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Original article| Volume 24, ISSUE 2, e211-e218, March 2014

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Out-of-Pocket Costs and Insurance Coverage for Abortion in the United States

DOI:https://doi.org/10.1016/j.whi.2014.01.003
Out-of-Pocket Costs and Insurance Coverage for Abortion in the United States
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      Abstract

      Background

      Since 1976, federal Medicaid has excluded abortion care except in a small number of circumstances; 17 states provide this coverage using state Medicaid dollars. Since 2010, federal and state restrictions on insurance coverage for abortion have increased. This paper describes payment for abortion care before new restrictions among a sample of women receiving first and second trimester abortions.

      Methods

      Data are from the Turnaway Study, a study of women seeking abortion care at 30 facilities across the United States.

      Findings

      Two thirds received financial assistance, with those with pregnancies at later gestations more likely to receive assistance. Seven percent received funding from private insurance, 34% state Medicaid, and 29% other organizations. Median out-of-pocket costs when private insurance or Medicaid paid were $18 and $0. Median out-of-pocket cost for women for whom insurance or Medicaid did not pay was $575. For more than half, out-of-pocket costs were equivalent to more than one-third of monthly personal income; this was closer to two thirds among those receiving later abortions. One quarter who had private insurance had their abortion covered through insurance. Among women possibly eligible for Medicaid based on income and residence, more than one third received Medicaid coverage for the abortion. More than half reported cost as a reason for delay in obtaining an abortion. In a multivariate analysis, living in a state where Medicaid for abortion was available, having Medicaid or private insurance, being at a lower gestational age, and higher income were associated with lower odds of reporting cost as a reason for delay.

      Conclusions

      Out-of-pocket costs for abortion care are substantial for many women, especially at later gestations. There are significant gaps in public and private insurance coverage for abortion.
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      Biography

      Sarah C.M. Roberts, DrPH, is an Assistant Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences and a public health social scientist at Advancing New Standards in Reproductive Health (ANSIRH), both at University of California, San Francisco.

      Biography

      Heather Gould, MPH, is the research manager for the Turnaway Study at Advancing New Standards in Reproductive Health (ANSIRH). She is interested in women’s reproductive outcomes related to unintended pregnancy, abortion and birth, as well as their experiences accessing and receiving health services.

      Biography

      Katrina Kimport, PhD, is an Assistant Professor in the Department of Obstetrics, Gynecology & Reproductive Science and a research sociologist in the Advancing New Standards in Reproductive Health (ANSIRH), both at University of California, San Francisco.

      Biography

      Tracy A. Weitz, PhD, MPA, is an Associate Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences, and the Director of Advancing New Standards in Reproductive Health (ANSIRH), both at University of California, San Francisco.

      Biography

      Diana Greene Foster, PhD, is an Associate Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences and Research Director at Advancing New Standards in Reproductive Health (ANSIRH), at University of California, San Francisco and Principal Investigator of the Turnaway Study.

      Article info

      Publication history

      Accepted: January 20, 2014
      Received in revised form: January 17, 2014
      Received: August 14, 2013

      Identification

      DOI: https://doi.org/10.1016/j.whi.2014.01.003

      Copyright

      © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

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