An anti-reform poster in the fight over health care.(WOMENSENEWS)–In the aftermath of health reform, the abortion-coverage restrictions that low-income women faced under Medicaid threaten to become the norm.

And that’s pushing a key campaign of the National Network of Abortion Funds into the pro-choice vanguard.

For years the network, a Boston-based organization formed in 1993 to assist low-income women pay for abortion services, has been working to repeal the Hyde Amendment, the 1976 budgetary restriction on using federal funds to pay for abortion that denied Medicaid recipients access to the medical service.

Now health reform could spread the restriction far and wide–with President Obama signing an executive order affirming the continuation of Hyde to appease anti-choice Democrats–and more pro-choice groups are joining the push to repeal Hyde.

When abortion was legalized in 1973, federal Medicaid funds could be used to pay for medically-necessary abortions, just as they could be used to pay for any other health care service needed by low-income women covered by Medicaid.

The Hyde Amendment stopped that. Now, more than three decades later, many reproductive rights advocates say health reform may encourage insurance companies to stop offering abortion coverage to even more women, including those with private coverage.

"More people within the movement really got it during health care reform that not fighting the Hyde Amendment earlier really came back to bite us," said Megan Peterson, the National Network of Abortion Funds’ deputy director.

The network is stepping up a four-year campaign to repeal the Hyde Amendment with a strategic planning meeting in mid-May in Washington, D.C.

Stephanie Poggi, the network’s executive director, will also be a featured speaker at the annual conference of the National Organization for Women, NOW, in Boston from July 2 to 4. At that meeting NOW will launch a nationwide campaign to mobilize local chapters to lobby elected officials and candidates to repeal Hyde, said Terry O’Neill, president of National Organization for Women.

"If we can’t change the minds of the people who are in Congress, we have to work to change the faces," O’Neill said.

Hyde the Root Cause

"Hyde is the root cause of the anti-abortion law that now applies to all women," O’Neill added.

A provision in health reform requires women to write a separate out-of-pocket premium check for abortion in states that prohibit abortion coverage through a new insurance exchange. By making a separate premium system for abortion so cumbersome and difficult, O’Neill predicts private insurance companies could stop covering abortion across the board in 10 years or less.

O’Neill bases that assertion on research released in December 2009 by The George Washington University School of Public Health. It found that states that choose to prohibit abortion coverage in health plans offered through an exchange "may determine that it is not sensible to sell a product covering medically indicated abortions in any of the state’s geographic markets, regardless of whether the purchaser is an individual in the exchange or a self-insuring employer."

Judy Waxman, vice president for Health and Reproductive Rights at the National Women’s Law Center, said the Washington-based organization has registered a significant surge in interest since the anti-choice provisions began appearing in health reform.

"Our outreach lists grew exponentially" with Facebook participation alone growing from 1,000 to 16,000, Waxman said. "Our Twitter lists started going crazy. People are very concerned about the situation."

Immediate Attention on Health Reform

While repealing the Hyde Amendment is a long-term goal, Waxman said the center plans to focus its immediate attention on improving the health care reform legislation.

"We do not like the language but there are better and worse ways it can be implemented while we still try to fix it legislatively," Waxman said.

Among the concerns is the stipulation that the new insurance exchanges have at least one plan that does not provide abortion coverage, while there is no requirement that at least one plan must cover abortion, she said.

"It was incredibly discouraging to see the messages of the anti-choice folks taken up by someone as prominent as the president," said Laura MacCleery, a spokesperson for the Center for Reproductive Rights in New York.

The center will "look for ways to take back ground on federal funding of abortion," MacCleery said. But the health care debate demonstrated how hard it will be to eliminate Hyde, she said.

Many pro-choice advocates say that, in terms of abortion services, health care reform leaves poor women, and even women covered by private insurance, worse off than before.

Susan Elan covered politics at daily newspapers in the New York metropolitan area for more than a decade. She is now working on a Master of Public Health degree at New York Medical College.

For more information:

For more information:

Center for Reproductive Rights:

National Network of Abortion Funds Petition Hyde:

The George Washington University School of Public Health analysis of the Stupak/Pitts Amendment: