Late last month the Supreme Court settled a bitter three-year controversy over abortion by deciding, 5 to 4, that the federal government has the right to refuse to pay for abortions with Medicaid funds. The Court thus upheld the amendment to the HEW budget that Catholic congressman Henry Hyde, an Illinois Republican, has sponsored every year since 1976. The latest amendment limits Medicaid-funded abortions to women whose lives are endangered by pregnancy and to victims of incest and rape.
Few people are in a better position to measure the decision’s impact than James Trussell and Jane Menken of Princeton University, senior authors of a study done on the aftereffects of the early Hyde amendments. Trussell, a 30-year-old bachelor, is associate professor of economics and a faculty associate of the university’s Office of Population Research. Menken, 40, married and the mother of two, is professor of sociology and assistant director of the population group. Trussell and Menken shared their findings and projections with PEOPLE correspondent Richard K. Rein.
What has been the impact of the Hyde amendments?
Menken: There were about 300,000 federally funded abortions in the U.S. in the year before the Hyde amendment took effect in August 1977. In 1978 there were only 2,000. But some women, barred from the federal program, were able to get free abortions because states have the option of offering broader services than federal Medicaid. Nine states plus the District of Columbia currently provide funds to continue Medicaid coverage for abortions. Thirteen other states were ordered by courts to provide abortion services to Medicaid patients.
What happened in the other states?
Trussell: We studied two, Ohio and Georgia. We found that about 80 percent of the Medicaid-eligible women obtained abortions without public assistance. They must have gotten the money by borrowing or by digging into their welfare budgets. The average cost of an abortion then was about $160. [It is now $200.]
Did you find some women took drastic steps to obtain abortions no longer accessible to them through Medicaid?
Trussell: Atlanta’s Center for Disease Control turned up some evidence of women resorting to self-induced or nonmedical abortions. In a few of those cases, the results were tragic—the women died.
What will be the impact of the Supreme Court’s ruling?
Trussell: States still can exercise their choice, but they do not have to fund. Almost surely the 13 states that were under lower-court orders to provide Medicaid abortions will no longer do so. Some states that were voluntarily funding may change their policy.
If all states withdraw their support, what will be the impact?
Menken: If we extrapolate from our study and assume that 20 percent of those women who formerly would have obtained Medicaid abortions now will be unable to have them, there will be about 60,000 additional births per year nationally.
Why did you undertake your study?
Trussell: When the Hyde amendment was enacted, HEW kept no figures on Medicaid abortions. The system was set up simply to process bills.
Menken: We wanted evidence that both sides in the abortion debate could examine. The guesses of the impact of Hyde have ranged from nearly 100 percent reduction in abortions to nearly zero. These guesses reflected hopes and fears. The fact that four-fifths of the women managed to find the money to get an abortion is an indication of a strong desire not to have an unwanted birth.
What was the basis of the Supreme Court ruling?
Trussell: The Court said, in effect, that the federal government does not have to provide medical care in this instance. Medicaid also does not pay for tuberculosis and mental health, which require prolonged treatment. Those disappointed in the ruling point out that abortion is the only surgical procedure not covered by Medicaid. The Court’s majority opinion argued that abortion is inherently different, since it involves the purposeful termination of life.
Who wins by the Supreme Court ruling?
Menken: No one. The pro-choice faction is upset that 20 percent of Medicaid-eligible women cannot obtain abortions, and that the 80 percent who do must make substantial sacrifices—even in some cases, it is claimed, be driven to crime—to come up with the money. The right-to-life people are unhappy that 80 percent managed to get abortions. They may take some consolation in the fact that as taxpayers they did not pay for these, but abortion has not been stopped altogether, as they hoped.
What about the taxpayers?
Trussell: Most people have strong moral feelings on the issue. Those whose only concern is how much is being spent will be unhappy to learn that more dollars are being spent now than before. Even if only one-fifth of the women have births, the Medicaid costs of those deliveries, at about $1,000 apiece, exceed the cost of abortions for those women. Future welfare costs for the women and their families may also be substantial. Both in the short term and the long term the amount of federal money spent will increase.