Abortion as a catastrophic health expenditure in the United States
Ibis Reproductive Health. Abortion as a catastrophic health expenditure in the United States. July 2021.
In the United States, abortion care is financially inaccessible for many individuals. Seventy-five percent of abortion patients in the United States have low incomes and almost half earn incomes below the federal poverty level, making the estimated average 2020 cost of an abortion ($465 for a first trimester abortion and $1,038 for a second trimester abortion) extremely difficult or impossible for many abortion seekers to pay out-of-pocket. In 2019, 37% of US adults were not able to cover a $400 emergency expense with cash or a credit card they could pay off at the end of the month, and with millions of people reporting job loss or reduced work hours due to the COVID-19 pandemic, the percentage of Americans experiencing financial hardship was likely higher in 2020 than in previous years.
Although insurance coverage of abortion would protect people from experiencing financial hardship for obtaining this essential reproductive health care service, policies at the federal and state level continue to restrict insurance coverage of abortion. At the federal level, the Hyde Amendment prevents federal funds contributed to Medicaid (which assists with medical costs for people earning low incomes) from being used for abortion, except in very limited circumstances. Legislators in many states have implemented policies to restrict private insurance plans and plans offered in health insurance marketplaces from offering abortion coverage, further limiting financial access to abortion.
Without insurance coverage, abortion seekers must either find a way to pay out-of-pocket or carry an unwanted pregnancy to term. When out-of-pocket spending for a health service is above a certain proportion of one’s income, this cost is considered a catastrophic health expenditure (CHE). To understand the extent to which out-of-pocket abortion costs impact the financial wellbeing of US households, we assessed whether abortion costs could be considered a CHE for households earning their state’s median income.