The Hyde Amendment does not ban states from using their own funds to cover abortion, and 16 states do. Nevada is not one of them. (Getty Images)
At least 7 out of 10 of Nevada’s insured population have health plans that do not cover elective abortions.
That’s because they are either insured through the federal government or receive subsidies subjected to prohibitions on federal spending on abortions.
For decades, few health insurance plans have covered abortion in America. Policies enacted by Congress over those same decades prohibit using federal funds for abortion services. Critics say those policies are particularly harmful to the economic well-being of low-income people and people of color.
“It’s definitely an economics issue and an equity issue,” said Lindsey Harmon, the executive director of Planned Parenthood Votes Nevada. “When you are asking for folks to pay for the cost of an abortion, transportation, and childcare — these insular costs associated with abortion – you’re making it more difficult to access care.”
Nevadans cannot get a comprehensive plan that covers abortion if their health coverage is provided by the federal government. The prohibition applies to those covered by Medicaid, all federal employees, from the Postal Service to the Peace Corps to all federal agencies, and members of the military.
Plans established under the Affordable Care Act also do not cover abortions for those who receive federal income-based subsidies.
The Hyde Amendment, first enacted in 1977 as part of a Medicaid appropriations bill, forbids federal funds for abortions except in cases of rape, incest, or when a person’s life is at-risk. The restriction has subsequently expanded to apply to other health programs that receive federal funding, including the Indian Health Service, and the Children’s Health Insurance Program (CHIP).
The Hyde Amendment does not ban states from using their own funds to cover abortion, and 16 states do. Nevada is not one of them.
“States like Nevada are short on Medicaid dollars. Both at the federal and state level. That’s a pervasive issue across the board here and I think everyone agrees that Medicaid rates are lower than they need to be,” Harmon said. “For a long time the state of Nevada has been very fiscally prudent with their dollars and unfortunately it hasn’t caught up with the demand.”
Those insured through their employers in group markets, or self-insured individuals, along with those covered by the ACA, account for 49% of the insured population.
About 11% of the state’s population is uninsured.
In Nevada, 40% of the state’s insured population is directly covered under federal plans, including Medicaid/ CHIP, Medicare and Tricare/VA Health Care (the health insurance plans for military members), which are regulated under provisions similar to ACA’s and are all subject to the Hyde Amendment, according to the 2021 Insurance Market Report to the Legislature by the Nevada Division of Insurance (DOI). The DOI does not break down the insured population by gender or age.
Residents with restricted access to abortion under Medicaid coverage were more likely to continue their pregnancy, spend longer looking for an abortion, report more financial barriers and were more likely to report having to gather money to travel for an abortion, according to a 2021 national cohort study.
The Hyde Amendment is criticized for disproportionately impacting Black and Hispanic and low-income women by the ACLU, the Guttmacher Institute, and other groups committed to advancing sexual and reproductive health and rights in the United States and globally.
Those who utilized these health plans based on income, putting the average cost of medical abortion— anywhere between $535 to $1,600 or higher depending on the state and provider — financially out of reach.
Half of all pregnancies are unintended in the U.S. and the bulk of women pay at least something out-of-pocket, according to the Kaiser Family Foundation.
Large group insurers, which represent 10% of Nevada’s insured population, are not subjected to the ACA provisions, and preliminary observations from the state Department of Insurance note these insurers have expanded coverage since the Dobbs ruling.
But less than 1 in 10 women used their private insurance to pay for an abortion, with half of those women saying that their insurance didn’t cover it and a quarter saying they were unsure if their insurance covered it, according to a 2011 study of women seeking an abortion.
Even if a person’s insurance does cover abortion, there was a decline in facilities that accepted any insurance, according to a study before the Dobbs ruling, which found that “the presence of restrictions on the use of insurance perpetuates economic and racial health care disparities.”
The Biden administration has excluded the amendment from health budget proposals, and while the act is symbolic (Congress would have to vote to repeal the amendment), it does set the tone of where the administration wants to go, Harmon said.
“It is setting the stage for Congress to take action should the elections vie in our favor,” Harmon said. “It’s about time. It’s about meaningful change, especially in light of Roe being overturned. It showed how taking that ruling for granted made Congress open their eyes to how the real impact this plays on real people’s lives on a regular basis.”
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