Health Reform to Impact Abortion?

The House and Senate bills both contain measures that restrict health insurance coverage for abortions. When you consider that the vast majority of private policies currently cover these services, this is a genuine step backwards for women's right to choose, in both practical and symbolic terms. Feminists are rightly livid, doubly so because they realize that these provisions are unlikely to be greatly softened given the delicate political compromises required to pass a health reform bill.

One question deserves more careful thought than it has received: How much will these measures actually prevent women from securing access to abortions? This is an empirical question. We don't precisely know the answer. It's depressingly unsurprising that most people's responses to this question are highly correlated with their political and moral views.

Moderates and conservatives note that the average cost of an abortion in America is less than $400. A woman determined to have one can hit the ATM, write a check, run up her credit card, borrow from a relative or a friend, or hit the local payday loan store. Poor people pay surprising amounts for cell phones and cable TV. They can be surprisingly resourceful in paying for abortions, too.

On the whole, the empirical record seems to favor this perspective. Via email, the distinguished health economist Theodore Joyce summarized the views of most empirical economists who have studied this question:

"I don't see it being very important at a population level. It is a $400-$500 procedure for 90 percent of terminations that occurs less than once per woman per reproductive lifetime. … Prices can [go higher] for late terminations in hospitals when indicated for fetal anomalies. Teens and poor women recognize pregnancies later and end up needing more second trimester abortion. … They will be hurt."

Phillip Levine of Wellesley College, one of the nation's leading experts on the economics of abortion, summarizes the available evidence in a useful little volume, Sex and Consequences: Abortion, public policy, and the economics of fertility.Many studies have examined changes in abortions and births induced by changes in state and federal abortion policies. Federal policies, notably the Hyde Amendment, greatly changed abortion policy in some states, and left policies unchanged in others.

Summarizing the available evidence, Levine concludes that restrictions on Medicaid funding reduced the number of abortions by 3 to 5 percent. That's a pretty small effect, although the effects are somewhat more impressive when one restricts one's attention to low-income women most strongly affected by these policies. There is little evidence that abortion restrictions actually increase the overall number of unwanted pregnancies carried to term. When low-income women face a more restricted environment, they respond by finding alternate strategies to finance abortions. They may also be more likely to aggressively practice contraception.

Levine cites this evidence in a recent New York Times op-ed, titled "False Alarm on Abortion." He notes that 12 percent of American women age 15-44 are covered by public insurance programs that are already barred from using federal funds to cover abortions. Another 20 percent of this same age-group is uninsured.
Of course for these women, $400 is a nontrivial amount of money. That's two months of cash welfare payments for a family of three in several states with the most punitive abortion laws.

Then there is the secrecy and the stigma. It's one thing to ask Mom for $400 to cover the rent or asthma medication. It's quite another to borrow funds for an abortion. Many women don't want their friends, parents, relatives, or partners to know that they are pregnant. When women are reluctant to borrow the money or to produce a tell-tale credit card bill, restricting abortion coverage can have a real impact on both the number of abortions and (though this is more complicated) on the number of unwanted pregnancies brought to term.