One of the central tenets of the Bernie Sanders campaign this election cycle is that we should scrap our current process of handling medical care for our nation’s citizens and instead implement a #Medicare4All handled by the government, taking the “profit motive” out of the equation. On the surface, the sound bites sound wonderful to many, but they haven’t really thought that all the way through.

Let’s put that whole argument about jobs and wiping out an entire segment of our economy for a moment as many would argue that many of those workers might well end up getting re-employed by the #Medicare4All program. Afterall, somebody’s gonna have to do that paperwork, get doctors and hospitals paid, and keep folks honest. Let’s instead skip right on past that, and let’s talk about women’s reproductive health.

As you should know, Medicaid is the federal health care program for low-income people living in the United States.

“The lady at the Medicaid office said that I would be covered for prenatal care but not for an abortion. I told her, I just sold my car to pay the heating bill last month and since I was laid off, my kids and I have been living with my brother’s family and there isn’t much room. I definitely can’t afford to have another child.”

In 1973, when abortion became legal across the country, the federal Medicaid program actually covered abortion as a part of standard medical care. In the first years of legalized abortion, federal Medicaid paid for over one-third of all abortions performed in the U.S. Thus, it became clear that Medicaid coverage of abortion was and is essential for low-income women to build more productive lives.

But that didn’t last long. You see, in 1976, Congress passed the Hyde Amendment, named after its author, Rep. Henry Hyde (R-IL6).

“None of the funds contained in this Act shall be used to perform abortions except where the life of the mother would be endangered if the fetus were carried to term; or except for such medical procedures necessary for the victims of rape or incest, when such rape or incest has been reported promptly to a law enforcement agency or public health service. Nor are payments prohibited for drugs or devices to prevent implantation of the fertilized ovum, or for medical procedures necessary for the termination of an ectopic pregnancy.”

After 6 months of delays and 25 roll call votes delaying passage of a $60 million appropriations bill, Rep. Hyde got his way.  And now, for 39 consecutive years, its banned federal Medicaid coverage of abortion, military and their family’s healthcare coverage of abortion, VA healthcare coverage of abortion and any other source of federal funds that someone might attempt to use to cover abortion expenses. The “Hyde Amendment” started getting applied to passed legislation starting in 1977, and in 1980, a conservative majority on the U.S. Supreme Court held that the “Hyde Amendment” did NOT violate the constitutional rights of women on Medicaid.

In a dissent of the majority opinion, Justice Thurgood Marshall, stated:
“The Hyde Amendment is designed to deprive poor and minority women of the constitutional right to choose abortion.”

Indeed, the absolute intent of the Hyde Amendment is to make it more difficult for low-income women to end an unwanted or problem pregnancy. In fact, when Rep. Hyde introduced the Hyde Amendment to the House of Representatives, he stated that he didn’t want any woman to be able to get an abortion, period, and that by targeting women on Medicaid, he was simply just getting started. Accordingly, it’s now routinely applied to any and every federal appropriations bill to ensure NO federal tax dollars are used to facilitate an abortion with a few exceptions, that many in the right to life movement would like to see prohibited as well.

People affected by Hyde have to overcome enormous barriers to obtain abortions. For someone living in poverty, the cost of an abortion can be insurmountable, and she or he may put off paying bills, sell belongings, and even put herself/himself in dangerous situations to come up with the money. No one should be denied access to health care just because they’re poor.

There are 15 states that use their own money to pay for abortion care as part of their Medicaid programs, but there are 35 that do not. And a dozen other laws now prevent federal health care programs from covering abortion for federal employees, women in the military and Peace Corps, disabled women, Native women using Indian Health Services, and federal prisoners. Plus thousands of other federal- and state-level barriers to abortion have popped up in the last 30 years. And they’re not stopping there. Now we’ve started seeing women investigated and charged with manslaughter for miscarriages.

So what’s my point? You say you want to transition to a #Medicare4All approach to accessing your medical care and managing its costs? Really? If you’re a woman, do you want some politician deciding the parameters as to what kind of care you can or can’t have based on their ideological whims? Do you want some politician to use his religious predilections to trump your religious beliefs and rights? Some politician opening his mouth and saying, “I’m pro-choice, but I think we also have the tradition in this town, historically, of not financing abortions as part of government-funded health care,” will simply NOT cut it when the only game in town becomes #Medicare4All.”

If we transition to a #Medicare4All” delivery system, one that uses federal tax dollars to administer your coverage, you can be assured that Republican Representatives and Senators in the U.S. Congress will demand that the “Hyde Amendment” be applied and you can kiss your reproductive care rights goodbye …. unless, of course, you’re a woman of means who can afford to shell out whatever such expenses might cost. Poor women, on the other hand, and potentially lower middle-class women and immigrants, will once again be relegated to their own devices (many times, hangers) and hope some zealot local prosecutor doesn’t file manslaughter charges against her should she not bring a pregnancy to term.