Moving beyond Roe: Policies and protections for expanding abortion access
This blog post was co-authored by Terri-Ann Thompson, who is a Senior Research Scientist at Ibis Reproductive Health, and Carmela Zuniga, who is an Associate Research Scientist at Ibis Reproductive Health.
As American voters prepare to go to the polls this November, abortion access is a key issue on their minds. But while some may be thinking that improving abortion access means restoring Roe v. Wade, going back to the status quo prior to the Dobbs decision is not the solution. Instead of going back, we must move forward — with new policies and better protections to create a future that guarantees access for all to the reproductive health services they need.
At no time in the past has everyone in the United States been able to enjoy their human right to reproductive health. Since 1977, the Hyde Amendment, an annual appropriations bill rider, has prohibited the use of federal funds for abortion except in cases of life endangerment of the pregnant person, rape, or incest. This restriction directly impacts people who rely on Medicaid to cover their health costs since Medicaid is partially funded by the federal government. Though state funding can be used to cover the cost of abortions for circumstances that go beyond the Hyde exceptions, most US states choose not to do this, making abortion financially inaccessible for many.
Prior to the Dobbs decision, close to 8 million women lived in states that restricted abortion coverage in accordance with the Hyde Amendment. Meanwhile, the average cost of even a telehealth abortion in 2021 was $239. Given that 71% of abortion patients in the US have incomes below 200% of the federal poverty line and 41% earn below the federal poverty line altogether, paying for an abortion out of pocket would have been extremely difficult or impossible for many. In their own words, we’ve heard the difficult choices people have had to make to receive the care they need. Some were forced to take out loans (putting themselves in further debt), had to forgo rent and utility payments, or were forced to delay care by two or more weeks.
Today, 21% of women ages 15–49 who are covered by Medicaid live in a state prohibiting abortion, and 35% live in a state where abortion is available but restricted by the Hyde Amendment. This means that most women ages 15–49 covered by Medicaid must not only raise funds for the procedure but must also have enough resources to travel out-of-state to obtain care. Further, the burden falls heaviest on people of color, who are disproportionately covered by safety-net programs such as Medicaid. Abortion funds — nonprofits that offer financial and logistical support to abortion seekers — have reported an increased need for support, especially for those leaving their state to get care. However, abortion funds cannot absorb the large need that this population presents. We won’t accept the status quo.
Each year that the Hyde Amendment is passed (last week marked its 47th anniversary), millions of people are forced to either find alternative means to cover needed abortion care, or carry an unwanted pregnancy to term. But now, we have a chance to move forward. And one of the first steps we can take is enacting the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act, which ensures that everyone receiving care or coverage through the US government will have abortion coverage. The EACH act would also prohibit the federal government from preventing private insurance companies from providing abortion coverage. Studies examining the impact of Medicaid coverage on abortion access have shown an increase in the number of people able to access the service, improved access among people of color, and a reduction in patient price.
And let’s not stop at ensuring abortion is affordable — let’s take a step further and make sure it’s also physically accessible. We can implement policies allowing abortion pills to be mailed directly to patients and allow advanced practice clinicians (APCs) to bring abortion care within reach of the people who need the service. We have the tools — let’s move forward.
You can learn more about Ibis’s research on the impact of insurance policies on abortion access and provision here.