This past September 30th marked the 41st anniversary of the Hyde Amendment, an unjust rule passed by Congress in 1976 to impose an anti-abortion ideology on a group with little power to fight back – low-income women. Barring Medicaid recipients from using their federal health insurance to pay for abortion, except in very narrow cases, the Hyde Amendment and the underlying notion that “no tax money supports abortion” has been allowed to expand over time, unchecked for the harm it is doing in the lives of women.

In addition to Medicaid, recipients of Medicare and the Children’s Health Insurance Program; Federal employees and their dependents; Peace Corps volunteers; Native Americans; women in federal prisons and detention centers; pregnant people who receive health care from community health centers; survivors of human trafficking; and low-income women in the District of Columbia are all barred from accessing abortion care with the health insurance they have access to through public programs.

In North Carolina, there are even more roadblocks. No state employees can access abortion in their health insurance plans, and the North Carolina General Assembly passed a law in 2013 which bars county and city governments from offering their employees an insurance plan that covers abortion.

This ban on public insurance has also made its way to the private insurance market – the General Assembly also barred any private insurance offered on the state ACA marketplaces from offering abortion coverage. There are likely a number of private insurance companies, many of which may be looking to exclude coverage for whatever they can, that have followed suit.

What we are left with is a two-tiered health care system inside a system that already privileges those who have money with better access to health care than those who do not. That better access to health care often also includes better access to family planning resources, as well as access to the preventative and prenatal care needed to ensure healthy pregnancies. Low-income women in this system are being set up for potentially difficult and unsafe situations.

These coverage bans are all founded on privileging an ideological belief about how tax dollars should be spent that applies to no other instance of government spending; nor does it take into account those who do think their tax dollars should go towards supporting the personal reproductive health care decisions people make for themselves. And anti-abortion activists will take their mantra of “no tax dollars for abortion” as far as they can, including:

The recent expansion of the “Global Gag Rule” to threaten any global health funding – whether it is for family planning, HIV-treatment and prevention programs, or child nutrition programs – if the foreign non-governmental organization uses any of its own, non-US funding to even partner with another organization that advocates for safe abortion. In countries where unsafe abortion is a major cause of maternal mortality and morbidity, this is an unconscionable interference with the work of health professionals trying to do what is best for the people in their country.

The recent efforts of the US federal government to block an undocumented 17-year-old young women seeking asylum in this country from obtaining an abortion, even though she had already gone through the judicial process Texas has for minors seeking abortion, and she had secured her own funding to pay for the procedure. Legislation introduced by North Carolina’s Rep. Robert Pittenger and other anti-abortion members of Congress to prevent citizens from voting on providing municipal bonds, which have tax-exempt interest, to organizations such as Planned Parenthood to build needed health care facilities in the community. As already noted above, no federal or North Carolina state money is used to pay for abortion, and Planned Parenthood already gets no money from any of its programs from the state. According to such convoluted logic, however, a reproductive health care facility having (federal) tax exempt interest on a loan is the same as paying for an abortion.

But none of this is about paying for abortion; it’s about continuing to play political games with the lives of poor women in order to make an ideological point; a point that is out of step with most Americans. Making abortion more accessible to low-income pregnant people does not mean more people will have abortions – it means low-income patients will have the dignity and safety of making an informed and supported choice about what is best for their lives, just as people with access to more resources do every day. Many people actually do support that option, because that is what we do in a society that values women as whole, autonomous people. It’s time to live out that value, and end the economic injustice of the Hyde Amendment.