In addition to restrictive state laws, the federal Hyde Amendment and subsequent federal and state laws banning public funding for abortion continue to limit access for low-income people, who are disproportionately women of color. Currently Medicaid covers abortion only in cases of rape, incest, or when the pregnant person’s life is endangered by an illness, injury, or physical disorder.

While the Hyde Amendment restricts state Medicaid programs from using federal funds to cover abortion outside the above circumstances, states can use their own funds to cover abortion. In 2020 sixteen states fund abortion services on the same terms as other pregnancy related health services, which means these states use their own funds to cover abortions in circumstances in addition to what the Hyde Amendment allows. Thirty-three states and the District of Columbia follow the federal standard and only provide abortions in the circumstances outlined in the Hyde Amendment. In 2017, over half of reproductive age women on Medicaid — 7.9 million women — lived in states that restrict abortion coverage. The Hyde amendment and its progeny have expanded in scope and currently also limit federal funding of abortion services for federal employees, women in the military and Peace Corps, American Indian and Alaskan native women who use the Indian Health Service, and women in federal prisons and immigration detention facilities.

Currently, under the leadership of women of color organizations and their allies, activists are attempting  to repeal Hyde and restore public funding for abortion health care. In a direct challenge to the Hyde Amendment, Congresswomen Barbara Lee (D-CA), Jan Schakowsky (D-IL), and Diane DeGette (D-CO), introduced the Each Woman Act in 2015 to ensure coverage of abortion for any person, regardless of how much she earns or the type of insurance she has. The All* Above All campaign unites organizations and individuals to lift the bans on public insurance coverage for abortions.

Congress has also blocked foreign aid from covering or even providing information on abortion health care. The Helms Amendment — first passed in 1973 and named after the former ultra-conservative Senator Jesse Helms (R-N.C.) — bars the use of U.S. foreign aid funds to support abortion care. In 1984, Ronald Reagan instituted the Mexico City Policy, which came to be known as the “global gag rule.” Under this gag rule, foreign nongovernmental organizations that want to continue receiving any U.S. family planning funding must agree to stop providing abortion-related services or advocating for the expansion of abortion access, using any source of their funding. The global gag rule has been in place under Republican presidents since 1984, although repealed by every Democratic president. In 2017, Donald Trump expanded the global gag rule to apply to all U.S. global health assistance."