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

      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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      References

        • American College of Obstetrics and Gynecology
        ACOG practice bulletin. Clinical management guidelines of obstetricians-gynecologists. Number 67, October 2005. Medical management of abortion.
        Obstetrics and Gynecology. 2005; 106: 871-882
      1. Congressional Budget Office (CBO). (2010). Selected CBO publications related to health care legislation, 2009-2010 [Internet]. Washington, DC. Available from: http://www.cbo.gov/publication/21993. Accessed June 17, 2013.

        • Bessett D.
        • Gorski K.
        • Jinadasa D.
        • Ostrow M.
        • Peterson M.J.
        Out of time and out of pocket: Experiences of women seeking state-subsidized insurance for abortion care in Massachusetts.
        Womens Health Issues. 2011; 21: S21-S25
      2. Citro C.F. Michael R.T. Measuring poverty: A new approach. National Academy Press, Washington, DC1995
        • Cohen S.
        Insurance coverage of abortion: The battle to date and the battle to come.
        Guttmacher Policy Review. 2010; 13
        • Dennis A.
        • Blanchard K.
        A mystery caller evaluation of Medicaid staff responses about state coverage of abortion care.
        Womens Health Issues. 2012; 22: e143-e148
        • Dennis A.
        • Blanchard K.
        Abortion providers' experiences with Medicaid abortion coverage policies: A qualitative multistate Study.
        Health Services Research. 2013; 48: 236-252
        • Dennis A.
        • Blanchard K.
        • Cordova D.
        Strategies for securing funding for abortion under the Hyde Amendment: A multistate study of abortion providers' experiences managing Medicaid.
        American Journal of Public Health. 2011; 101: 2124-2129
        • Drey E.A.
        • Foster D.G.
        • Jackson R.A.
        • Lee S.J.
        • Cardenas L.H.
        • Darney P.D.
        Risk factors associated with presenting for abortion in the second trimester.
        Obstetrics and Gynecology. 2006; 107: 128-135
        • Finer L.B.
        • Frohwirth L.F.
        • Dauphinee L.A.
        • Singh S.
        • Moore A.M.
        Timing of steps and reasons for delays in obtaining abortions in the United States.
        Contraception. 2006; 74: 334-344
        • Gould H.
        • Perrucci A.
        • Barar R.
        • Sinkford D.
        • Foster D.
        Patient education and emotional support practices in abortion care facilities in the United States.
        Womens Health Issues. 2012; 22: e359-e364
      3. Guttmacher Institute. (2012, January 1). State policies in brief: An overview of abortion laws. Available from: http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf.

      4. Guttmacher Institute. (2013a). State policies in brief: Restricting insurance coverage of abortion. Available from: https://www.guttmacher.org/statecenter/spibs/spib_RICA.pdf. Accessed April 12, 2013.

      5. Guttmacher Institute. (2013b). State policies in brief: State funding of abortion under Medicaid. Available from: https://www.guttmacher.org/statecenter/spibs/spib_SFAM.pdf. Accessed April 12, 2013.

        • Henshaw S.K.
        • Wallisch L.S.
        The Medicaid cutoff and abortion services for the poor.
        Family Planning Perspectives. 1984; 16 (177–180): 171-172
        • Hoffman C.
        • Paradise J.
        Health insurance and access to health care in the United States.
        Annals of the NY Academy of Science. 2008; 1136: 149-160
        • Jones R.K.
        • Finer L.B.
        Who has second-trimester abortions in the United States?.
        Contraception. 2012; 85: 544-551
      6. Jones, R. K., Finer, L. B., & Singh, S. (2010). Characteristics of U.S. abortion patients. Available from: http://www.guttmacher.org/pubs/US-Abortion-Patients.pdf. Accessed June 20, 2013.

