By Sharon Johnson
WeNews senior correspondent
Thursday, April 25, 2013
Telemedicine for medical abortions, which controls costs for rural women in particular, is under legislative attack. These and other state restrictions drive up prices that abortion providers have contained amid overall rising health costs.
Credit: Dave Fayram on Flickr, under Creative Commons (CC BY 2.0).
(WOMENSNEWS)--Abortion clinics and women's health centers have kept the cost of abortion stable since the onset of the 2008 recession, at a time of escalating health costs. But now state legislatures are considering a wide range of restrictions that will make the procedure less accessible, driving up costs.
One restriction focuses on telemedicine in medical, or drug-induced, abortions.
In the first three months of 2013, three states passed bills that require physicians to be in the physical presence of patients when they prescribe the abortion pill rather than on camera. Both houses of the Mississippi legislature approved the telemedicine ban; the measure is now awaiting debate by a conference committee. As of the end of March, similar provisions passed a legislative chamber in Alabama and Indiana and are pending in the second body. Seven states have similar laws.
"Telemedicine has been used successfully by the Veterans Administration and health care facilities in rural areas where there are few physicians for decades to treat conditions, such as strokes, because it is medically safe," said Dr. Anne Davis, consulting medical director of the New York-based Physicians for Reproductive Health, an organization that aims to make quality reproductive health services an integral part of mainstream medicine. "Bans force women to travel long distances, lose wages and incur expenses for child care."
Iowa and Texas have legislation pending that would require abortion clinics to revert to an old Food and Drug Administration protocol that requires three visits to a physician's office to receive the medication. It also would decrease the use of medical abortions because the pill could only be used up to 49 days after the woman's last period.
"Based on studies by the World Health Organization that showed that the pill was effective at one-third the standard dosage, clinics began to allow patients in 2001 to administer the second pill at home as well as the medication to be used up to 63 days," said Davis, an associate professor of clinical obstetrics and gynecology at the Columbia University Medical Center in New York City. "Virtually all Planned Parenthood facilities use the newer protocol, so this change would have a great impact on clinics if it becomes the norm."
Medical abortion accounted for 17 percent of all non-hospital abortions and about one-fourth of abortions before nine weeks gestation in 2008, according to a 2011 study in the journal Perspectives on Sexual and Reproductive Health.
Arizona and Ohio now require the old Food and Drug Administration protocol; a similar law in North Carolina has been stopped by court challenges.
"Keeping costs down has been especially important since the 2008 recession," said Vicki Saporta, president and CEO of the Washington-based National Abortion Federation, which includes more than 400 nonprofit clinics, women's health centers, hospitals and other abortion providers, in a phone interview. "Poor women often have a harder time obtaining contraceptive services, resulting in more unintended pregnancies. In addition, many women who might have been able to support a child in a better economy cannot do so because they have lost their jobs or suffered other financial setbacks."
Low-income women may also be more likely to face the full costs of an abortion because of the Hyde Amendment. Passed by Congress in 1976 and affirmed by the Supreme Court in 1980, the amendment prohibits federal funds from being used for abortions except in cases of rape, incest or endangerment to the life of the mother.
Abortion, meanwhile, has become concentrated among low-income women, according to a January report by the Guttmacher Institute. Forty-two percent of women who have an abortion are below the federal poverty level ($11,940 for a single person and $23,550 for a family of four in 2013).
"Poor women have great difficulty obtaining abortions because only 17 states have policies to cover medically necessary abortions of their Medicaid beneficiaries with their funds," said Adam Sonfield, senior policy director of the Guttmacher Institute, in a phone interview. "Many poor women report having to borrow money from family and friends and forego payments for rent, groceries and utilities to pay for the procedure."
Saporta estimates that a first trimester abortion costs $500 today rather than $1,000 had the cost kept pace with other procedures.
During the first three months of 2013, state legislatures introduced 694 abortion-related bills, 47 percent of which seek to address access to abortion rather than imposing requirements, such as a woman having to undergo an ultrasound or complete a waiting period before getting an abortion, as they have done in the past.
"The more restrictions placed on access, the greater the wait to have the procedure and the more expensive the procedure becomes because the woman is farther along in her pregnancy," said Saporta. "A second trimester abortion can easily cost $10,000 if a woman has medical complications."
Currently, more than 6 in 10 abortions occur within the first eight weeks of pregnancy; almost 3 in 10 take place at six weeks or earlier, according to the Guttmacher Institute.
Legislatures in Indiana, Kansas, Michigan, Pennsylvania and Virginia have imposed costly facilities regulations on centers performing abortions. In Virginia, for example, clinics must meet the latest standards for newly constructed hospitals.
"Regulations specifying the width of public hallways and the number of parking spaces for each surgical room are medically unnecessary," said Davis in a phone interview. "Requiring clinics to pay thousands of dollars to meet these architectural standards are a thinly disguised attempt to cripple clinics and cause some facilities to close."
Fifty-seven percent of women pay out of pocket for abortions because of the lack of insurance, lack of abortion coverage or desire to ensure confidentiality, the Guttmacher Institute noted.
These high costs can lead some low-income women to seek cheap, substandard care, according to Think Progress, a project of the Washington-based Center for American Progress. A first trimester abortion at the clinic of Kermit Gosnell in Philadelphia was $330, for example. But the 72-year-old physician at the clinic is accused of killing seven late-term fetuses by snipping their spinal cords after they were born and murdering a woman who had overdosed on sedatives while waiting for an abortion.
In 2012, 43 abortion restrictions were enacted in 19 states, the second most of any year. More than half of all U.S. women of reproductive age (15 to 44) live in a state that is hostile to abortion, whereas less than one-third did a decade ago.
Sharon Johnson is a New York-based freelance writer.
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