In September, when the Texas law that outlaws abortions after cardiac activity is detected went into effect, experts predicted that nearly 85 percent of people seeking abortions would be too far along in their pregnancies to qualify for care. As predicted, many thousands of Texans have been denied care under Senate Bill 8, as the state’s anti-abortion measure is known. It continues to cause emotional and financial devastation for Texans who have been forced to seek care in other states. In the first four months it was in effect, nearly 5,600 Texans traveled out of state to get abortion care.
But recent data shows that the decline in the number of abortions in Texas was less than expected, dropping by about half compared to the same months in 2020.
There are a number of reasons the decrease in abortions isn’t as large as anticipated: Some frightened patients are making earlier appointments. Abortion facilities changed their appointment and staff scheduling systems to help expedite care. But perhaps the biggest shift is an influx in donations to clinics and abortion funds that has thrown a financial lifeline to patients who otherwise would have to delay getting care until they had enough money.
Before S.B. 8, most residents could expect to pay at least $600 in out-of-pocket expenses for an in-clinic procedure or medication abortion in the first trimester of pregnancy. That was true whether patients were covered by health insurance or not. (Texas has the highest uninsured rate in the country.) The state prohibits most private insurance plans from covering abortion care, and Medicaid has been prohibited from covering abortions, except in rare instances, since the passage of the Hyde Amendment in 1976. Texas’ policies saddle many patients with an often impossible financial burden.
A new study of over 600 abortion patients in Texas in The American Journal of Public Health paints a troubling picture about what happens to patients who suddenly have to come up with hundreds of dollars to pay for their abortion care.
We were among the researchers at the University of Texas at Austin who asked patients getting abortions in 2018 (well before S.B. 8 went into effect) about the impact of abortion-related out-of-pocket costs. We found that more than half the women we surveyed reported serious financial hardships. One in seven had to skip buying groceries to pay for an abortion. Eight percent skipped or delayed a rent payment, risking getting evicted. Hardships were most common among the poor and uninsured.
When S.B. 8 took effect last September, abortion facilities and abortion funds responded by using the huge influx of donations they received to maximize access. (Abortion funds are nonprofit organizations that collect donations and distribute them to patients who need financial assistance for abortion care.) Now at least some people who detect their pregnancies early enough to have an abortion under S.B. 8 can get care in Texas, even if they can pay only a fraction of the costs; donations usually cover the rest. Some of the patients who might have had to postpone care for weeks or months — skipping rent, delaying bills or borrowing from friends or family — before getting the cash together to pay for their health care are today moving forward more quickly.
Abortion rights almost surely will be further eroded in the months to come, and abortion funds will need more sustained financial assistance to prepare for that future. Meanwhile, some conservative lawmakers have attempted to cut off the funds that do exist with new legislation targeting exactly this sort of fund-raising.
But people shouldn’t have to rely on abortion funds for essential health care. For the same reason we cringe with collective shame at the GoFundMe campaigns for people unable to afford their insulin, we should not tolerate a system in which people’s reproductive health care is determined by the emotional appeal of a fund-raising pitch or outrage about a draconian law.
Making abortion available as early as possible in a pregnancy — and preventing the hardships that result from high out-of-pocket costs and S.B. 8-style restrictions — will require more durable political change.
Ideally, it means repealing the Hyde Amendment and ending restrictions on private insurance coverage for abortion (currently in effect in 25 states), which punish the middle class in the same way that Hyde punishes the poor. It also means expanding Medicaid in Texas, Florida and the 10 other states that continue to refuse to accept federal funding that would allow their poorest residents to get health insurance. Long term, it means following the lead of other wealthy countries by providing universal, publicly financed health coverage that ensures equal access to care for injuries, illnesses and reproductive health needs, including abortion.
S.B. 8 and copycat legislation around the country are a reminder that Americans’ health and well-being suffer enormously because we’ve allowed political ideology to undermine the foundation of a socially just health care system. Medical services should be accessible and free.
Samuel Dickman, an internist, is a health policy researcher at the Population Research Center at the University of Texas at Austin and an abortion provider. Kari White is an associate professor of social work and sociology and directs the Texas Policy Evaluation Project at the University of Texas at Austin.
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