This letter responds to a request for additional information about the Congressional Budget Office’s estimates for the Labor, Health and Human Services, Education, and Related Agencies appropriation bill and the effects of the Hyde amendment. That amendment bars the use of federal funds to pay for abortions other than to save the life of the woman or if the pregnancy arises from incest or rape. The amendment historically has been included in annual appropriation acts but was not incorporated into the language contained in the President’s budget request for fiscal year 2022.
CBO’s estimate reflects the assumption that the budgetary effects of the Hyde amendment would be in place for one year because that amendment’s language applies to just one year at a time. That approach is consistent with CBO’s treatment of such estimates in the past. For example, to account for the effects of the Hyde amendment as enacted under the Consolidated Appropriations Act, 2021, in its baseline projections for fiscal year 2021, CBO estimated a reduction in Medicaid spending of $19 million. That effect results from the prevention of federal reimbursements in that year to states that provide abortion services (beyond the exceptions allowed under the Hyde amendment) to women enrolled in the Medicaid program.
Beginning in fiscal year 2022, however, CBO’s baseline incorporates the assumption that those states would be allowed to request and receive Medicaid reimbursement for such services. CBO’s analysis of the President’s budget request for fiscal year 2022 is consistent with that baseline projection of Medicaid spending. That is, the estimate incorporates the assumption that the Hyde amendment would not be in effect in fiscal year 2022.
CBO’s baseline projections for the 2022-2031 period include Medicaid reimbursements for abortion services (beyond those necessary to cover the exceptions allowed under the Hyde amendment). CBO estimates that those reimbursements would average $30 million annually over that period. That estimate is made on the basis of the number of abortions reported to have been performed in each state in 2017. Because CBO expects that factors other than Medicaid reimbursement would drive states’ decisions about covering abortions, the baseline for 2022 and beyond does not incorporate any estimated change in the number of abortions performed in the country. That is, the estimated cost reflects a projected change in who pays for these abortions rather than a change in their number.