Two New Analyses Show Women Have “Much at Stake” Under Stupak Amendment

Jodi Jacobson

Two new studies show what many have already argued: Implementation of the Stupak-Pitts Amendment would likely result in the almost total loss of coverage for abortion care, including in situations where life and health are at risk.

Two new analyses, one by the Kaiser Family Foundation (KFF) and the other by George Washington University, show just how much the Stupak Amendment would undermine women’s basic human rights to exercise choice over childbearing, to access comprehensive reproductive health care, to access abortions (a legal procedure in the United States), and to ensure they are covered by insurance for unanticipated pregnancy-related conditions that could, absent coverage, leave them and their families with enormous debt.

The Kaiser Study

"Women have much at stake in the ongoing national debate on health reform," states a new brief by KFF, which continues:

Comprehensive coverage and the scope of benefits are at the heart of making health care accessible to women. The decisions that policy makers enact regarding access and coverage of abortion are sure to be the subject of tremendous discussion and debate, and could affect care for millions of women today and in the future.

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The KFF brief compares the bill passed 10 days ago by the House of Representatives with those still working their way through the Senate.  (It was written prior to release today of the omnibus Senate bill by Majority Leader Harry Reid.)

"The way that the final House bill addresses abortion coverage has
the potential to affect many women," notes KFF, underscoring the incorrect ways in which the media has portrayed this issue. 

"[A]bortion is one of the most common surgical procedures performed on women. In 2005, there were more than 1.2 million abortions in the United States. It is estimated that at current rates, about a third of women will have had an abortion by age 45." 

The Kaiser brief first reviews current law, noting:

  • Current federal law bans the use of any federal funds for abortion, except in the event of rape, incest, or the woman’s life endangerment, as specified in the federal Hyde Amendment, which has been in effect since 1977.
  • This amendment is not a permanent law but is attached annually to Congressional appropriations bills, and has been approved every year by the Congress.
  • The broadest reach of the Hyde Amendment is on Medicaid, basically limiting federal Medicaid funding for abortions to life endangerment, rape, or incest cases in most states. States can choose to broaden the circumstances to cover other “medically necessary” abortions for women on Medicaid with their own funds and 17 states do, but in the majority of states women on Medicaid only have coverage in cases of rape, incest, or when the pregnancy is documented by a physician to be a threat to the life of the woman. Over the years, the Hyde Amendment has been broadened to limit federal funds for abortion for federal employees, in the Indian Health Service, and women in the military.

 

The House bill expands coverage to many of the nation’s uninsured by extending Medicaid eligibility to all qualifying individuals with incomes up to 150% of the federal poverty level and establishing a national health insurance exchange–a sort of marketplace where individuals with incomes above 150% of poverty can purchase insurance coverage. Initially, the Exchange would be open to all qualifying people who are uninsured and employees of some small businesses, with the possibility of opening it to more people over time. It would offer multiple insurance plans from which individuals can choose including at least one publicly financed plan as well as several privately operated plans. To help individuals purchase insurance, the federal government will provide subsidies (in the form of premium credits) to eligible individuals and families with incomes between 150% and 400% above the poverty level.

The House bill also extends premium credits to individuals with employer-sponsored insurance if their share of premiums exceeds 12% of their income, which could make an additional 1 million people eligible for purchasing coverage in the Exchange.

"In total," notes Kaiser, "it is estimated that 86% of participants in the Exchange would receive subsidies."

Kaiser notes:

The House bill places a number of restrictions on coverage of abortion, with the most direct impact on the plans that will be offered in the new Health Insurance Exchange. According to the legislation, the public plan within the Exchange would be prohibited from providing coverage for abortions beyond those permitted by current federal law (to save the life of the woman or in cases of rape or incest). The House bill also prohibits federal premium credits that low-income individuals will receive from the federal government from being used to purchase a health plan in the Exchange that includes coverage for all but federally permitted abortions. Although it is not required, private insurers may opt to offer a plan in the Exchange that covers abortions beyond those permitted by federal law. These insurers, however, will be required to also offer an identical plan that does not cover abortions for which federal funding is prohibited.

