Payment for abortion prior to new insurance restrictions

New state-level policies restrict private insurance coverage for abortion. This abstract describes payment for abortion care prior to new restrictions. Almost 1000 women seeking abortion at 30 facilities across the U.S. were asked how they paid for their abortions. Two thirds received financial assistance (85% after 20 weeks, 67% between 14 and 20 weeks, 44% receiving a medication abortion). Seven percent received funding from private insurance, 34% public insurance, and 29% other organizations. Median out-of-pocket costs when public and private insurance paid were $0. Median out-of-pocket cost for other women were $575. Out-of-pocket costs represent more than one-third of monthly personal income for more than half of participants. One-quarter of women who had private insurance had their abortion paid for by private insurance. Among women eligible for public funding based on income and residence, more than 1/3 did not receive public funding. More than half reported that cost was a reason for delay in receiving the abortion. In a multivariate analysis, living in a state where public funding for abortion was available, having public or private insurance, being at a lower gestational age, and higher income were associated with lower odds of reporting cost as a reason for delay. Prior to new restrictions, many women struggle to pay for abortion care. Public insurance did not cover abortion in all instances where it should have. Insufficient coverage for abortion resulted in women not receiving their abortions until later in pregnancy, when abortions are more costly and have some additional medical risk.