Online Program

Payment for abortion prior to new insurance restrictions

Monday, November 4, 2013 : 11:00 a.m. - 11:15 a.m.

Sarah C. M. Roberts, DrPH, Advancing New Standards in Reproductive Health, Dept. of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, CA
Heather Gould, MPH, Bixby Center for Reproductive Health Research and Policy, University of California, San Francisco, Oakland, CA
Tracy A. Weitz, PhD, MPA, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA
Diana Greene Foster, PhD, Bixby Center for Global Reproductive Health, Department of Ob/Gyn, University of California, San Francisco, Oakland, CA
New state-level policies restrict private insurance coverage for abortion. This abstract describes payment for abortion care prior to new restrictions. Almost 1000 women seeking abortion at 30 facilities across the U.S. were asked how they paid for their abortions. Two thirds received financial assistance (85% after 20 weeks, 67% between 14 and 20 weeks, 44% receiving a medication abortion). Seven percent received funding from private insurance, 34% public insurance, and 29% other organizations. Median out-of-pocket costs when public and private insurance paid were $0. Median out-of-pocket cost for other women were $575. Out-of-pocket costs represent more than one-third of monthly personal income for more than half of participants. One-quarter of women who had private insurance had their abortion paid for by private insurance. Among women eligible for public funding based on income and residence, more than 1/3 did not receive public funding. More than half reported that cost was a reason for delay in receiving the abortion. In a multivariate analysis, living in a state where public funding for abortion was available, having public 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. Prior to new restrictions, many women struggle to pay for abortion care. Public insurance did not cover abortion in all instances where it should have. Insufficient coverage for abortion resulted in women not receiving their abortions until later in pregnancy, when abortions are more costly and have some additional medical risk.

Learning Areas:

Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe how much women pay out-of-pocket for abortion care under different financial assistance and gestational age scenarios. Identify the gaps between eligibility for insurance coverage and insurance paying for abortion care. Understand how lack of financial support for abortion delays needed care.

Keyword(s): Abortion, Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: In collaboration with my co-authors, posed the research question, and analyzed the data. I also conduct research about abortion, as well as other aspects of women's health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.