Commentary

Why Medicaid should cover abortions in Pennsylvania

In addition to creating confusion and fear of jail time for health care providers and patients, state abortion bans have led to women and girls being denied emergency medical care to maternity wards closing to an increasing shortage of OB-GYNs. (Getty Images)

In addition to creating confusion and fear of jail time for health care providers and patients, state abortion bans have led to women and girls being denied emergency medical care to maternity wards closing to an increasing shortage of OB-GYNs. (Getty Images)

By Allie Hecht, DO

As a family physician, my daily practice involves caring for those who are pregnant. They often seek medical care soon after having a positive home pregnancy test. Whether the pregnancy was intended or not, whether the patient feels that it is good news or bad, as part of my routine care for these patients, at the first appointment I always discuss their options: Continuing the pregnancy or not continuing the pregnancy.

Out of the many encounters I have had so far as a young physician in Pennsylvania, I have observed that when patients of lower socioeconomic status do not want to continue the pregnancy, they often struggle with the financial burden of paying for an abortion.

In Pennsylvania, the average cost of a medication abortion is $400 to $600, and for a surgical abortion, the price greatly varies based on the gestational age, therefore the cost can range from $500-$1000. Given the far greater costs associated with continuing the pregnancy and giving birth, not only is this obstacle frustrating and unjust, but it prevents people from making the medical decision that is right for them.

Most of the population I take care of utilizes Medicaid, the state and federally funded health insurance program for low-income individuals. Under Medicaid, the federal government pays 90% of costs for family planning services; however, the federal Hyde Amendment prohibits federal spending on abortions, except when the pregnancy is the result of rape or incest or puts the life of the pregnant person in danger.

Therefore, it is up to states to ensure that their Medicaid programs provide coverage for abortion care beyond these rare situations.

Unfortunately, Pennsylvania is not one of these states, and after the recent U.S. Supreme Court decision which overturned the constitutional right to abortion, we are seeing even further limited availability of abortion services and insurance coverage in our state and across the nation.

In 1982, Pennsylvania enacted the Abortion Control Act which banned Medicaid from covering abortion except in limited circumstances. In 2019, a lawsuit (Allegheny Reproductive Health Center v. Pennsylvania Department of Human Services) was filed to challenge this act, containing a court order to overrule the Medicaid ban and require the Pennsylvania Department of Human Services to comply with the Pennsylvania Constitution’s Equal Rights Amendment and equal protection guarantees.

As we still await a ruling from the Supreme Court of Pennsylvania, it is so important, especially in the wake of Dobbs, to ensure Medicaid coverage for abortion in Pennsylvania, which is legal up to 23 weeks gestation, and why I strongly support ARHC v PA DHS.

In Pennsylvania, 20% of women ages 15-49 have Medicaid insurance, and half of U.S. patients who obtain abortions have incomes below the federal poverty threshold, compared with only 14% of the full population of U.S. women aged 15-44 . These communities, who already have limited access to healthcare and face health care discrimination, have few resources to navigate a thicket of restrictive abortion laws and costs.

Abortion care for all women of reproductive age is a right, and providing affordable and accessible services, especially for individuals with social and financial disadvantages, is crucial in this ever-changing reproductive health landscape. Expanding Medicaid coverage of abortion care in Pennsylvania would lift many of the financial limitations my patients face in obtaining safe abortion care in our state.

Dr. Allie Hecht is a family physician in Lancaster, PA. She has a medical degree from Rowan University School of Osteopathic Medicine and an undergraduate degree from McGill Univeristy. She is passionate about reproductive justice and family planning as well as osteopathic and integrative medicine.

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