We've all seen the movie scene where a young woman, distraught over her unwanted pregnancy, enters into a lengthy emotional debate about whether or not to have an abortion. She considers an array of factors — personal morals, societal taboos, sometimes even her partner’s perspective on the matter. But one factor that plays a key role in most women's real-life decisions rarely comes into play in media depictions: how to pay for an abortion.
Out-of-pocket costs for terminating a pregnancy are considerable: a clinic-based abortion at 10 weeks’ gestation is estimated to cost between $400 and $550, whereas an abortion at 20-21 weeks’ gestation costs roughly $1,100-$1,650. Of course, it's more than just an abstract financial figure: many of us know women who have nearly gone broke paying for their abortions. Four of my close friends who had abortions by their mid-twenties each paid completely out-of-pocket; in high school, my best friend split the cost of her abortion with her boyfriend and still had to cash out her savings to fund the procedure. And there are still countless other women who, unable to find the money for an abortion, are forced to carry their unwanted pregnancies to term.
But when I had my abortion in August of 2014, my health insurance ended up covering roughly 80 percent of the $600 procedure. At the time, I didn't understand how truly rare this was.
The idea that paying for an abortion is "our own problem" is so ingrained in the culture that few of us ever consider whether our health insurance might cover a pregnancy termination. But when I found out that I was pregnant in the summer of 2014 (during a month when I was off birth control, the pull-out method finally failed me), my first thought was to contact my insurance to see if an abortion would be covered in my plan.
I came to the decision to have an abortion, without any consideration at all to continue on with my pregnancy. This is not to say I was not emotionally affected by this experience. Seeing the positive pregnancy test for the first time was upsetting, but mostly because I was so shocked this actually happened.
The thought to check with my insurance honestly came to me because I truly felt this operation was like any other medical procedure (I had, luckily enough, just started a new job that offered health insurance after leaving a previous uninsured position I held for two years). When I bluntly asked the insurance representative if my abortion would be covered, she politely explained that yes, my insurance would cover one procedure each year. At that moment I sighed with relief — I was so grateful I no longer had to worry about putting the procedure on my already maxed-out credit card.
After finding out the procedure was covered, I booked my appointment at a clinic on the Upper East Side. I found the women’s clinic online by simply googling “abortion clinic new york city” and, after a quick consideration, decided on the place with the best reviews. During the preliminary phone call to set up the appointment, the attendant at the clinic required me to provide my insurance and my member ID so they could confirm my coverage — standard procedure at any doctor’s office for any procedure.
I came into my appointment knowing I would have to pay the $25 copay. During the entire process, I also paid out of pocket for a few tests that were not covered by my insurance, including $45 for bloodwork and $85 for a transvaginal ultrasound, which was only required because, at just five weeks along, the fetus was too small to be detected by an abdominal ultrasound (which would have been covered).
My procedure left little lasting effect on my psyche or my bank account. Reflecting on it, I came to realize my experience was much simpler that many other women's — not just because I wasn't interested in motherhood and had a partner who supported my choice, but because I did not have to figure out where the money for my abortion was going to come from, or even struggle to find a nearby clinic to have the procedure at all.
Abortion coverage is not standard in all insurance — far from it, actually. Very few companies that do cover abortion make any clear mention of it to plan members, so the only surefire way to figure out your own plan's coverage is to call an insurance representative, or read your individual terms and conditions. And you'll have to read those terms closely — coverage varies from state to state and also depends on whether you have private insurance through an employer or an Affordable Care Act plan.
Luckily, New York State, where I live, is one of the 19 states that still offer health insurance coverage of abortions. This is pretty rare — according to the Guttmacher Institute, the U.S. has adopted 231 new abortion restrictions since 2010. Much of this is due to the power given to states to regulate the details of its residents' abortion coverage — and a law called the Hyde Amendment.
In 1977, the Hyde Amendment banned the use of federal funds to cover abortion unless the pregnancy is a result of rape, incest, or is determined to endanger the woman’s life. This is especially relevant today, as more and more people receive their health insurance through Medicaid, Medicare, or an Affordable Care Act-based Marketplace plan.
A major initiative of the ACA was to create the Marketplace — a state and federally funded exchange intended to provide affordable health insurance to individuals who are not offered benefits through their employers. And since the Marketplace is publicly funded, the Hyde Amendment can sometimes be utilized by state lawmakers to prevent those plans from covering abortion.
The good news is, state funding has no regulations on expenditures. Currently, 17 states use state-only funds to pay for abortions in circumstances different than those federal limitations set in the Hyde Amendment.
But even if insurance is privately funded by an employer, states are still able to regulate abortion coverage. As of 2015, 10 states have laws in effect restricting insurance coverage of abortion in all private insurance plans, in addition to the 25 states that restrict abortion coverage in plans offered through the Marketplace.
States are restricting abortion rights through private and Affordable Care Act plans because legislators argue that pro-life taxpayers should not have to finance a procedure against their ethical beliefs. A solution to this issue has been proposed with the implementation of Multi-State Plans in the Marketplace. These plans offer coverage in multiple states. Integrating more plan options into the Marketplace increases the number of plans offered per state, which in essence will allow pro-life Marketplace users to choose a plan that does not offer abortion coverage.
As interesting as Multi-State Plans sound, the future of insurance-funded abortions does not necessarily look promising. An increasing number of states are either banning abortion coverage from insurance policies altogether, or adding regulations that complicate obtaining the procedure including waiting periods, mandated parental involvement, spousal approval, or limitations on publicly funded abortions. Others have even narrower requirements, limiting abortion coverage to only life-threatening circumstances and even prohibiting coverage in cases of rape or incest.
What about the millions of women who live in states that ban abortion coverage by insurance providers, or do not even have health insurance — is the only other option to pay for the procedure entirely out of pocket? The existence of abortion funds fills a much needed gap for many of those women.
Abortion funds are grassroots organizations that use private donations to help women pay for the procedure; they also offer help scheduling the appointment, provide transportation, and even give women who have to travel great distances a place to stay. Abortion funds provide a level of emotional and financial support that in many cases just may be the deciding factor in whether a woman is able to obtain an abortion — but since these groups get their money from donors, not the government, funds can be extremely limited, and not every woman can get the help she seeks.
I got lucky. At the time, I thought my insurance experience was commonplace because in my mind, insurance should cover all medical procedures. However, I was naïve in my assumptions and came to realize my experience is uncommon. As states’ insurance policies drop abortion coverage at exponential rates, it will become increasingly difficult to access the procedure. My story — the one in which a woman made a clear decision about her future and went in for a simple medical procedure covered by her insurance — is in jeopardy of becoming a thing of the past. Women who need help paying for abortions are people with a costly medical need — exactly the kind of people who are supposed to be aided by insurance. And we need to work to help them.