Affordability and Access to Abortion Care in the United States

Dickman, Samuel; White, Kari; Grossman, Daniel

doi:10.1001/jamainternmed.2021.3502

Cited by 22 publications

(20 citation statements)

References 11 publications

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“…As women increasingly delay childbearing for a variety of reasons [107,108], insurance coverage for infertility has emerged as an important means of encouraging educational ambitions, facilitating career opportunities, and promoting gender equality [109]. Alongside existing limitations in access to contraception, abortion, and prenatal care in the US [110][111][112], fertility treatments are often prohibitively expensive and require not only adequate financial resources, but significant psychosocial support as well. Therefore, infertility care is a fundamental pillar of reproductive health that requires robust cultural and institutional infrastructure to be accessible.…”

Section: Discussionmentioning

confidence: 99%

Impact of in vitro fertilization state mandates for third party insurance coverage in the United States: a review and critical assessment

Peipert

Montoya

Bedrick

et al. 2022

Reprod Biol Endocrinol

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The American Society for Reproductive Medicine estimates that fewer than a quarter of infertile couples have sufficient access to infertility care. Insurers in the United States (US) have long considered infertility to be a socially constructed condition, and thus in-vitro fertilization (IVF) an elective intervention. As a result, IVF is cost prohibitive for many patients in the US. State infertility insurance mandates are a crucial mechanism for expanding access to fertility care in the US in the absence of federal legislation. The first state insurance mandate for third party coverage of infertility services was passed by West Virginia in 1977, and Maryland passed the country’s first IVF mandate in 1985. To date, twenty states have passed legislation requiring insurers to cover or offer coverage for the diagnosis and treatment of infertility. Ten states currently have “comprehensive” IVF mandates, meaning they require third party coverage for IVF with minimal restrictions to patient eligibility, exemptions, and lifetime limits. Several studies analyzing the impact of infertility and IVF mandates have been published in the past 20 years. In this review, we characterize and contextualize the existing evidence of the impact of state insurance mandates on access to infertility treatment, IVF practice patterns, and reproductive outcomes. Furthermore, we summarize the arguments in favor of insurance coverage for infertility care and assess the limitations of state insurance mandates as a strategy for increasing access to infertility treatment. State mandates play a key role in the promotion of evidence-based practices and represent an essential and impactful strategy for the advancement of gender equality and reproductive rights.

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Section: Discussionmentioning

confidence: 99%

Impact of in vitro fertilization state mandates for third party insurance coverage in the United States: a review and critical assessment

Peipert

Montoya

Bedrick

et al. 2022

Reprod Biol Endocrinol

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“…Current president Joe Biden historically expressed pro-Hyde sentiments but changed this opinion during his latest campaign, saying "I can no longer support an amendment that makes the right (to healthcare) dependent on someone's ZIP code [41]." Progressive politicians and reproductive health research and policy organizations have made increasing calls for the removal of payer restrictions on abortion [3,6]. In July 2020, Representative Ayanna Pressley of Massachusetts introduced an amendment to repeal Hyde from the HHS funding bill [42].…”

Section: Discussionmentioning

confidence: 99%

“…Barriers include a sociopolitical landscape of abortion restrictions and clinic closures, deep-set cultural stigma, and difficulty traveling to the nearest abortion clinic [1]. However, one of the most powerful obstacles to abortion care is cost [2,3].…”

Section: Introductionmentioning

confidence: 99%

Real-Time Effects of Payer Restrictions on Reproductive Healthcare: A Qualitative Analysis of Cost-Related Barriers and Their Consequences among U.S. Abortion Seekers on Reddit

Higgins

Lands

Valley

et al. 2021

IJERPH

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Objective: The Hyde Amendment and related policies limit or prohibit Medicaid coverage of abortion services in the United States. Most research on cost-related abortion barriers relies on clinic-based samples, but people who desire abortions may never make it to a healthcare center. To examine a novel, pre-abortion population, we analyzed a unique qualitative dataset of posts from Reddit, a widely used social media platform increasingly leveraged by researchers, to assess financial obstacles among anonymous posters considering abortion. Methods: In February 2020, we used Python to web-scrape the 250 most recent posts that mentioned abortion, removing all identifying information and usernames. After transferring all posts into NVivo, a qualitative software package, the team identified all datapoints related to cost. Three qualitatively trained evaluators established and applied codes, reaching saturation after 194 posts. The research team used a descriptive qualitative approach, using both inductive and deductive elements, to identify and analyze themes related to financial barriers. Results: We documented multiple cost-related deterrents, including lack of funds for both the procedure and attendant travel costs, inability to afford desired abortion modality (i.e., medication or surgical), and for some, consideration of self-managed abortion options due to cost barriers. Conclusions: Findings from this study underscore the centrality of cost barriers and third-party payer restrictions to stymying reproductive health access in the United States. Results may contribute to the growing evidence base and building political momentum focused on repealing the Hyde Amendment.

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“…4 In doing so, individuals must take time off work and find child or elder care potentially in the absence of a primary partner or others who may provide social support. 5,6 When combined with the financial burden those seeking abortion may face to access care, the impact of such restrictions is made especially palpable. 5 In addition to the burden on pregnancy-capable people and their families, fragile health care systems in states that may provide better abortion access are increasingly burdened by treatment-seekers from out of state.…”

mentioning

confidence: 99%

“…5,6 When combined with the financial burden those seeking abortion may face to access care, the impact of such restrictions is made especially palpable. 5 In addition to the burden on pregnancy-capable people and their families, fragile health care systems in states that may provide better abortion access are increasingly burdened by treatment-seekers from out of state. For example, Las Vegas, Nevada has reported an estimated 200% increase in the numbers of individuals from out of state seeking abortion care since Roe v. Wade was overturned.…”

mentioning

confidence: 99%