How to Pay for and Access a Legal Abortion – Investopedia
In Dobbs v. Jackson, the U.S. Supreme Court overturned Roe v. Wade, the half-century-old precedent that guaranteed federal abortion protections. After the controversial June 2022 decision, the matter was kicked back to the states, leading to a tangle of laws. It’s an ever-evolving landscape.
Cost varies. Abortions are less expensive in the first trimester than later in the pregnancy. According to Planned Parenthood, the procedure can cost up to $750 in the first trimester, though it’s often less, and that amount climbs up to $1,500 later in the pregnancy. According to the latest available data from the U.S. Centers for Disease Control and Prevention’s Abortion Surveillance System, the vast majority of abortions happen in the first trimester, with 92.7% occurring at or before 13 weeks of gestation, which is the beginning of the second trimester.
However, as discussed below, advocates say that sending the matter to the states has increased costs in some circumstances, potentially putting the procedure out of reach for many people. A big driver of the price increase is the need for some to travel out of state.
Health insurance is one way to cover the expense of an abortion. What insurance covers will differ depending on where you live, as will the legality of abortion procedures. For employees, coverage may also vary, depending on what the policy includes.
The 1977 Hyde Amendment decreed that federal funds—including Medicaid, the program for low-income insurance—can only be used for abortions resulting from rape or incest or when the life of the pregnant person is imperiled.
States have their own rules about using Medicaid for abortions, though many shadow the federal rules. Currently, 33 states and the District of Columbia apply the federal standard. Fewer states, 16, use their Medicaid to cover medically necessary abortions in part or in whole. Twenty-two states also restrict coverage for plans offered to public employees. Private companies are also restricted on what they may offer, and the abortion seeker may have to hit a deductible.
The Affordable Care Act (ACA), the Obama-era healthcare reform, set up the Health Insurance Marketplace, where small businesses and individuals can shop for insurance. The plans aren’t required to cover abortion, and insurers that offer abortion coverage above the federal limits have to be careful to use private money only. States can also restrain coverage. To date, exactly half—25—of the 50 states have restricted abortion coverage in their exchanges.
In eight states—California, Illinois, Maine, Maryland, Massachusetts, New York, Oregon, and Washington—private insurers must cover abortions, and in New York, they must do so without co-payments. However, 11 states—Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, Oklahoma, Texas, and Utah—limit all private insurers that want to offer abortion coverage, though with differing restrictions. In the first nine of those states, abortion coverage beyond the restrictions is available through the purchase of a separate rider at additional cost.
One pre-Dobbs review of self-pay charges found that what patients pay for first-trimester abortions has been increasing, while the acceptance of health insurance by abortion facilities has been declining.
There has always been a great deal of variance in abortion cost, depending on where it occurs, whether the person’s insurance covers the procedure, whether the person can access financial support systems, and other factors.
In Virginia, for example, abortion is legal up until the second trimester. In 2011, the year after the ACA was passed, Virginia disallowed abortion coverage on the state exchange. However, that was repealed in 2021, so procedures may be covered depending on the plan. Public employees get coverage only for rape, incest, fetal impairment, and life endangerment.
In Richmond, one of the state’s more populated cities, medication abortions average $525, according to figures from Planned Parenthood. Medication abortions are available only up until week 11. After that, in-clinic abortions are legal up until 20 weeks and six days. The cost rises as the gestation period advances. Before 12 weeks, it’s $600; from 12 to 13.6 weeks, it’s $665; and it’s variable after that.
In early August 2022, Kansas voters, by a nearly 59% majority, shot down an amendment that would have removed the right to abortion from their state’s constitution. Nevertheless, Kansas forbids abortions after 20 weeks, with limited exceptions. It also limits the use of insurance to pay for abortions to cases of life endangerment for both public and private insurance, though the latter can offer abortion riders to cover the procedure. Outside of Kansas, restrictions vary.
When Dobbs came before the court, there were a number of states primed to cut off abortions, including more than a dozen states with so-called trigger laws—bans meant to be automatically put in place by the collapse of federal protections. In all, 22 had laws set up already, and another four were expected to pass bans swiftly after protections were lifted, according to nongovernmental institution the Guttmacher Institute.
