Understanding the impact of removing cost barriers on early abortion access and method choice
Awarded 2020
Increasing access to medication abortion
Lee Hasselbacher, JD
The University of Chicago

Evidence suggests there is unmet demand for medication abortion and that patients highly value a choice of abortion method. Cost is a significant barrier to abortion access and can create delays in accessing early abortion care, pushing patients beyond eligibility for medication abortion. To reduce financial barriers and associated delays, reproductive health advocates have argued for expanding insurance coverage for abortion. However, there is little research on the impact of state policies providing this coverage. To guide future policy, advocates and legislators need research demonstrating how insurance coverage affects individuals’ experience seeking abortion care and preference for abortion method (i.e., medication vs. procedure). Research is also needed to assess the impact of the COVID-19 pandemic on clinic access and patient preferences for abortion care. Due to recent policy changes, Illinois provides the perfect research environment for this topic. In 2018, Illinois Medicaid began covering abortion, and, starting in 2019, most private health insurance plans must also cover it. By examining patient data from abortion clinics before and after these policy changes, and conducting interviews with patients (n=50) and other key informants (n=10), we will examine two research questions: 1) Since the policy changes, a) are more patients able to pay for their abortion with insurance? b) are patients seeking abortion at earlier gestational ages? c) is there a change in the proportion of patients choosing medication abortion? d) have clinics experienced barriers or facilitators to accepting and billing insurance? 2) Among those patients who are eligible to select medication abortion a) how does insurance coverage affect their experience obtaining an abortion? b) how is abortion method selection influenced by clinic or personal circumstances stemming from the COVID-19 pandemic? c) what other factors influence their abortion method selection? This team, comprised of policy and medical experts, will build on our existing research examining providers’ experiences with Illinois Medicaid to now address the impact of Medicaid and private insurance coverage on patient services and access to method choice.