Cost shouldn’t impede access to abortion for Californians

Time and time again, California has stepped up and positioned itself at the forefront of facilitating women’s ability to obtain abortion care in our state. Now, when abortion access is on the line nationwide, it’s time for the state to ensure that every Californian, no matter what her financial status, can obtain abortion care when she needs it.

In 2014, California passed the Contraceptive Coverage Equity Act, which requires health care plans to cover prescribed FDA-approved contraceptives for women without cost sharing. This law was predicated on research showing that contraception is essential reproductive health care, and that cost-sharing requirements, including small copayments, could dramatically reduce preventive health care practices, especially among Americans working to make ends meet. It’s time for California to enact a law that takes the same approach toward abortion.

Abortion care is a critical aspect of reproductive health care. Measurable harm results from the inability to obtain an abortion. A significant barrier to abortion care, especially for low-income women, is cost. California now has an opportunity to remove that obstacle and eliminate cost-sharing for abortion or abortion-related services by passing Senate Bill 245.

The out-of-pocket cost of abortion can be substantial, especially later in pregnancy. A national study I led showed that without private insurance or Medicaid, the median out-of-pocket cost of an abortion was $575. For abortions at later gestations, the out-of-pocket cost more than doubled. For more than half of the people in the study, these out-of-pocket costs represented more than one-third of their monthly incomes; this figure was closer to two-thirds for those having later abortions. While California does mandate that insurance policies cover abortion care, health plans can still charge high deductibles and copays, ranging from $40 to thousands of dollars. These deductibles and copays can function as the equivalent of having no insurance coverage for abortion care.

My research finds that the cost of abortion can be a significant barrier to care and can affect people in a number of ways.

First, having to come up with money to pay these costs has direct economic effects. For people struggling to make ends meet, paying a significant copayment or footing the bill out of pocket for an abortion can mean delaying or forgoing paying rent or buying food. 

Second, costs contribute to delays. In a nationwide study of more than 1,000 women seeking abortion, more than half reported that the need to raise money to cover the cost was a reason they delayed having the procedure. Raising money to cover the cost of an abortion can take time. If women delay into the second trimester, the cost of an abortion goes up, which can lead to further delays as they struggle to raise additional money.   

As a 20-year-old explained to us, “[I] get paid every week, but every time I think I have enough money, it all gets taken out in taxes, so I’m just under the amount I need. Every time I try to make an appointment, something else comes up that I have to pay.”

Third, most women obtain abortions despite the costs.  But some do not. Some experience so many delays in raising the money that the cost becomes prohibitive, or the delays lead them beyond the gestational limit for obtaining abortion care in their state.  

It’s time for California to eliminate cost as a barrier to abortion care once and for all by ensuring that health plans cannot require cost-sharing for abortion or abortion-related services. The Legislature should remove cost-sharing obstacles to abortion care and pass SB 245.