The EACH Act

On March 25, 2021, Sen. Tammy Duckworth (D-IL) and Rep. Barbara Lee (D-CA) reintroduced the Equal Access to Abortion Coverage in Health Insurance Act of 2021 (The EACH Act S. 1021/H.R. TBD). The EACH Act would do away with the Hyde Amendment and guarantee abortion coverage to people who get their heath insurance through the federal government. It would also forbid state and federal governments from prohibiting abortion coverage in private insurance plans.

First authored by Rep. Henry Hyde (R-IL) in 1976, the Hyde Amendment is not part of statutory law. Instead, it has been included as part of the congressional appropriations process every year since 1977. It forbids the use of federal dollars to pay for abortions, except in cases of rape, incest, and when the life of the pregnant person is threatened.

Initially, the Hyde Amendment was only applied to Medicaid, a joint state/federal health program for low-income populations. Because the amendment restricts funding for the Department of Health and Human Services (HHS), it also impacts abortion funding under other programs, including Medicare, the Children’s Health Insurance Program, and the Indian Health Service. In the years since its introduction, the Hyde Amendment (and language similar to it) has made its way into other federal programs, including the military health insurance program, the federal employees insurance program, the Peace Corps, and even the Affordable Care Act (ACA).

Because contributions to Medicaid come from both states and the federal government, states can choose to more broadly cover abortions, as long as they use their own money. Currently, only 16 states do so. The District of Columbia has done so in the past, but because its budget is subject to congressional approval, its residents’ access is intermittent.

The Hyde Amendment is a significant equity issue: People enrolled in Medicaid are, by definition, low-income; they are more likely to be people of color; and they are more likely to experience an unintended pregnancy. Lack of Medicaid coverage for abortion services means patients must pay out-of-pocket for the procedure. Costs vary widely depending on location, length of pregnancy, and type of abortion chosen, but an uninsured patient can expect to spend at least $500—an enormous burden for someone already struggling financially.

The right to have an abortion is useless if it’s unaffordable. The EACH Act is an enormous step toward meaningful access for all.