by Megan Burbank
In 1991, a Washington State voter initiative established the law that would go on to keep abortion legal locally after Roe v. Wade was overturned last summer. Initiative 120’s drafters had a U.S. Supreme Court like the one currently in power in mind when putting together their initiative, and when Roe was overturned, Initiative 120 kicked in just as it had been intended to, upholding abortion access for Washingtonians.
But there’s a second component of Initiative 120 that’s less flashy but has been quietly revolutionary in its own way when it comes to broadening access to abortion in Washington: The voter initiative also established State Medicaid funding for abortion, flying in the face of national funding restrictions under the Hyde Amendment and allowing pregnant people on Medicaid to access abortion care without coinsurance in Washington State. Given that abortion tends to be disproportionately inaccessible for Black, Indigenous, and People of Color, as well as for young people and low-income folks, ensuring Medicaid coverage served as one way to broaden access in the deeply varied patchwork of abortion access that existed even with the legal backstop of Roe.
Now, Medicaid coverage for abortion could become a way for states to continue that push toward greater health equity, even without the legal protections Roe once provided. That’s the dynamic explored in a new study from the American Institutes for Research (AIR), a nonpartisan nonprofit organization that conducts research on behavioral and social science. For the study, released in January, the group examined how implementing Medicaid coverage for abortion — or revoking it — impacts patients, providers, abortion funds and clinics, the cost of treatment, and potential ramifications in a post-Roe health care landscape. The study examines impacts in Illinois and Maine, which initiated Medicaid coverage for abortion between 2017 and 2019, and West Virginia, which discontinued it in the same time period.
The findings are stark: In states where Medicaid coverage for abortion was initiated, write AIR staff in a report on their findings, “there was an immediate decline in the share of total price paid by patients, which continued in the following months.” But that didn’t apply to everyone: Patients from other states, whose insurance did not include coverage for abortion, or who had high-deductible insurance plans, still needed financial support to pay for their procedures. Still, AIR reports, “there was an immediate increase in access, as evidenced by a higher number of completed procedures, after the implementation of state Medicaid coverage for abortion care.”
In states that ended Medicaid abortion coverage, the opposite occurred: “an immediate and sustained increase in the share of total price paid by patients,” with abortion funds filling the gap.
In Illinois, the policy change bolstered health equity, expanding access for People of Color and low-income patients: The gap in access driven by economic factors was reduced by 37%, AIR found, and the average amount patients paid for their procedures fell from $421 to $249. In both Maine and Illinois, Medicaid coverage for abortion broadened access and coverage for procedures, reduced both delays in obtaining care and related travel, eased hardships for patients and service providers, and allowed abortion funds to target and expand their offerings due to reduced demand.
Because more patients were covered under Medicaid, abortion funds in Maine and Illinois reported to AIR that they could shift their services to serve patients more efficiently and holistically. In Illinois, one local fund reported that the need for assistance was so high before the policy change that it could only accommodate approximately 30% of the abortion patients who reached out; after Medicaid coverage went into effect, the fund could serve 100% of its clients. In Maine, another abortion fund was able to grow its services to include practical support for callers.
While Medicaid coverage is one way to expand abortion access, it presents its own challenges, as clinics may need to shore up capacity to accommodate a growing number of patients following these policy shifts. It’s also critical to note that AIR’s study precedes the reversal of Roe v. Wade. While abortion-related travel was not a new development after the Dobbs v. Jackson Women’s Health decision, data shows it has only increased since the ruling, and Medicaid coverage for abortion does little to offset the costs of abortion care for out-of-state patients or patients on high-deductible insurance plans.
Still, Washington State was on the cutting edge of Medicaid coverage for abortion in 1991, and its implementation in other states shows that this may be one way, amid increasing abortion restrictions elsewhere, to reduce demand on abortion funds and address long-standing inequities in abortion access — inequities that existed long before Roe v. Wade was overturned.
Megan Burbank is a writer and editor based in Seattle. Before going full-time freelance, she worked as an editor and reporter at the Portland Mercury and The Seattle Times. She specializes in enterprise reporting on reproductive health policy, and stories at the nexus of gender, politics, and culture.
📸 Featured image by WIN12_ET/Shutterstock.com.
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