Private plans participating in the Exchange may choose to offer
supplemental coverage for abortions in the form of riders that are totally
separate from other benefits, but that coverage must be paid for entirely with non-federal funds. Furthermore, the plans must be separately operated to assure that federal funds are not used to administer or operate plans that cover abortions.

According to Kaiser, an estimated 12.4 million women ages 15 to 44 are uninsured, 94% of whom would qualify for federal assistance (61% through Medicaid—7.5 million women; and 33% for federal
premium credits subsidies to purchase coverage—4.1 million women).

Impact of the House Bill:

Kaiser states that provisions in the House bill would "have direct effects on women seeking coverage in the Exchange as well as on plans that
offer coverage in the Exchange."

  • Women who choose the public option would not have abortion coverage nor would they have access to a rider.
  • Women who receive any level of federal subsidy cannot purchase coverage from a plan that offers abortion coverage, but they do have the option of purchasing a separate rider for abortion coverage alone, if offered by the plan.
  • Women who do not receive federal subsidies and seek coverage in the Exchange could be able to buy coverage from a plan that offers an abortion benefit, if such a plan is available.

Kaiser underscores what others have also noted:

It is unclear whether a woman would necessarily seek or know to buy a service-specific rider for abortion when she is choosing her insurance plan, or whether women without subsidies would necessarily know whether they are buying coverage from a plan that covers abortion or not. It is also unknown what the price differential would be between the two plans and how much the rider would cost, if offered. The House bill goes beyond the Senate committee bills by requiring the sale of a distinct insurance product that is designed specifically for those receiving subsidized coverage. For insurers, the House bill sets a number of restrictions, particularly the requirement to isolate federal dollars from private funds because a plan that receives any federal funds cannot provide abortion coverage. Although it is hard to predict the response of insurance plans to this type of law, some legal scholars contend that given the size of the potential pool of women and their families that will be eligible for federal subsidies under the exchange and other complexities, this might limit he development of insurance plans that offer either abortion coverage or a rider, and ultimately carry over to products offered in the employer market.

Many women who now have coverage for abortion care would lose it.

This complex combination of restrictions means that many women who will obtain coverage under health reform either through Medicaid or the Exchange would have to pay for an abortion out-of-pocket, the cost of which varies depending on factors such as location, facility, timing, and type of procedure.

A clinic-based abortion at 10 weeks’ gestation is estimated to cost
between $400 and $550, whereas an abortion at 20-21 weeks’ gestation is
estimated to cost $1,250-$1,800. The vast majority of abortions are
performed early in pregnancy. In 2004, 89% were in the first twelve
weeks of pregnancy and only 1% were at 21 weeks or later.  In general,
abortions performed in hospitals are more expensive than those
performed at clinics.

The House bill dramatically expands the Medicaid program, and extends insurance to qualifying uninsured individuals with incomes below 150% of the federal poverty line.

"The Medicaid program already serves millions of low-income women," notes Kaiser, "and is a major financier of reproductive health services. It is estimated that two-thirds of adult women on Medicaid are in their reproductive years."  In 33 states and the District of Columbia, state Medicaid programs do not pay for any abortions beyond the Hyde restrictions.  In these states, an estimated 4.5 million women ages 15-44 are currently uninsured and also have incomes less than 150% of the
federal poverty level.  Many of these women would likely qualify for Medicaid under the new House bill.

They will be forced to pay for their insurance with their rights.

The George Washington University (GWU) Study

This study, conducted by the George Washington University School of Public Health, focused on the implications of the Stupak Amendment for the health benefits industry on the whole; the growth of the public market for supplemental coverage: and the implications for covering abortions that are a consequence of an unexpected condition.

The study concludes that:

  • The treatment exclusions required under the Stupak/Pitts Amendment will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women, not only those whose coverage is derived through a health insurance exchange. [emphasis added]. 