Almost all states—to date, 44—already have some form of restriction on abortions once the pregnancy reaches preselected points. Nine of those states ban abortion completely, with a larger share introducing bans at viability (usually somewhere from 24 to 28 weeks).
Here are a couple of specific examples:
There has been some federal movement after Dobbs. The U.S. Department of Health and Human Services put out guidance saying that doctors have to provide abortions when the mother’s life is endangered, even in states where abortions aren’t normally allowed, citing the Emergency Medical Treatment and Labor Act, a preexisting federal law.
The Biden administration has also signed two executive orders. The first one tried to smooth out privacy and safety-related issues raised in Dobbs’ wake. The second tried to extend support to women traveling for abortions, including a new Task Force on Reproductive Healthcare Access.
There is cultural and political power in these kinds of statements and actions, says Debasri Ghosh, managing director of the National Network of Abortion Funds, a membership organization for abortion fundraising groups. For the moment, she says, providing legal protections to people traveling to get abortions out of state is where there is a chance for impact. “But the cost, both for the actual abortion as well as all the associated needs, remains a barrier,” says Ghosh.
There are a slew of other regulations, including mandatory waiting periods and the involvement of parents in abortions with underage patients.
Some other restrictions include:
The legal landscape is changing quickly. Law trackers, like one from the Guttmacher Institute, collect information about what the law is, as well as what new laws are being introduced.
One concern that advocates have is that travel incurs extra expenses. This trend predates Dobbs, as the number of cross-state abortions grew in the decade or so before 2020 as states amped up restrictions. It has deepened inequities in access, according to Guttmacher. And with abortion services ceasing in some states, the trend is accelerating. Many more people are being forced to travel, and the entire experience is much more costly, says Ghosh.
In the legally unfriendly abortion landscape, projections hold that as many as 41% of pregnant people could see their closest provider shutter, stretching travel times significantly—especially in states such as Texas, whose neighbors are also taking an anti-abortion line. This means that, depending on their situation, patients could have to absorb the costs of lost work time, childcare, hotels, and travel—on top of paying for the procedure.
The Kaiser Family Foundation estimates that abortion travel expenses could add “hundreds or even thousands of dollars” to the bill, depending on the circumstances. Meanwhile, the Federal Reserve reports that about 35% of adults in the United States can’t pay for a $400 emergency expense.
A number of companies—mostly large corporations with experience offering benefits or navigating legal jurisdictions, including Amazon.com Inc., Citigroup, and Lyft—have offered to cover reproductive care travel costs for those who need to leave their areas of residence to access it. So has IAC. (Investopedia is part of Dotdash Meredith, an IAC-owned company.)
At least one payroll services firm, TriNet, has rolled out a tool that it claims will assist small and midsize businesses in giving nontaxable reimbursement for out-of-state travel for abortions. “There are various ways you can react to what’s going on around you in the macro environment. Every step you take says a lot about you as an employer,” Samantha Wellington, TriNet’s executive vice president of business affairs and chief legal officer, told The Washington Post.
The offers have been praised, though they vary from company to company. They’ve also raised questions about whether the benefits are taxable, as well as whether they open up the companies to retaliation from legislators. There are also concerns that the offers wouldn’t provide enough help for the workers with the most need, such as part-time employees.
Clinics will sometimes reduce charges for the uninsured. Philanthropic organizations known as abortion funds also provide both money and support for wading through the complexities. For example:
As arrests for self-managed abortions increase, legal defense funds, such as If/When/How, have also emerged.
Access to abortion care is unstable in the United States. Abortion funds are philanthropic groups that exist to help get financial assistance for those who can’t meet the expense of an abortion.
Some health insurance covers abortion care, but that’s not true everywhere. There are also limitations on what can be covered. Simply having insurance doesn’t mean that you’ll be able to find an available provider.
Abortion costs differ drastically depending on where you live, the kind of care you need, and other considerations. For some people, insurance will cover most—or even all—of the cost. For others, it won’t.
The legal landscape for abortions in the U.S. is extremely fluid at present. The recent Supreme Court rescission of the federal constitutional right to an abortion means that the matter is now regulated by individual states, which has led to more people having to cross state lines to access abortion care.
