Financial Hardships Caused by Out-of-Pocket Abortion Costs in Texas, 2018

Abstract

Objectives. To identify financial hardships related to costs of obtaining abortion care in Texas, which has the highest uninsured rate in the United States and restricts insurance coverage for abortions. Methods. We surveyed patients seeking abortion at 12 Texas clinics in 2018 regarding costs and financial hardships related to abortion care. We compared mean out-of-pocket costs and the percentage reporting hardships across income and insurance categories. Results. Of 603 respondents, 42% were Latinx, 25% White, and 21% Black or African American, and most (62.0%) reported having low incomes (< 200% federal poverty level). Mean out-of-pocket costs were $634, which varied little across insurance groups. Patients with low incomes were more likely to obtain financial assistance from an abortion fund than were wealthier patients (12.3% vs 1.6%, respectively; P < .05). Financial hardships related to abortion costs were more common among uninsured (57.6%) and publicly insured (55.1%) patients than those with private insurance (48.2%). One in 5 (19.8%) uninsured respondents delayed buying food to pay for abortion care. Conclusions. Restrictions on insurance coverage for abortions result in high out-of-pocket costs and major financial hardships for most patients with low incomes in Texas. (Am J Public Health. Published online ahead of print March 24, 2022: e1–e14. https://doi.org/10.2105/AJPH.2021.306701 )

Patient and provider experiences using a site-to-site telehealth model for medication abortion

“…Abortion can be difficult to access in the United States for many reasons, including state and federal regulations that restrict how a pregnant person can access abortion care (1)(2)(3); decreasing numbers of abortion providers (4,5); the need to travel long distances to reach an abortion-providing facility (6)(7)(8); and costs associated with the procedure and/or travel to the facility (9,10). Over the past decade, abortion providers have implemented site-to-site telehealth for medication abortion (referred to here as "site-to-site TeleMAB") services to allow health centers that do not have a clinician onsite to provide medication abortion services remotely.…”

Abortion Access and Medically Complex Pregnancies Before and After Texas Senate Bill 8

“…26 These administrative and structural burdens exacerbate health and access barriers for groups that already experience structural oppressions. [27][28][29] Delays or inability to get care after abortion bans have the potential to further increase morbidity and mortality, particularly among Black and Latino/a/x people. 14,[28][29][30][31] This study comparing changes in health care professionals' practice after implementation of a law that limited most abortions provides insights into what may happen elsewhere after the overturn of Roe v Wade.…”

“…26 These administrative and structural burdens exacerbate health and access barriers for groups that already experience structural oppressions. 27–29 Delays or inability to get care after abortion bans have the potential to further increase morbidity and mortality, particularly among Black and Latino/a/x people. 14,28–31…”

Abortion patients' decision making about where to obtain out‐of‐state care following Texas' 2021 abortion ban

“…Long travel distances and associated costs created hardships that added to the logistical, financial, and social challenges that many people of color and those living on low incomes face obtaining an abortion. 24,38,39 Distance and cost also may have posed insurmountable barriers for people who considered but did not obtain out-of-state facility-based abortion care. 40,41 Along with expanding on prior studies of people's decisionmaking on local sources of abortion care and experiences of forced travel, 10,12,14,15 these results point to opportunities to facilitate care navigation until restrictive abortion policies are repealed.…”

“…23 The majority of Texans who obtain abortions are parents, work but live on low incomes, and identify as Hispanic or Black, similar to abortion patients nationally. 7,24,25 To explore abortion patients' decision-making about where to obtain out-of-state care, we draw on in-depth interviews we conducted for a rapidresponse study. We assess how pregnant Texans evaluated outof-state options in light of their personal circumstances and what they prioritized if they were unable to find a location that met all their needs.…”