Access to reproductive health care in Texas: Rosie's Law and the Hyde Amendment | LBJ School of Public Affairs | The University of Texas at Austin

LBJ MPAff student Marjorie Crowell

By Marjorie Crowell (@marjoriecrowell)
Center for Health and Social Policy Ambassador

Access to reproductive health care in Texas is an issue for many living in the state. Many abortion clinics in Texas have closed since HB 2 took effect in 2013.1 More broadly, rural areas of Texas have faced widespread closures of health facilities, leaving many without nearby access to care.2 Barriers to care can also include financial barriers: If someone does not have insurance, or if their insurance doesn’t cover a procedure to the extent that they can afford to get that procedure, they will be unable to access that care.

The Hyde Amendment, passed in 1976 by the U.S. House of Representatives, prohibits federal funds from covering abortion except in the case of rape, incest, or a danger to life.3 States may choose to pay for abortions under Medicaid but must use their own funds.4 As of Dec. 1, 2018, 34 states and the District of Columbia follow the federal standard and only cover abortion in the case of rape, incest or a danger to life.5 One state (South Dakota) only allows for coverage in cases of life endangerment.6 Fifteen states have a policy in place that allows Medicaid to pay for all or most medically necessary abortions.7 Texas is not one of these such states.8

Rosasura "Rosie" Jimenez was a single mother who sought an abortion in McAllen, Texas in September 1977, two months after the Hyde Amendment had taken effect.9 She had previously obtained an abortion from a doctor, covered by Medicaid, but she was no longer covered for abortion under Medicaid because of the Hyde Amendment.10 Because she could not afford the price that the local ob-gyns charged for the procedure, she had to go to a midwife who was not licensed to provide abortions but was willing to provide the service more cheaply.11 The procedure was unsafe and Jimenez ended up contracting a bacterial infection and passing away.12 Many consider Rosie Jimenez to be the first person who died as a result of the Hyde Amendment prohibiting federal funds from covering abortion services.13

Texas State Rep. Sheryl Cole (D–46) proposed Rosie's Law, a measure which would expand insurance coverage for abortion procedures for those covered by Medicaid.14 The city of Austin passed a similar resolution last year, declaring abortion to be health care and calling for public and private insurance coverage bans to be removed.15 A study in Obstetrics & Gynecology from 2017 found a 16 percent associated decrease in risk of severe maternal morbidity for states whose Medicaid programs cover medically necessary abortions.16

Rosie's Law poses a step in the right direction to improve access to comprehensive reproductive health care for people in Texas and improve health outcomes for the state.

The views, information, or opinions expressed by blog contributors are solely those of the individual authors and do not necessarily represent those of the Center for Health and Social Policy, the LBJ School of Public Affairs, or The University of Texas at Austin or affiliated employees.

Marjorie Crowell is a first-year Master of Public Affairs student and CHASP Ambassador at the LBJ School of Public Affairs. Before LBJ, she worked in sexual and reproductive health research at the Guttmacher Institute, a leading research and policy organization committed to advancing sexual and reproductive health and rights in the United States and globally. She is interested in health policy, especially reproductive health policy. After her time at the LBJ School, Crowell hopes to work in health policy research to increase access to reproductive health care and improve health equity and outcomes.


  1.   David Yaffe-Bellany, "Five Years after Wendy Davis Filibuster, Texas Abortion Providers Struggle to Reopen Clinics,” The Texas Tribune, June 25, 2018.
  2.   John Henderson, "Texas Must Address Rural Hospital Closures,” TribTalk, Aug. 27 2018.
  3.   The Hyde Amendment of 1976, The Embryo Project Encyclopedia.
  4.   Alina Salganicoff, Caroline Rosenzweig, and Laurie Sobel, "The Hyde Amendment and Coverage for Abortion Services,” Kaiser Family Foundation.
  5.   "State Funding of Abortion Under Medicaid,” Guttmacher Institute.
  6.   Ibid.
  7.   Ibid.
  8.   Ibid.
  9.   Alexa Garcia-Ditta, “What a 38-Year-Old Abortion Story Can Teach Us Today,” Texas Observer, Nov. 3, 2015.
  10.   Ibid.
  11.   Ibid.
  12.   Ibid.
  13.   Ibid.
  14.   Cole, HB 895 — Introduced version
  15.   Tara Pohlmeyer, "Austin Becomes First Texas City to Stand against Laws Banning Insurance Coverage for Abortion Care,” Progress Texas, Oct. 4, 2018.
  16.   M. Jarlenski, J.A. Hutcheon, L.M. Bodnar, and H.N. Simhan, "State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality," National Center for Biotechnology Information, May 2017.