Abortion pills are increasingly expensive and difficult to supply

The most common method of abortion seems to be getting more and more expensive, in part because of new state restrictions that have made it harder and more expensive to provide.

The average price of a medical abortion – which accounted for the majority of all abortions last year – rose from $495 in 2017 to $560 in 2020, according to a study published Monday in the journal Health Affairs. The authors expect this trend to continue through 2022. At the same time, clinics are increasingly less likely to accept insurance that could help ease some of that burden.

The increase in costs is significant. In 2020, the authors note, the Federal Reserve estimated that 1 in 4 Americans did not have $400 in savings for an emergency medical expense.

“We know from previous research that we’ve done – people report not having to pay their bills to cover this unexpected cost, having to borrow money from people around them, having to sell things like their televisions,” said Ushma Upadhyay, the study’s leader. author. “We have evidence that it’s a huge burden on people.”

The research highlights the impact of decades of state-level abortion restrictions, which have made care more expensive to provide.

In many states where abortion restrictions are in place, clinics have been required to adhere to particularly stringent regulations — adhering to the same building standards as day surgery centers or taking specific steps to dispose of remains fetuses – even though doctors agree that these measures are not medically necessary. . These restrictions appear to have driven up the price of medical and surgical abortions. This is especially true in the South and Midwest, where medical abortions cost more on average than in the Northeast, although other medical expenses can generally be lower. (Medical abortions appear to be the most expensive in the West, a phenomenon researchers attribute to the higher cost of living.)

“There are certainly some reasons why those costs could be higher, particularly in terms of what it means to comply with onerous and unnecessary clinical regulations and to comply with safety and to ensure that you have of a safe space for patients and staff,” said Elizabeth Nash, who follows state policy at the Guttmacher Institute and did not participate in this article. “There are only costs incurred by these clinics that are not elsewhere.”

The findings come from analyzing a large national database of abortion providers, collecting price details from publicly available information on providers’ websites, and calling directly on abortion providers when prices were not available. But they are not complete.

Medical abortions can be performed throughout the first trimester. But after 10 or 11 weeks, patients can only benefit from surgical abortions. And in many cases, researchers haven’t been able to figure out how much those second-trimester abortions would cost, especially those performed later in pregnancy, which are much more expensive.

As a result, the paper may not fully capture the price increase, Upadhyay noted, pointing in particular to the study’s finding that in 2020, a second-trimester abortion costs an average of $895.

” For later [second-trimester] abortion, the cost could reach $4,000,” she said. “That probably grossly underestimates the range of potential loads.”

The cost burden takes on particular significance ahead of this summer, when the Supreme Court is expected to rule in a case known as Dobbs v. Jackson Women’s Health Organization. Court watchers believe it will use this decision to nullify or significantly weaken the protections established by Roe v. Wade, the 1973 ruling that guaranteed the right to abortion until a fetus could live independently outside the womb.

Such a move could allow some states to further restrict access or even ban abortion altogether, making providers even harder to find and more expensive to reach.

“If there is a major change in abortion access, people will have to travel even further to access abortion services,” Upadhyay said. “Increases in procedure costs – coupled with further increases in travel costs – could really put abortion out of reach for many people.”

And, according to the new study, just as abortion prices rise, the number of providers accepting health insurance declines. From 2017 to 2019, researchers found that the number of abortion facilities accepting at least one insurance plan fell nine percentage points, from 89% to 80. This figure remained stable in 2020, and the researchers believe that the percentage of abortion providers taking out insurance has either remained stable or continued to decline.

Even though most facilities accept some sort of health insurance, there are few plans that actually cover abortion – due to state and federal laws limiting abortion benefits in both private coverage and Medicaid, the public health insurance program for low-income people. As a result, most people still pay for abortions out of pocket.

If fewer clinics take out any kind of insurance coverage, it further increases the number of people who will have to pay hundreds or even thousands of dollars from their own savings, Upadhyay said.

“All of this points to an overall reduction in access,” she said.

For many, the financial burden of an abortion is only increasing as more and more people have to travel far from their homes to access the procedure.

In Texas, where a six-week abortion ban has been in effect since September, about 1,400 people leave the state each month to terminate a pregnancy. While nearly half of those people have traveled to neighboring Oklahoma, some have traveled as far as Mississippi and Florida for treatment.

Texans reported the total cost of an out-of-state abortion to be several thousand dollars, according to a recent study by the Texas Policy Evaluation Project. Some said they fell behind on other bills, including rent and car insurance. Others did not buy food.

And because Texans now have to travel farther for treatment and because fewer abortion providers are available, clinics have reported seeing patients later in pregnancy than usual — including in the second. quarter, more expensive.

The Idaho state legislature has passed a ban similar to Texas’s — though it has yet to take effect — and Oklahoma lawmakers are also debating it. If more comparable abortion bans come into effect, it could push more people seeking abortions to wait longer and ultimately pay more for care, Upadhyay said.

“It will take them more time to organize their trip. It will take them longer to plan their trips. It will actually end up pushing them further into gestation and leading to more expensive abortions,” she said. “That is, if they can get out of state.”

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