likely to die from pregnancy-related complications than white women. Access to abortion care is crucial to improving maternal health outcomes, especially for Medicaid enrolleess of color. For example, women who are denied abortion care are also more likely to delay prenatal care, which can result in higher incidence of poor maternity-related and infant health outcomes.

While access to abortion is an essential component of women’s health, it is also imperative to reaffirm women’s rights to dignity and bodily autonomy. Approximately one in four Medicaid-eligible people with an unintended pregnancy is forced to carry that pregnancy to term because of restrictions on Medicaid funding for abortion. Medicaid advocates must rally behind the EACH Act to give people the tools to live their lives and make decisions on their own terms, just as Medicaid advocates have done for seniors and people with disabilities when fighting for expansion of home and community-based services.

Without coverage of abortion care in Medicaid, low-income people with unintended pregnancies face burdensome barriers in order to find abortion care, including high out-of-pocket costs for care and difficulty finding and traveling to a provider. When considering additional costs, such as transportation, child care, and hotel and other travel costs, people can then be forced to choose between paying for rent or food and accessing abortion care. As a result, many people on Medicaid are forced to delay abortion care. However, the cost of care only increases the more it is delayed.

Medicaid beneficiaries who cannot overcome such barriers, and thus never receive abortion care, face life-long economic consequences. The most common reason women desire an abortion is because of a lack of financial secruity to raise a child, and without abortion care, the financial responsibility of caring for a child puts women and their families at greater risk of economic hardship. Women who are denied an abortion are more likely to fall into poverty than women who are able to obtain the care they need.

If Medicaid advocates do not work together to help pass the EACH Act and dismantle the Hyde Amendment, BIPOC people will continue to disproportionately face barriers to abortion access, and racial and socioeconomic inequities in our health care system will persist.