Taking Insurance in Abortion Care: Policy, Practices, and the Role of Poverty

Abstract

Most women seeking abortion pay out-of-pocket for care, partly due to legal restrictions on insurance coverage. These costs can constitute a hardship for many women. Advocates have sought to ensure insurance coverage for abortion, but we do not know whether the intermediaries between policy and patient – abortion-providing facilities – are able and willing to accept insurance.

We interviewed 22 abortion facility administrators, representing 64 clinical sites in 21 states that varied in their legal allowance of public and private insurance coverage for abortion, about their facility’s insurance practices, and experiences.

Respondents described challenges in accepting public and/or private insurance that included, but were not limited to, legal regulations. When public insurance broadly covered abortion, its low reimbursement failed to cover the costs of care. Because of the predominance of low income patients in abortion care, this caused financial challenges for facilities, leading one in a state that allows broad coverage to nonetheless decline public insurance. Accepting private insurance carried its own risks, including nonpayment because costs fell within patients’ deductibles. Respondents described work-arounds to protect their facility from nonpayment and enable patients to use their private insurance.

The structure of insurance and the population of abortion patients mean that changes at the political level may not translate into changes in individual women’s experience of paying for abortion.

This research illustrates how legal regulations, insurer practices, and the socioeconomics of the patient population matter for abortion-providing facilities’ decision-making about accepting insurance.

Citation

Kimport, K. and Rowland, B. (2017), "Taking Insurance in Abortion Care: Policy, Practices, and the Role of Poverty", Health and Health Care Concerns Among Women and Racial and Ethnic Minorities (Research in the Sociology of Health Care, Vol. 35), Emerald Publishing Limited, Leeds, pp. 39-57. https://doi.org/10.1108/S0275-495920170000035003