‘What If the Government Funded Adoptions Instead of Abortions?’
During ongoing national debate about a new abortion law in New York in February 2019, a Facebook user shared a meme with a photograph of an infant atop an American flag, bearing the following caption:
WHAT IF THE GOVERNMENT FUNDED ADOPTIONS INSTEAD OF ABORTIONS?
In the midst of this debate, this uncited meme proved popular and racked up a six-figure share count. Its premise clearly resonated with a number of users, many of whom presumably opposed the new law in New York state (which broadly re-legislated abortion as a health matter rather than a criminal one.)
But the question made two presuppositions — first that the government funds abortions, and second that the money funding abortions could be used to place unwanted children for adoption.
The second matter, adoption, does not contain the same emotional and political minefields as the abortion debate; further, this is a prescriptive opinion (they “should” fund adoptions) and not a statement of fact. That leaves the first question — does the United States government actually fund abortion? Typically, the Hyde Amendment of 1976 is cited in these debates. The amendment, passed just a few years after the landmark Roe vs. Wade case, blocks the use of federal funds for abortion services:
Since the Supreme Court’s 1973 decision in Roe v. Wade, abortion has been squarely in the middle of political debates at the national and state levels. Soon after the Court’s ruling, Congress enacted the Hyde Amendment which blocks federal funds from being used to pay for abortion outside of the exceptions for rape, incest, or if the pregnancy is determined to endanger the woman’s life. Since its passage 40 years ago, the law has dramatically limited coverage of abortion under Medicaid, as well as other federal programs. The amendment was sponsored and supported by legislators who opposed abortion and, in particular, objected to the federal government’s use of taxpayer money for abortion services. The policy was not passed as a permanent law, but rather was attached as a temporary “rider” to the Congressional appropriations bill for the Department of Health and Human Services (HHS). Since then, the Hyde Amendment has been renewed annually by Congress.
That excerpt comes from an October 2017 Kaiser Family Foundation (KFF) page about the Amendment, and it also notes that the legislation largely pertains to the federal level — arguably, “the government.” But examining public funding for abortion through the lens of the Hyde Amendment left open the question of individual states funding abortion services. According to KFF, 33 states do not choose to pay for abortions with their own funds — and in the 17 other states, any additional coverage is not funded federally (i.e., by the government):
Because Medicaid is jointly funded by the federal and state governments, states can choose to pay for abortions under Medicaid in other instances, but must use their own revenues, and not federal funds, to cover the service. Currently, 17 states have a policy directing the use of their own funds to pay for abortions for low-income women insured by Medicaid beyond the Hyde limitations, 12 of which provide coverage as the result of a court order.
Since Medicaid, as a federally funded health service, does not cover abortion, women who seek abortions as Medicaid recipients do pay out-of-pocket for these procedures. They are not covered by the government in all but a handful of cases:
Without coverage for abortion under Medicaid, women must pay out-of-pocket for the procedure. Costs vary by location, facility, and gestational age, but on average an abortion costs $485 among women who had out-of-pocket costs, with some paying upwards of $3500.
In its sources, KFF referenced a 2014 Guttmacher Institute study examining abortion services and low-income women. In it, Guttmacher called for a repeal of the Hyde Amendment due to barriers for Medicaid recipients surmounting abortion costs. Put another way, the government (via Medicaid) was not funding abortions (“except in cases of rape, incest or life endangerment”):
Medicaid is the largest source of funding for medical services for poor and low-income individuals in the United States. To reduce barriers to abortion care, all states need to participate in the Medicaid expansion program, laws restricting the use of insurance coverage of abortion services must be prevented or repealed, and — most critically — the Hyde Amendment must be struck down. Abortion services are an integral part of reproductive health care, and they should be covered by health insurance without exception.
In a separate portion, Guttmacher noted that in states where state funds are used, the abortions covered are still the ones deemed medically necessary and not elective:
While federal Medicaid dollars can be used to pay for abortions only under very limited circumstances, 15 states allow state funds to cover all or most medically necessary procedures for patients with Medicaid coverage, including states with large populations, such as California and New York.
Coverage of abortions not deemed medically necessary is rare enough to be newsworthy, and occur only in a small handful of states. The Chicago Tribune reported one such case in June 2018:
The patient was surprised and relieved to learn state Medicaid would cover the cost of the roughly $500 procedure, the result of a controversial Illinois law that expanded taxpayer-subsidized abortions and went into effect Jan. 1.
“I didn’t know what I was going to do,” she said, asking to remain anonymous. “I’m thankful I was able to use the medical card because I don’t have the money right now.”
Even in a state considered a reproductive rights haven within the more restrictive Midwest, debate over House Bill 40 divided Illinois — just one battle in a decadeslong war over public funding for abortion that continues here and nationwide.
Guttmacher maintains a regularly updated list of states with expanded coverage, services once again not covered by the federal government. As of March 4 2019, the list was current to February 1 2019.
The meme claims that the government funds abortions, and that it should fund adoption instead. It is premised on a fundamentally flawed claim, as the federal government is generally prohibited from funding abortions under the 1976 Hyde Amendment. During the 2016 election campaigns, Hillary Clinton called for its repeal, but she was not elected. A handful of populous states (including New York, California, and Illinois) cover a small number of additional abortions, but the federal government does not fund abortions, with a very few medical exceptions.