The federal government created the Medicaid program in 1965 as joint federal-state initiative to provide subsidized health coverage for low-income individuals. Today, Medicaid is the largest health care program in the United States, and covers more than 50 million people, including 11.5% of women of reproductive age. Although states run their own Medicaid programs, each state must still comply with federal regulations in order to qualify for federal funding.

Unfortunately, for 30 years, federal regulations have severely restricted low-income women's access to abortion care. The Hyde Amendment bans the use of federal Medicaid funding for low-income women's abortions. The amendment was first introduced in 1976 by then-Representative Henry Hyde (R-IL) as part of the initial backlash against Roe v. Wade, the landmark 1973 U.S. Supreme Court decision that legalized abortion nationwide.

Since the Hyde Amendment first passed as part of the Congressional budget process, it has varied from year to year. Originally, the Hyde Amendment provided no exceptions – even when a woman's life was in danger. Currently, it permits federal funding for abortions in cases of rape, incest, or when a woman's life is in danger.

In 1980, the Supreme Court upheld the Hyde Amendment in Harris v. McRae. In its 5-4 decision, the Court found that the federal law did not violate the constitutional rights of low-income women. The Court also ruled that states were not required to use their own funds for abortions under Medicaid. Harris v. McRae marked the beginning of a gradual attempt to chip away at the rights recognized in Roe v. Wade that continues to this day.

By denying women coverage for abortion care under Medicaid, the Hyde Amendment creates disparities in access to abortion for low-income women – including many women of color who are more likely to rely on public programs for their health care and more likely to face an unintended pregnancy today.

For some women, the Hyde Amendment renders meaningless the right to choose abortion established in Roe. A woman who cannot afford to pay for an abortion may continue her pregnancy, even if she is unable to support the child financially or emotionally. She may also feel compelled to use funds that would otherwise go toward food, shelter, and clothing to pay for an abortion. Forcing a woman to chose between the bare necessities and her own health creates an immense social disadvantage for many women.

1976: The Hyde Amendment is passed. It includes no exceptions, even for when a woman's life is in danger. It was challenged in court the day after it passed, and U.S. District Court Judge John F. Dooling issued an injunction against enforcement, finding that the amendment was unconstitutional.

1977: The U.S. Court of Appeals for the Second Circuit lifted Judge Dooling's injunction in August, allowing the Hyde Amendment to take effect; this time, Congress had included exceptions for rape, incest, and when a woman's life is in danger.

1980: The U.S. Supreme Court upheld the constitutionality of the original language of the Hyde Amendment in Harris v. McRae, finding that imposing restrictions on the funding of medically necessary abortions was unconstitutional. The Court also held that states that participate in the Medical program are not required by Title XIX of the Social Security Act to fund medically necessary abortions for which federal funds are unavailable under the Hyde amendment.

1981: Congress removed the rape and incest exceptions from the amendment.

1993: Under pressure from women's health advocates emboldened by the election of a pro-choice President, Congress expanded federal Medicaid funding for abortion care for rape and incest victims.

1997: Congress adopted language to make it clear that the Hyde Amendment applies to Medicaid recipients already enrolled in managed care plans. Additionally, Congress passes the Budget Reconciliation Act of 1997, which applies to the State Children's Health Insurance Program.

2010: The day after health care reform was signed into law, President Obama issued an executive order confirming the bill's compliance with the Hyde Amendment and reaffirming that federal funds would not be used for abortions under the new law, including in the health exchanges to be implemented in 2014, except in cases of rape, incest, or danger to the woman's life. The order was crucial to the bill's passage, as it won the support of a coalition of anti-choice House Democrats led by Congressman Bart Stupak of Michigan.