• March 31, 2023

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The U.S. Supreme Court officially overturned Roe v. Wade on Friday, eliminating the constitutional right to an abortion after almost 50 years. Experts predict it will lead to all but total bans on the procedure in about half of the states.

When it comes to how much public money is spent on abortions via Medicaid, the impact is much lower. That’s because in conservative states that are set to ban abortions, the procedure is already very difficult to obtain for lower income women.

Medicaid-funded abortions are already uncommon

Most states have followed the federal government’s lead in restricting public funding for abortion. According to the ACLU, only 17 states fund abortions for low-income women on the same or similar terms as other pregnancy-related and general health services. The remaining states, with the exception of South Dakota, pay for abortions for low-income women in cases of life-endangering circumstances, rape, or incest, as mandated by federal Medicaid law. South Dakota, however, will only pay for lifesaving abortions.

State-by-state financial data on publicly-funded abortions is lacking but national statistics show that only a fraction of Medicaid dollars goes toward them. According to the Guttmacher Institute, Medicaid covered slightly more than 157,000 abortions nationwide in 2015 and almost all were in states that use their own funds to cover the cost. By my estimate, this amounts to .02% of all Medicaid expenditures that year.


Lack of abortion access disproportionately affects low income women

Data collected by the institute also shows that lack of abortion access disproportionately impacts low-income women as they make up three-quarters of abortion patients. Depending on timing, the out-of-pocket cost ranges from $500 to $1,200, the latter expense nearly equal to an entire month’s income.

The institute also notes that low-income women are more likely than more affluent women to have an unintended pregnancy. In 2011, the unintended pregnancy rate among women with an income below the federal poverty level was more than five times the rate among women with an income at or above 200% of the poverty level.

According to a study by the Brookings Institution, this disparity is likely due to the fact that lower income women are not only are they less likely to use contraception, they are also less likely to have access to an abortion.

Another reason is that red states tend to have higher shares of lower-income residents and sex education in these states tends to focus on abstinence instead of contraceptive use. It’s already the case that more lower-income women are carrying unplanned pregnancies to term, in these states. That’s now likely to increase.

OTUS ruling likely to exacerbate existing inequities

Taken together, all this information means that lower income women, who already face challenges in obtaining a legal abortion, will have an even more difficult time doing so.

Moreover, women in conservative-leaning states are likely facing restricted health coverage in other ways. Most states in the Southeast, for example, have not adopted Medicaid expansion. That also leads to disparate spending between states—Mississippi, the poorest state in the union, spent 25% of its budget on Medicaid last year while New York, one of the richest, spent 35%.

Abortion access, therefore, is just more way in which systemic inequities are reinforced.


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