receive health care through the U.S. government the option of paying for the procedure out of pocket. According to a 2014 national survey of abortion patients, women in states without Medicaid coverage of abortion were three times as likely to pay for their abortions out of pocket, and five times as likely to rely on financial assistance from an abortion fund, compared to women in states with Medicaid coverage. State actions 17 states have a policy to use their own Medicaid funds to pay for abortion beyond the Hyde Amendment requirements, and an estimated 20% of abortions are paid through Medicaid. As of 2021, 16 states use their own state funds to pay for elective abortions and similar services, exceeding federal requirements. Consequently, the cutoff of federal Medicaid funds prompted some states to provide public funding for abortion services from their own coffers. Over time the number of states doing so has gradually expanded, either through legislation or consequent to judicial rulings. Specific stipulations have been put in place by some state governments. Some of these provisions remove restrictions that have been put in place at the federal level while others are used to further extend the reach that Hyde Amendment has put into place. For example, in Iowa, in order to receive an abortion under the Medicaid program, approval must be given from the governor. In Iowa, Mississippi, and Virginia, a provision has been made for the case of fetal impairment. Further developments Stupak-Pitts (2010) The Stupak–Pitts Amendment, an amendment to the Affordable Health Care for America Act, was introduced by Democratic Rep. Bart Stupak of Michigan. It prohibits the use of Federal funds "to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion", except in cases of rape, incest, or danger to the life of the mother, and was included in the bill as passed by the House of Representatives on November 7, 2009. However, the Senate bill passed by the House on March 21, 2010, did not contain that Hyde Amendment language. As part of an agreement between Rep. Stupak and President Obama to secure Stupak's vote, the President issued Executive Order 13535 on March 24, 2010, affirming that the Hyde Amendment would extend to the new bill. Hillary Clinton (2016) The 2016 Democratic platform marked the first major political party platform to include an