(WOMENSENEWS)–Lauren Porsch first learned about the connection between poverty and lack of access to abortion two years ago when she was a junior at Barnard College in New York City. While working on a Saturday escort team at an abortion clinic, one woman arrived who couldn’t afford her abortion. The health insurance she relied on would not cover the procedure. Porsch and the other escorts considered pooling their money to help her. Eventually, the clinic made arrangements with the woman so that she could obtain the care she needed. For Porsch, the experience was an eye opener.

"We were confronted head-on with the personal effects of public restrictions," said Porsch, and so she decided to do something about it. While still in college, Porsch and her three friends formed the New York Abortion Access Fund in 2000. By the end of that first year, they had raised $8,000 and provided financial assistance to 30 women, including one woman who traveled to New York from out of state the week after her house burned down.

Porsch’s organization is one of 85 independent groups across the country that provide funds to women who lack money to pay for abortions and whose government health insurance, such as Medicaid, does not cover their procedures, reports the National Network of Abortion Funds of Amherst, Mass.

These groups are one front of a two-prong effort to make abortion an option for all women. Attorneys have also gone to court to challenge states with Medicaid plans that limit abortion payments.

Lawyers for the American Civil Liberties Union will seek a temporary restraining order in Idaho today to block the implementation of an April 2001 law that would prevent women from securing abortions with public medical assistance, except in cases of rape and incest. An Idaho court threw out a similar law in 1994.

Serious restrictions on state funding for abortions for women relying on Medicaid are also being challenged in Arizona, Florida, Indiana and Texas, said Bebe Anderson, an attorney with the Center for Reproductive Law and Policy. The center is going to court in those states to widen the scope of coverage for women. "It’s ironic that the system set up to help low-income women with their health needs is denying them the health care that they need," Anderson said.

Hyde Amendment Denies Medical Insurance Coverage to Many Women

January 22 marks the 29th anniversary of the Supreme Court’s Roe v. Wade decision, which legalized abortion in every state. But that right lasted only a few years for women who rely on Medicaid, the federal health insurance program for low-income families.

In 1976, U.S. Rep. Henry Hyde, a conservative Republican from Illinois, whose latest claim to fame came from directing the failed Congressional inquiry into alleged conduct by President Bill Clinton, passed the first version of an amendment named after him to restrict Medicaid coverage for abortion. The Supreme Court upheld the Hyde Amendment in 1980 by a 5-4 decision. Freedom of choice for a woman does not mean "financial resources to avail herself of protected choices," the court wrote.

"I think the court misunderstood the reality of low-income women," Anderson said. "The restriction is designed to influence low-income women’s decisions and place them in a situation in which they are forced to carry a pregnancy."

Today, under the Hyde Amendment, the federal Medicaid program requires funding for abortion only in cases in which a woman is a victim of rape or incest or when the pregnancy may kill her. Not covered are procedures for women who choose to terminate a pregnancy, who need an abortion for medical reasons or are carrying a fetus with a health problem.

Although approximately 6 million women of reproductive age receive Medicaid, much of the public remains unaware or unconcerned about the restrictions, and "the chances of overturning the Hyde Amendment are very slim," said Heather Boonstra, senior public policy associate at the Alan Guttmacher Institute in Washington.

Lawsuits Successful in Many States; Failures in Others

With federal protection in shambles, advocates began seeking recourse in the states. States share funding for Medicaid services, have considerable leeway in making decisions on how Medicaid money is spent and can expand services beyond the Hyde Amendment. In addition, lawyers frequently lean on state constitutions, arguing that their clauses on privacy, equal protection or equal rights provide more protection for women than the U.S. Constitution. Because of this, policies on abortion funding differ greatly from state to state. Since the passage of the Hyde amendment, attorneys have produced a constant stream of legal challenges to both federal and state restrictions.

"We’ve done remarkably well in states," said Louise Melling, acting director of the Reproductive Freedom Project of the American Civil Liberties Union. In July, for example, the Alaska Supreme Court ruled that the state legislature could not eliminate funding for medically necessary abortions, saying that funding power "does not create a license to disregard citizens’ constitutional rights."

Cases have been brought by a variety of organizations in 21 states to expand abortion services for women relying on Medicaid, said Anderson, with favorable decisions in 15 states: Alabama, California, Connecticut, Idaho, Illinois, Indiana, Mississippi, Minnesota, Montana, New Jersey, New Mexico, Oregon, Texas, Vermont and West Virginia. So far, courts have ruled against expanding services in six states–Arizona, Florida, Kentucky, Michigan, North Carolina and Pennsylvania.

In addition, laws or regulations in Hawaii, Iowa, New York, Virginia, Washington and Maryland provide services beyond the limitations of the Hyde Amendment, according to NARAL, a national abortion-rights advocacy organization.

NARAL also reports that anti-choice legislators in some states continue to try to eliminate options for women. In 2000, 11 states enacted legislation that restricted the provision of abortion or reproductive health services in public facilities. In violation of the minimal requirements of the federal law, Mississippi and South Dakota exclude Medicaid funding for abortion when the pregnancy is the result of rape or incest; no court challenges are underway in either of these states.

In other states, women must contend with a flurry of regulations. In Pennsylvania, Medicaid coverage is severely restricted to situations covered by the Hyde Amendment. Rape and incest victims must complete the "MA3," a form attesting to their situation, including the signature of a doctor, said Shayna Nagel, a center manager at a contraception and pregnancy testing center of Planned Parenthood of Southeastern Pennsylvania. Finding a doctor to sign is difficult, Nagel said.

"If you have been a victim of rape or incest, you may have to tell your story to six strange people on the telephone," she said. "Some women have to go to extreme measures to get money for abortions, like using money they need for rent or food."

Number of Funds Growing Rapidly

Funds to help pay for abortions exist in 40 states, with about 10 new funds opening annually in recent years, said Shawn Towey, communications director for the National Network of Abortion Funds.

"It’s so unfair, so obviously unfair. People realize we’re just going to have to take care of the women in our community with our own funds," Towey said.

Other abortion funds date to pro-choice clergy counseling services established before the legalization of abortion. All but a few of the funds operate with volunteers and are supported by individual donations. One-third of the funds are connected to particular clinics; others provide money by geographical area or for specific needs, such as travel.

The National Network of Abortion Funds estimates that 17,000 women are helped each year by $1.6 million from the funds, often with partial aid or a loan. But many women in need are unfamiliar with the funds.

Women most commonly learn about a fund from an abortion provider or the hotline of the National Abortion Federation.

"It depends how aggressive the woman is. Do they talk to the right friend?" Towey said.

The resources are still small compared to the need. Towey estimates 60,000 low-income women each year need help for abortion services.

"The funds provide an incredible service," said Melling of the ACLU. "But it shouldn’t be the funds’ responsibility. The government should pay if a woman who qualifies for Medicaid chooses abortion as an option."

Cynthia L. Cooper is an independent journalist in New York who writes about reproductive rights.