H.K. Gray had an abortion, but her insurance wouldn’t pay for it.

“When I was pregnant with my daughter, I used my Medicaid to cover almost all of her birth, almost all of her ultrasounds, and almost everything I needed for pre-natal care,” Gray told ThinkProgress, “So when it came time to when I needed my abortion for my third pregnancy, I just assumed it would work for that as well.”

That’s when Gray learned about the Hyde Amendment, which has barred Medicaid insurance from paying for abortion services since 1976.

When insurance wouldn’t pay, Gray had to ask a family member for $300 to pay for the abortion. (The procedure was about $650, but nonprofit funds helped her pay for the rest.) Gray decided to terminate her pregnancy because she couldn’t afford to have another child. She had her first child when she was 16 years old. She tried to secure birth control afterwards, but wasn’t able to because a Texas law requires parental consent and she couldn’t get it; her father is homeless and her mother was incarcerated.

The experience galvanized Gray. She’s now an activist with Youth Testify, a program with  the National Network of Abortion Funds. This week, she testified before Congress on the dismal state of abortion access.  

“When I first started getting into this movement, I didn’t know a lot about Hyde,” said Gray, who is white. “I didn’t know there were so many people affected by it, primarily people of color.”

The communities more likely to be impacted by coverage restrictions — people of color, young people, and LGBTQ people — are also the people who’ve been actively working to get elected officials to eliminate restrictions around abortion coverage. On Thursday, activists secured their latest victory when presidential nominee Joe Biden again reversed his position on the Hyde Amendment, saying he wants to repeal it. Now, nearly every Democratic presidential candidate supports repealing Hyde.

“Where we are today with this reversal would not be possible without the work of reproductive justice leaders throughout this country over the last 10 years and particularly the last five when we went public with the All Above All campaign,” said Destiny Lopez, co-director of All Above All Action Fund.

The campaign made up of lesser known reproductive rights and justice organizations, mostly run by activists of color, united in 2013 to repeal Hyde. The campaign has seen numerous victories along the way, including the introduction of a Senate in 2019 and House bill in 2015 that would eliminate all insurance restrictions around abortion services. The campaign also secured abortion as a covered benefit in House and Senate Medicare for All bills.

The Hyde Amendment is named after former Rep. Henry Hyde (R-IL), who introduced the legislation in 1973.

“I would certainly like to prevent, if I could legally, anybody having an abortion — a rich woman, a middle-class woman, or a poor woman. Unfortunately, the only vehicle available is the Medicaid bill,” Hyde once said.

The federal government allows for some narrow exceptions in Hyde, like for rape or incest but they generally don’t work. A ThinkProgress investigation found that in 2017, nine states never paid for a survivor’s abortion and four only paid for one. States can decide to use their own public funds to cover abortion, but less than half do.

For activists, abolishing the Hyde Amendment has always been about addressing a long legacy of racial inequity, because more than half of female Medicaid enrollees of reproductive age subjected to coverage restrictions are women of color.

It became clear the message was landing. A big moment came in 2016, when the Democratic Party included repealing Hyde in its platform. The party has moved a lot on this issue, and a great example of this was when the public, including many prominent Democrats, pressured Biden to change his own position on Hyde.

Lopez is disappointed by the way Biden reached his new decision. He refused to apologize for supporting Hyde or voting in favor of the amendment as senator. Instead, he defended his previous position on the grounds that there used to be “sufficient money and circumstances” where women were able to exercise that right, claiming he now supports repealing Hyde because abortion rights are under attack.

Anyone who’s been paying attention knows abortion rights have been under attack since the Supreme Court declared the constitutional right to have abortion, Lopez said.

This recent phenomenon — Republicans willing to say they want to overturn Roe v. Wade and using near-total abortion bans to do it — is bringing awareness to new groups of people. But accessing abortion care has been challenging for some time, even with Roe in tact. Indeed, about 90% of U.S. counties are considered abortion deserts and six states have only one clinic left.

Ultimately, Lopez is pleased that Biden did correct course because of what it represents.

“It speaks to the power of our vote, as women of color, as people of color — like black women are the ones who are getting a lot of these candidates into office and they happen to be the ones that are most impacted by Hyde,” she added.

It’s hard to put a hard figure on how many people are impacted. A 2009 literature review from the Guttmacher Institute estimated, “Approximately one-fourth of women who would have Medicaid-funded abortions instead give birth when this funding is unavailable.”

Coverage bans don’t just affect people enrolled in Medicaid. Congress has long barred federal dollars from paying for many groups who get health care through the federal government: military personnel, peace corps volunteers, federal employees, federal inmates, Native Americans, and District of Columbia residents. The Trump administration has been trying to make it harder for private insurance to cover abortion care.

“It’s much more far reaching than Hyde, which is why we need to have, we’re trying to have frankly, a broader conversation,” said Lopez, “Let’s put some action behind the words and let’s actually hear what the proposals are.”

Several Democratic candidates vying to unseat Donald Trump have already released abortion proposals, including Sens. Kirsten Gillibrand (NY), Kamala Harris (CA), and Elizabeth Warren (MA). Biden has not.