Being forced to travel to obtain an abortion significantly balloons the cost. Some insurers offer abortion coverage, and other forms of assistance are available, such as abortion funds.
Still, for people who don’t have the money to travel to states where abortion is legal, the post-Dobbs world means greater legal risk, higher maternal mortality rates, and more self-induced abortions, according to an article that doctors Daniel Grossman, Jamila Perritt, and Deborah Grady wrote for the American Medical Association’s JAMA Network. The overall picture for affording to pay for an abortion in the U.S. is growing increasingly grim; the consequences for being unable to do so are sobering.
U.S. Supreme Court. “19-1392 Dobbs v. Jackson Women’s Health Organization.”
Planned Parenthood. “How Much Does It Cost to Get an Abortion?”
U.S. Centers for Disease Control and Prevention. “Abortion Surveillance — United States, 2019.”
Congress.gov, U.S. Congress. “S. 142 — Hyde Amendment Codification Act: Summary.”
Guttmacher Institute. “State Funding of Abortion Under Medicaid.”
Guttmacher Institute. “Regulating Insurance Coverage of Abortion.”
Congressional Research Service. “Overview of Health Insurance Exchanges,” Page 1.
Kaiser Family Foundation. “Coverage for Abortion Services in Medicaid, Marketplace Plans and Private Plans.”
American Civil Liberties Union. “Bans on Insurance Coverage of Abortion.”
Health Affairs. “Trends in Self-Pay Charges and Insurance Acceptance for Abortion in the United States, 2017–20.”
Virginia Law. “Code of Virginia: Article 9. Abortion.”
Virginia Legislative Information System. “2011 Session: Senate Bill No. 1202.”
Virginia Legislative Information System. “2021 Special Session I: HB 1896 Essential Health Benefits; Abortion Coverage.”
Planned Parenthood. “Abortion in Richmond, Va.”
Ballotpedia. “Kansas No State Constitutional Right to Abortion and Legislative Power to Regulate Abortion Amendment (August 2022).”
Kansas State Legislature. “Article 67. — Abortion: 65-6709.”
Guttmacher Institute. “26 States Are Certain or Likely to Ban Abortion without Roe: Here’s Which Ones and Why.”
Guttmacher Institute. “State Bans on Abortion Throughout Pregnancy.”
Texas Legislature Online. “H.B. No. 1280.”
The Ohio Legislature. “Senate Bill 23,” Pages 1 and 25.
U.S. Department of Health and Human Services, via Centers for Medicare and Medicaid Services. “Reinforcement of EMTALA Obligations Specific to Patients Who Are Pregnant or Are Experiencing Pregnancy Loss (QSO-21-22-Hospitals Updated July 2022).”
The White House. “Fact Sheet: President Biden to Sign Executive Order Protecting Access to Reproductive Health Care Services.”
The White House. “Fact Sheet: President Biden Issues Executive Order at the First Meeting of the Task Force on Reproductive Healthcare Access.”
Guttmacher Institute. “An Overview of Abortion Laws.”
Guttmacher Institute. “State Legislation Tracker: Major Developments in Sexual & Reproductive Health.”
Guttmacher Institute. “Even Before Roe Was Overturned, Nearly One in 10 People Obtaining an Abortion Traveled Across State Lines for Care.”
The New York Times. “Where Abortion Access Would Decline If Roe v. Wade Were Overturned.”
Kaiser Family Foundation. “Employer Coverage of Travel Costs for Out-of-State Abortion.”
Federal Reserve System. “Economic Well-Being of U.S. Households in 2020 — May 2021.”
The Washington Post. “This Company Helps Small Businesses Offer Abortion Travel Coverage.”
Bloomberg Law. “Employer-Paid Abortion Travel Coverage Triggers Tax Consequences.”
National Abortion Federation. “NAF Hotline.”
National Network of Abortion Funds. “Need an Abortion?”
If/When/How. “Fund Bail and Legal Support for People Who Are Criminalized for Self-Managed Abortion.”
National Network of Abortion Funds. “Common Questions About Abortion Funds,” select “What is an abortion fund?”
JAMA Network. “The Impending Crisis of Access to Safe Abortion Care in the US.”
Government & Policy
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