Backing Off Hyde Would Betray a Core Principle on Abortion

P resident Trump recently encouraged congressional Republicans to allow greater “flexibility” on the question of the Hyde amendment and abortion funding, to not mandate abortion restrictions on funds given to Americans in health savings accounts. National Review’s editorial and a piece by Catholic University of America professor Michael New provide exhaustive reasons why this move would be wrong. But “flexibility” on Hyde could also undermine a fundamental principle: that taxpayers should not pay for abortion, and insurance should not cover it, because it isn’t properly “health care.”

A bit of history is in order. Since 1976, the annually renewed Hyde amendment has prevented federal funds from paying for abortion directly. It represents a critically important national compromise: Americans might disagree on whether abortion should be legal, but the millions who believe that it is immoral should not be forced to fund it with their taxes.

This compromise arose because abortion was rightly understood to be something separate from normal health care. There are various ways to define the term “health care,” but fundamentally, it involves interventions to restore or maintain the body at a state of function and flourishing. Abortion is not a treatment to restore healthy functioning, but rather an intervention designed to artificially end the natural process of pregnancy, along with ending the life of the pre-born child. It is chiefly chosen for social, rather than medical, reasons: a woman’s lack of financial stability, lack of partner support, or simply not desiring to have a child at a specific point in her life.

The question of whether abortion is or is not health care has profound implications for public policy dealing with health care and insurance. If abortion were basic health care, then pro-lifers’ views might be given the minimal deference shown to Jehovah’s Witnesses for their objections to blood transfusions, but nothing more. Blood transfusions are covered by every form of health insurance under the sun, public or private.

But since abortion isn’t health care, the arguments for government funding and insurance mandates collapse. Abortion is something analogous to cosmetic plastic surgery: an elective intervention that is not solving a health problem or helping maintain optimal health. It is generally chosen for social, not medical, reasons. By this perspective, it absolutely should not be funded by taxpayers or made mandatory for coverage by insurers, no more than a Michael Jackson–esque rhinoplasty.

Hyde’s support among Democratic lawmakers began to crumble in the 2010s. Defeats in the 2010 and 2014 elections led to a purging of moderate congressional Democrats who supported Hyde. The pro-abortion movement also began to change its rhetoric and ideology, moving away from the Clinton-era “safe, legal, and rare” mindset to the language of “abortion access” and “abortion care.” Any hindrance to a woman’s ability to “access” abortion “care” — state health regulations, costs, lack of coverage in government or private insurance, lack of proximity to an abortion clinic, conscientious objections by doctors or hospitals — needed to be knocked down to allow every woman seeking this form of “basic women’s health care” to obtain it. If a woman can’t afford an abortion, then the government — i.e., taxpayers — should foot the bill.

The Hyde amendment stood as a roadblock to this vision. As a result, Hillary Clinton in 2016 became the first major presidential nominee to oppose the Hyde amendment, and opposition to Hyde has become a litmus test for Democratic candidates ever since. Joe Biden, after supporting Hyde for more than 40 years, memorably abandoned his position on the issue over the course of two days in 2019 after realizing that this reversal was necessary for him to win the Democratic presidential nomination. To quote Groucho Marx, “Those are my principles! And if you don’t like them, well, I have others!”

But before Hillary Clinton and Joe Biden’s open opposition, Democrats undermined Hyde drastically with the Affordable Care Act. As Michael New detailed, the ACA allowed federal dollars to subsidize Obamacare health insurance plans that included abortion coverage, increasing its accessibility to millions of Americans. President Obama’s promised executive order to limit such subsidization (a necessary fig leaf for garnering moderate Democratic support for the ACA) and the ACA’s various accounting gimmicks didn’t change the reality: that federal dollars were making insurance plans with abortion coverage accessible to millions.

Trump’s idea to give the subsidies to Americans directly, in individual health savings accounts, could disastrously undermine the principles underlying Hyde. The accounts will obviously be narrowed in their scope, such that they are limited to paying for health-care costs. If abortion costs aren’t specifically excluded, Republicans would concede on the bedrock truth that abortion isn’t health care. While Trump is trying to argue that sending the money to individuals effectively washes Congress’s hands of guilt or responsibility, I would say the opposite: It reinforces the lie that abortion is within the universe of health care.

It appears that congressional Republicans, led by Speaker Mike Johnson, may hold the line on Hyde. Republicans cannot concede either the dollars or the principles at play.