 

Stupak-Pitts, according to the authors:

Can be expected to move the industry away from current norms of
coverage for medically indicated abortions. In combination with the
Hyde Amendment, Stupak/Pitts will impose a coverage exclusion for
medically indicated abortions on such a widespread basis that the
health benefit services industry can be expected to recalibrate product design downward across the board in order to accommodate the exclusion in selected markets.

  • The Amendment will inhibit development of a supplemental coverage market for medically indicated abortions. 

In any supplemental coverage arrangement, it is essential that the supplemental coverage be administered in conjunction with basic coverage. This intertwined administration approach is barred under Stupak/Pitts because of the prohibition against financial comingling. This bar is in addition to the challenges inherent in administering any supplemental policy. These challenges would be magnified in the case of medically indicated abortions because, given the relatively low number of medically indicated abortions, the coverage supplement would apply to only a handful of procedures for a handful of conditions. Furthermore, the House legislation contains no direct economic incentive to create such a market [and would leave in doubt] states’ ability to offer supplemental Medicaid coverage to
women insured through a subsidized exchange plan.  

  • "Spillover" effects as a result of administration of Stupak/Pitts will result in dramatically reduced coverage for potentially catastrophic conditions.

 

The authors write: "The administration of any coverage exclusion raises a risk that, in applying the exclusion, a plan administrator will deny coverage not only for the excluded treatment but also for related treatments that are intertwined with the exclusion."

The risk of such improper denials in high risk and costly cases is great in the case of the Stupak/Pitts Amendment, which, like the Hyde Amendment, distinguishes between life-threatening physical conditions and conditions in which health is threatened. Unlike Medicaid agencies, however, the private health benefit services industry has no experience with this distinction. The danger is around coverage denials in cases in which an abortion is the result of a serious health condition rather than the direct presenting treatment.

Noting that the entire industry may be pushed toward using life-threatening conditions as "the standard," the authors note that "it is likely that all women will risk coverage denials, regardless of the market in which their coverage is obtained," and will lose coverage for medically indicated abortions that may well threaten both health and ultimately life.

Under these circumstances, what is the norm today in the employer-sponsored market – broad coverage of medically indicated abortions – is likely to narrow considerably as the industry seeks to restructure its product design to meet the most restrictive demands. If this consequence flows, then the industry, confronting the challenges of distinguishing between enrollees for a handful of covered procedures and specific conditions, can be expected simply to eliminate certain procedures and conditions from coverage altogether, leaving women and families exposed.

"Stupak/Pitts and Hyde…presume that abortion is the immediate subject of the claim for coverage," note the authors. 

But this is not always the case.

High risk pregnancies themselves could be identified as potentially
abortion-related.

Conditions such as diabetes (observed in 1% of pregnancies) which are poorly controlled can lead to serious health consequences for both the woman and the fetus, including major congenital abnormalities, and a higher risk of spontaneous loss, which might in turn trigger an abortion if the pregnancy cannot be saved. Management of recurrent pregnancy loss or complicated multi-fetal pregnancies (increasingly prevalent with widespread use of assisted reproductive technologies) may also be considered abortion-related conditions. Similarly, uncontrolled hypertension, trauma during pregnancy, seizure disorders and other conditions, all require complex management and may
persist beyond the pregnancy, and may result in abortion-related care. These concerns have increasing individual and public health consequence as age at pregnancy, body mass index and associated metabolic and cardiovascular abnormalities, Cesarean section rates, multi-fetal pregnancy rates, and use of assisted reproductive technologies have all increased dramatically in recent years.

Additionally, state the authors, "in response to more limited access to abortion services, there may be an increase in self-induced abortion, potentially through increased self-administration of misoprostol. Coverage for treatment of complications such as hemorrhage and incomplete abortion in such cases could be denied."

In these circumstances, how are plan administrators to distinguish between the abortion procedure and the rest of the treatment? Will the entire cost of a course of treatment (e.g., surgery to repair a damaged pelvis following an automobile accident) be denied if violation for paying for the excluded abortions, may elect to deny the treatment altogether, claiming that it is all related to the excluded treatment.

"As the denial is appealed, the financial consequences for patients potentially will be enormous."

