Invited paper| Volume 21, ISSUE 3, SUPPLEMENT , S21-S25, May 2011

Out of Time and Out of Pocket: Experiences of Women Seeking State-Subsidized Insurance for Abortion Care in Massachusetts



      Massachusetts has implemented reforms aimed at providing universal health care coverage and covers abortion through subsidized state insurance programs. Three Massachusetts abortion funds evaluated their referral processes for low-income women from April to October 2010 to learn about women’s experiences applying for subsidized insurance and to identify barriers to obtaining insurance or its use for abortion services.


      Follow-up interviews were conducted with 39 low-income women thought eligible for subsidized insurance at least 1 month after their initial contact with the funds.


      Health insurance literacy was low, and participants reported confusion distinguishing between levels of subsidized insurance. The process of applying for subsidized insurance delayed a substantial proportion of procedures. More than two thirds of the women who applied for state coverage had become insured or expected to become insured shortly, but only one third of respondents who applied were able to secure insurance in time for their abortion care. Two women were unable to obtain abortions as a result of delays. Delays also limited low-income women’s ability to obtain medication abortion.


      This analysis suggests that the process for enrolling in subsidized insurance does not currently meet the goal of providing women with coverage for abortion care (and other health needs) in a timely way. Systemic improvements are needed to ensure that enrollments are processed quickly and disruptions in coverage are minimized. Information resources should be developed to help women and their families understand health insurance and coverage of services.
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      Danielle Bessett, PhD, was an Ellertson Fellow from 2008–2010 and is now Assistant Professor of Sociology at the University of Cincinnati, Cincinnati, Ohio. Her research interests are in medical and family sociology, focusing on sexual and reproductive health issues and inequality.


      Katey Gorski studies Government at Smith College in Northampton, Massachusetts, and expects to receive her BA in the spring of 2011. She interns with the Abortion Rights Fund of Western Massachusetts.


      Deepani Jinadasa, MPH, is a member of the Board of Directors of the Eastern Massachusetts Abortion Fund. Her public health interests include better understanding health disparities, social determinants of health, and barriers to healthcare access.


      Marcy Ostrow has a BS in Zoology from the University of Massachusetts, Amherst. She is the Intake Hotline Coordinator, a hotline volunteer and a member of the Board of Directors of the Jane Fund of Central Massachusetts.


      Megan J. Peterson is the Deputy Director of the National Network of Abortion Funds where she works to ensure access to abortion for low-income women through policy advocacy and support to member Funds who provide financial assistance to women in need.