SOCIAL SCIENCE ORAL ABSTRACTS: Trends in self-pay costs and insurance acceptance for abortion across the United States, 2017 to 2020

Abstract

<h3>Introduction</h3> Abortion cost can be a significant financial burden and a barrier to care. The Hyde Amendment prevents Federal funding from being used for abortion care, forcing many low-income people to pay for abortion out of pocket rather than using their Medicaid coverage. Current data on self-pay abortion costs are limited to national estimates or small sample sizes. We provide data on trends in self-pay abortion costs by region for medication abortion and first and second trimester procedures using a national database of abortion clinics in the United States. We also examine the proportion of clinics that accept any type of insurance. <h3>Method</h3> We used data from University of California San Francisco (UCSF)/Advancing New Standards in Reproductive Health (ANSIRH's) abortion facility database which includes data on publicly advertising abortion clinics and is updated each year. We used Chrome browser's incognito mode to search for clinics by State and City using the key words: "Abortion clinic in [State]", "Abortion clinic in [City]" for all cities with a population of 100,000 or larger in each state, and the 3 largest cities for states that did not have a city of that size. We examined links to clinics from the first 3 pages of results for states and first 2 pages for cities. We then conducted mystery shopper phone calls to clinics to supplement any missing data not found on facility web pages. Mystery callers did not make clinic appointments. Clinics were only included if they reported being open and providing abortions for a given year. Abortion training sites such as teaching hospitals were only included if they publicly advertised abortion services. To estimate mean costs of abortion for clinics that gave a range of prices for a certain abortion type (e.g., second trimester) we first averaged the prices for that procedure type per clinic. Then, clinic mean prices were averaged by region to develop regional means. We reported the number and percentage of clinics in each region that reported accepting any insurance. <h3>Results</h3> We identified 751 to 776 publicly advertising abortion clinics per year in the United States: 776 in 2017, 751 in 2018, 758 in 2019, and 765 in 2020. The national mean self-pay price for medication abortion increased from $511 in 2017 to $644 in 2020. Mean price for medication abortion varied greatly by region, the lowest cost in 2020 being $489 in the South Atlantic and the highest being $873 in the Pacific. Nationally, mean first-trimester aspiration abortion costs also increased over time, from $489 to $715 between 2017 and 2020. Mean price for first-trimester aspiration abortion varied greatly by region, with the lowest cost in 2020 being $493 in the South Atlantic and the highest cost being $1191 in New England. In contrast, mean second trimester abortion costs decreased nationally, from $1180 in 2017 to $1068 in 2020. This decrease was mostly concentrated in the Pacific, East North Central, and New England regions, while other regions saw an increase in the same period. There was a sharp national decline in the proportion of clinics that accepted insurance from 88% to 80% between 2018 and 2019, which was sustained in 2020. This decline was observed in all regions. <h3>Conclusions</h3> An improved understanding of patient costs for an abortion and how that varies by region and state is a crucial first step to reducing financial barriers and to inform public and private insurance coverage policy. Abortion costs are increasing over time, while the proportion of clinics that accept insurance is decreasing. This may be because public and private insurance reimbursement rates do not cover the full costs of providing abortion care. Insurance reimbursement rates must be increased to reflect actual clinic costs. Additionally, repealing the Hyde Amendment would have profound impacts on people who have abortions in the United States.