New Study Underscores the Critical Role State Medicaid Coverage Has in Improving Abortion Access

Discriminatory bans on coverage disproportionately impact communities of color and those living with low incomes

According to new data from the Guttmacher Institute, 71% of patients who received care in states where Medicaid can be used to cover the costs of abortion paid $0 out of pocket for their pills or procedure, compared with only 10% of all abortion patients in states where Medicaid is prohibited from covering abortion. 

“Medicaid’s role in alleviating some of the financial burden of abortion,” originally published in Perspectives on Sexual and Reproductive Health, compared patient experiences in paying for abortion in states where state Medicaid funds covered abortion (Medicaid states) and those where it did not because of stipulations of the Hyde Amendment (Hyde states). Drawing on findings from Guttmacher’s 2021–2022 Abortion Patient Survey, this study uses national data from a sample of people obtaining abortions during the 12 months prior to the overturning of Roe

“By covering the cost of the abortion, Medicaid helps alleviate some financial burdens and can improve access for communities that have been marginalized within the US health care system,” says Rachel K. Jones, principal research scientist at the Guttmacher Institute. “Policymakers must understand that in addition to having to figure out how to pay for the abortion, many people—more than one-third—also have to cover indirect costs such as travel and childcare in order to access abortion care.”  

Medicaid is a joint federal-state program that provides health insurance to people living with low incomes. The Hyde Amendment prohibits the use of federal dollars for abortion, but states have the option of using their own funds to cover abortion care under Medicaid. At the time of the study, the use of Medicaid for abortion care was prohibited in 34 states and DC and allowed in 16 states. The Hyde Amendment intentionally and disproportionately impacts people already facing systemic barriers to care, particularly Black and Brown folks, indigenous communities and people with low incomes.  

Discriminatory insurance bans, like Hyde, exacerbate inequities to abortion access, and the new study documents several ways in which this happens. Among all abortion patients, respondents in Medicaid states differed from those in Hyde states on almost all of the payment measures:  

  • Abortion patients in Medicaid states were almost nine times more likely to be using insurance (public or private) to pay for their abortion than patients in Hyde states.  
  • In Medicaid states, 20% of respondents paid out of pocket compared to 82% of respondents in Hyde states.  
  • Sixty percent of respondents in Medicaid states indicated that it was very or somewhat easy to pay for the abortion, compared with 30% of respondents in Hyde states.  

  • Medicaid usage for abortion care was highest among respondents in Medicaid states who identified as Black (70%), Latinx (66%), had one or more prior births (70%–77%), those having second-trimester abortions (75%) and those with the lowest incomes (78%). 

  • One-third of abortion patients in Hyde states had Medicaid health insurance coverage but were unable to use it to pay for this care. 

“This study adds to a growing body of evidence that the Hyde Amendment and related abortion coverage bans deepen inequities in access to abortion and must be eliminated,” says Amy Friedrich-Karnik, principal federal policy associate at the Guttmacher Institute. “Congress must immediately enact proactive policies like the Equal Access to Abortion Coverage in Health Insurance (EACH) Act that lifts the discriminatory Hyde Amendment and ensures coverage for abortion for those insured through Medicaid, as well as [for those] who work for or receive health insurance from the federal government. And then Congress must go further and pass the Abortion Justice Act, which includes provisions that support the full spectrum of services that surround abortion care, which as this research shows, can also add to the costs and make abortion out of reach for too many.”