"One of the great challenges in insurance reform is the unintended consequences of regulation," write the authors.

The Stupak/Pitts Amendment is intended to reach only a specific part of the market. But the cumulative effect of the provision, in combination with existing federal laws governing Medicaid and federal employee health benefits (as well as the law of certain states) inevitably can be expected to move the entire health benefits industry away from its current inclusive coverage norms and toward a new norm of exclusion. The provisions of the legislation, as well as the technical challenges that arise in benefits administration, militate against the creation of a supplemental coverage market. Thus, if the result of national health reform is to move millions of women into a market that operates subject to the exclusion, then it is fair to predict that the entire market for coverage ultimately will be affected as a product tipping point is reached and virtually no supplemental market appears.

In addition, state the authors:

Given past experience and the sanctions that arise from a violation, it is reasonable to predict that in interpreting and applying the exclusion, health plan administrators will err on the side of coverage denial. This is because the legal risks associated with coverage determination are all on the side of incorrectly awarding coverage, not erroneously denying it. This balancing of risks can be expected to lead insurers to calibrate coverage determinations in a way that works against women whose medical conditions ultimately lead to an abortion that they never willingly sought. 

In short, as many have already argued, women will bear the brunt of a policy created based on ideology and discrimination, not public health, pushed through by those who appear to care little for either women’s rights or their lives and health.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

News Abortion

Study: United States a ‘Stark Outlier’ in Countries With Legal Abortion, Thanks to Hyde Amendment

Nicole Knight Shine

The study's lead author said the United States' public-funding restriction makes it a "stark outlier among countries where abortion is legal—especially among high-income nations."

The vast majority of countries pay for abortion care, making the United States a global outlier and putting it on par with the former Soviet republic of Kyrgyzstan and a handful of Balkan States, a new study in the journal Contraception finds.

A team of researchers conducted two rounds of surveys between 2011 and 2014 in 80 countries where abortion care is legal. They found that 59 countries, or 74 percent of those surveyed, either fully or partially cover terminations using public funding. The United States was one of only ten countries that limits federal funding for abortion care to exceptional cases, such as rape, incest, or life endangerment.

Among the 40 “high-income” countries included in the survey, 31 provided full or partial funding for abortion care—something the United States does not do.

Dr. Daniel Grossman, lead author and director of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California (UC) San Francisco, said in a statement announcing the findings that this country’s public-funding restriction makes it a “stark outlier among countries where abortion is legal—especially among high-income nations.”

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The researchers call on policymakers to make affordable health care a priority.

The federal Hyde Amendment (first passed in 1976 and reauthorized every year thereafter) bans the use of federal dollars for abortion care, except for cases of rape, incest, or life endangerment. Seventeen states, as the researchers note, bridge this gap by spending state money on terminations for low-income residents. Of the 14.1 million women enrolled in Medicaid, fewer than half, or 6.7 million, live in states that cover abortion services with state funds.

This funding gap delays abortion care for some people with limited means, who need time to raise money for the procedure, researchers note.

As Jamila Taylor and Yamani Hernandez wrote last year for Rewire, “We have heard first-person accounts of low-income women selling their belongings, going hungry for weeks as they save up their grocery money, or risking eviction by using their rent money to pay for an abortion, because of the Hyde Amendment.”

Public insurance coverage of abortion remains controversial in the United States despite “evidence that cost may create a barrier to access,” the authors observe.

“Women in the US, including those with low incomes, should have access to the highest quality of care, including the full range of reproductive health services,” Grossman said in the statement. “This research indicates there is a global consensus that abortion care should be covered like other health care.”

Earlier research indicated that U.S. women attempting to self-induce abortion cited high cost as a reason.

The team of ANSIRH researchers and Ibis Reproductive Health uncovered a bit of good news, finding that some countries are loosening abortion laws and paying for the procedures.

“Uruguay, as well as Mexico City,” as co-author Kate Grindlay from Ibis Reproductive Health noted in a press release, “legalized abortion in the first trimester in the past decade, and in both cases the service is available free of charge in public hospitals or covered by national insurance.”