How has Massachusetts health care reform affected abortion access? a qualitative investigation

Background: In 2006, Massachusetts passed sweeping health care reform legislation leading to an expansion of the number of residents with insurance. Little research has explored the impact of this legislation on abortion access.

Methods: We explored low-income women's experiences accessing abortion in a state where health care reform was passed over six years ago and where most public and subsidized insurance plans cover abortion. Twenty-seven in-depth interviews were conducted with low-income women who obtained an abortion post reform. Interviews were digitally recorded, transcribed verbatim, coded in Atlas.ti, and analyzed thematically.

Results: Overwhelmingly, participants reported they have ready access to publicly funded and subsidized abortion care. Women who obtained insurance coverage for their abortion also reported high levels of satisfaction securing coverage and had few suggestions for improving the process. However, a minority of participants—in particular, women who are new to Massachusetts and/or public and subsidized health insurance plans, and immigrants—described difficulties enrolling or maintaining enrollment in insurance plans. These challenges forced them to raise money to pay out of pocket for their abortion care.

Conclusion: Women's reports of their experiences accessing abortion in Massachusetts highlight that state funding of abortion can be an important resource for populations with limited financial resources, particularly when coverage is accompanied by other supporting factors such as policies enabling high levels of insurance coverage. However, findings also show that the existence of coverage does not guarantee access to affordable care, and that some populations may need support accessing the coverage for which they are eligible.