        • Jones R.K.
        • Kavanaugh M.L.
        Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion.
        Obstetrics and Gynecology. 2011; 117: 1358-1366
        • Jones R.K.
        • Kooistra K.
        Abortion incidence and access to services in the United States, 2008.
        Perspectives on Sexual and Reproductive Health. 2011; 43: 41-50
        • Jones R.K.
        • Upadhyay U.D.
        • Weitz T.A.
        At what cost? Payment for abortion care by U.S. women.
        Womens Health Issues. 2013; 23: e173-e178
        • Kacanek D.
        • Dennis A.
        • Miller K.
        • Blanchard K.
        Medicaid funding for abortion: Providers' experiences with cases involving rape, incest and life endangerment.
        Perspectives on Sexual and Reproductive Health. 2010; 42: 79-86
      7. Kaiser Family Foundation. (2013). Health insurance coverage of women, state estimates, 2011-2012. Available from: http://kff.org/uninsured/fact-sheet/health-insurance-coverage-of-women-state-estimates/. Accessed November 13, 2013.

      8. Missouri Foundation for Health. (2007) Missouri Medicaid basics. Winter 2007. Available from: http://mffh.org/mm/files/medicaidbasics07.pdf. Accessed May 7, 2012.

      9. National Network of Abortion Funds. (2012). Can Medicaid cover my abortion? Available from: http://www.fundabortionnow.org/get-help/medicaid. Accessed April 27, 2012.

      10. Oklahoma Health Care Authority. (2012). SoonerCare and Insure Oklahoma Income Guidelines. Available from: http://www.okhca.org/individuals.aspx?id=10328. Accessed May 7, 2012.

      11. Pennsylvania Department of Public Welfare. (2012). Income and resource requirements for Healthy Beginnings, Pennsylvania. Available from: http://www.dpw.state.pa.us/foradults/healthcaremedicalassistance/incomeandresourcerequirementsforhealthybeginnings/index.htm. Accessed May 7, 2012.

        • Pazol K.
        • Creanga A.A.
        • Zane S.B.
        • Burley K.D.
        • Jamieson D.J.
        Abortion surveillance–United States, 2009.
        MMWR. 2012; 61: 1-44
        • Phillips K.A.
        • Grossman D.
        • Weitz T.A.
        • Trussell J.
        Bringing evidence to the debate on abortion coverage in health reform legislation: Findings from a national survey in the United States.
        Contraception. 2010; 82: 129-130
        • Ranji U.
        • Salganicoff A.
        • Stewart A.M.
        • Cox M.
        • Doamekpor L.
        State Medicaid coverage of perinatal services: Summary of state survey findings.
        Henry J. Kaiser Family Foundation, Oakland, CA2009
        • Roberts S.C.
        • Avalos L.A.
        • Sinkford D.
        • Foster D.G.
        Alcohol, tobacco and drug use as reasons for abortion.
        Alcohol and Alcoholism. 2012; 47: 640-648
        • Rocca C.
        • Kimport K.
        • Gould H.
        • Foster D.
        Women's emotional responses to unintended pregnancy, abortion and being denied an abortion in the United States.
        Perspectives on Sexual and Reproductive Health. 2013; 45: 122-131
        • Rosenbaum S.
        The Patient Protection and Affordable Care Act: Implications for public health policy and practice.
        Public Health Reports. 2011; 126: 130-135
        • Schaler-Haynes M.
        • Chesnokova A.
        • Cox C.
        • Feinstein M.
        Abortion coverage and health reform: Restrictions and options for exchange-based insurance markets.
        University of Pennsylvania Journal of Law and Social Change. 2011; 15: 323
        • Smolderen K.G.
        • Spertus J.A.
        • Nallamothu B.K.
        • Krumholz H.M.
        • Tang F.
        • Ross J.S.
        • et al.
        Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction.
        JAMA. 2010; 303: 1392-1400
        • Towey S.
        • Poggi S.
        • Roth R.
        Abortion funding: A matter of justice. Report.
        The National Network of Abortion Funds, Boston2005
        • Upadhyay U.
        • Weitz T.
        • Barar R.
        • Jones R.
        • Foster D.
        Denial of abortion due to provider gestational age limits in the United States.
        American Journal of Public Health. 2013; (Epub ahead of print.)
        • Van Bebber S.L.
        • Phillips K.A.
        • Weitz T.A.
        • Gould H.
        • Stewart F.
        Patient costs for medication abortion: Results from a study of five clinical practices.
        Womens Health Issues. 2006; 16: 4-13

      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.