The Supreme Court guaranteed abortion a constitutional right more than 40 years ago. Knowing they can’t make it illegal, activists have instead focused on making it unaffordable and inaccessible.

Almost immediately after Roe v. Wade, extreme members in Congress began exploiting opportunities to restrict access to safe and legal abortion, especially for women of low income. Rep. Henry Hyde said when he introduced an amendment to exclude Medicaid coverage for abortion, “I certainly would like to prevent, if I could legally, anybody from having an abortion, a rich woman, a middle-class woman or a poor woman. Unfortunately, the only vehicle available is the … Medicaid bill.”

The Hyde Amendment has for nearly three decades penalized women working to make ends meet by forcing them to pay the most for access to safe and legal care. As a result of this exclusion, in Maine and 32 other states, a woman who is eligible for Medicaid isn’t able to make a real decision about her pregnancy.

Medicaid coverage including abortion coverage should never be a game, and it’s wrong for politicians to be playing “keep away” with health care.

But here we are, with a system that pushes a woman living paycheck to paycheck to support her family deeper into poverty — forced to shut off her own heat or take another job — to pay for an abortion.

That’s wrong. We can’t let coverage for abortion be excluded from health care benefits just for political reasons. And it’s why I’m a sponsor of the EACH Woman Act, a bill that would guarantee every woman who qualifies for health coverage through federal programs such as Medicaid has full access to all pregnancy services, including abortion.

Whether to end a pregnancy can be such a personal decision, and it makes sense that a woman would make that decision in a personal way, often talking with those she loves and trusts the most. And if she’s truly going to be able to decide for herself, even about something this personal, we need to build our society in ways that support real decision-making. Is child care available and affordable if she is going to need to work? Is abortion covered by her health plan or by Medicaid if she qualifies for assistance? If not, then maybe she’s not really getting that chance to decide for real.

And Americans agree. An overwhelming majority of voters want the Hyde Amendment repealed, with 86 percent agreeing that, however, we personally feel about abortion, politicians should not be allowed to deny a woman’s health coverage because she is poor.

But that hasn’t stopped those who want to take away women’s access to abortion from using whatever tactic they can.

A well-known anti-abortion group spent years on a smear campaign that culminated with secret recordings that they seemed to think proved Planned Parenthood had done something unethical or even illegal. But after extensive hearings by a Congressional committee, even the anti-abortion chair of the committee admitted they found no wrongdoing.

At health centers across the country, firebombings, violent threats and vandalism are intended to frighten and intimidate the professionals who work at Planned Parenthood, as well as the women who are there to seek basic health care — many of whom have no other access.

And in Washington, anti-abortion politicians have tried, with some success, to make it harder and harder for women to make their own decisions about very personal health care issues by passing legislation that limits access to a full range of pregnancy services. One of the biggest hurdles they’ve placed in the way of women seeking these services is the exclusion of abortion coverage in programs such as Medicaid.

Even though most of the money to pay for Medicaid coverage comes from Washington, it’s up to the states to administer the program. In 17 states, low-income women who qualify for Medicaid have access to a full range of pregnancy services, including abortion. In those places, state government has stepped in to ensure a woman is actually able to make a real decision about her pregnancy. But everywhere else in America, including Maine, being poor can mean she cannot afford to make her own decision.

That’s why we need the EACH Woman Act, so no matter what state you live in or how much money you make, you can make your own decisions about your health care.

By excluding coverage through programs such as Medicaid, politicians are placing their own judgement and personal beliefs above a woman’s ability to make the best decision for her own life.

Rep. Chellie Pingree, a Democrat, represents Maine’s 1st District in the U.S. House of Representatives.