Photo by Ted Eytan.

When the House of Representatives drafts its annual Financial Services Bill, it’s become a not-so-beloved tradition to include measures that limit the District of Columbia’s ability to self-govern. And Capitol Hill remains steadfast in preventing D.C. from funding abortions for low-income women, made possible because of the District’s lack of statehood.

It all begins with the Hyde Amendment, a budget rider that has been added to appropriations bills every year since 1976. It prevents the use of federal funds like Medicaid for abortions, except in cases of life endangerment, rape, or incest. Exactly 40 years after the amendment first popped up, there’s a movement underway to get rid of it once and for all.

Today marks the start of a week of action by advocates called “United for Abortion Coverage,” which includes events around the country. The goal is aims to raise awareness about the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act, which would end federal funding restrictions on the procedure. EACH Woman was introduced last year by Congresswoman Barbara Lee (D-CA), Jan Schakowsky (D-IL) and Diana DeGette (D-CO), and currently has 120 co-sponsors.

“The Hyde Amendment was seen as untouchable, but in the last five years or so, the conversation around the Hyde Amendment has changed dramatically,” Schakowsky said during a press call earlier this month. “It’s an issue we must touch.”

The rider’s author, Henry Hyde, made no secret of who would be impacted by it. “I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman,” he said in 1977 in Congress. “Unfortunately, the only vehicle available is the [Medicaid] bill.”

And that’s generally how it has panned out. “The burden of Hyde generally falls hardest on women who are struggling already economically and already have barriers to accessing good quality healthcare,” says Georgeanne Usova, legislative counsel at the American Civil Liberties Union. “I can’t think of another healthcare service that is excluded in this way.”

Hyde doesn’t just impact people on Medicaid; federal employees, Peace Corps volunteers, federally incarcerated women and women in immigration detention centers, military personnel, and Native Americans are also affected by the ban.

“The fact that it impacts folks who then have to staff members [of Congress] who are annually approving this is the ultimate irony,” says Destiny Lopez, the co-director of All Above All, a grassroots advocacy group pushing for the bill’s passage. “In some instances, that means that they’re essentially voting to ban coverage for their own employees.”

While Hyde particularly affects Washingtonians because so many residents hold jobs in the federal government, Congress also found a special way to further tread on D.C. by including what’s often called the Dornan Amendment as a rider. Starting in 1989, it uses similar language as the Hyde Amendment to prevent D.C. from using its own, locally raised funds for funding abortion.

“D.C. women are hit hardest by this, compared to states, because Congress does have control over the D.C. budget that they don’t have in the states,” says Usova of the ACLU. While D.C. bucks the national trend of enacting barriers to abortion access, and providers see patients from as far away as Texas and Colorado, the city can’t help many of its own residents.

The D.C. Abortion Fund has stepped in, helping low-income women pay for abortions. The non-profit estimates that the Dornan Amendment affects around 60,000 Washingtonians, which it calculates by looking at the number of women of reproductive age that qualify under Medicaid.

“This is a thorn in our side,” says D.C. Congresswoman Eleanor Holmes Norton. “We try to get Dornan removed every single appropriations cycle. Most of my time in Congress I’ve been in the minority. Every time I’ve been in the majority, I’ve gotten something done on this.”

During President Barack Obama’s first two years in office, when Democrats had control over the House and Senate, the Dornan amendment was not included in the appropriations bills.

DCAF Board Member Emily Crofoot describes 2009 and 2010 as “two very short, very sweet years” when D.C. Medicaid funding could help pay for abortions. “Then, D.C. was used as bargaining chip during the budget debate and yet again, we lost the funding. It was very, very frustrating.” (The Dornan Amendment was also not included in the budget in 1994 or 1995.)

When the local funding ban was reinstated in 2011, 28 District women who were scheduled to have abortions were informed that D.C. Medicaid could no longer provide assistance.

“There were women in line waiting to have an abortion, so it had a devastating effect,” says Norton. She adds that it angered many Washingtonians who thought the president should have done more to stop the rider.

According to the Kaiser Family Foundation, 17 states have policies that provide state-level Medicaid coverage of abortion beyond the Hyde limitations. “It’s not this mystical thing where D.C. is the only liberal paradise who wants to do this,” Crofoot says.

Abortions aren’t cheap, and they get more expensive as the pregnancy progresses. First trimester abortions (which amount to about 90 percent of procedures performed) cost between $400 and $550, according to Kaiser. For second trimester procedures, which are available in D.C. and Maryland, but not Virginia, “you’re creeping into $3,000, $4,000, $5,000,” says Crofoot.

Without the ability for governments to help, organizations like DCAF act like stopgap measures to assist these women and their families. DCAF funds approximately 1,000 abortions every year, 30 percent of them for women in D.C. (32 percent are for Virginians, 29 percent for Marylanders, and the rest for women from outside the region coming here for the procedure.) Crofoot says that means that DCAF is funding nearly one D.C. woman’s abortion every day of the year.

The EACH Woman Act would do two major things to change this, as currently drafted: first, it would require the federal government ensure abortion coverage in its public health programs; and second, it would end restrictions on abortion coverage in the private insurance market. Lopez, of All Above All, says that the law would prevent Dornan from being reintroduced in future appropriations bills.

This “act would end these restrictions on the federal and state level,” confirmed Lee in a press call.

As long as Republicans have control on Capitol Hill, though, Norton sees the prospects for EACH Woman as dim. “For Republicans who now control House and Senate, it’s automatic” to include the riders, she says. She adds that Democratic nominee Hillary Clinton has come out in favor of ending Hyde. “There’s no other way” to change that status quo without “changing the composition” of Capitol Hill.

Until then, though, Norton is glad that EACH Woman is getting the word out about Hyde and Dornan. “If you let an issue like this die, then it will be very hard to keep the public on your side,” she says. To that end, Norton has participated in events like abortion speakouts. But she says the only way to truly avoid Congress from intervening in D.C. affairs is through statehood.

Statehood is on the ballot this November for D.C. residents, though it will require Congressional approval to become the 51st star on the flag. And the fact that hopes for funding local abortions require statehood is exactly why Republicans Speaker of the House Paul Ryan say the District shouldn’t even control its own budget. “The D.C. government wants to use revenues to fund abortions in the District,” Ryan said in a statement in May. “House Republicans will not stand for that.”