An unprecedented leak of a Supreme Court draft opinion on Monday revealed that the nation’s highest court has voted to strike down the landmark Roe v. Wade decision that guarantees abortion rights.
If the decision goes through, abortion will be made instantly illegal in 13 states due to so-called trigger laws already enacted by their legislatures, and 10 more states would likely institute their own bans shortly thereafter, according to the Center for Reproductive Rights.
While the implications of the Court’s decision are just now being digested, one thing is clear: Abortions will become increasingly expensive in the U.S.
Dr. Ushma Upadhyay, an associate professor at the University of California at San Francisco (UCSF) and research director for the University of California Global Health Institute’s Center of Expertise in Women’s Health, Gender, and Empowerment, told Fortune that a federal abortion ban would force women in many states to travel significant distances in order to find the reproductive care they need, greatly increasing the average cost for an abortion.
“If Roe v. Wade is overturned, we expect about half of states to dramatically restrict abortion,” Dr. Upadhyay said. “So people will have to travel out of states to obtain abortion care. And we expect the cost of that travel to be exceedingly difficult for people.”
Dr. Upadhyay noted that women will have to take time off work, arrange for childcare, and plan for a multiday trip to get treatment.
Those rising costs would add yet another roadblock for those looking for access to reproductive healthcare. But even before the recent Supreme Court decision, abortion costs were on the rise nationwide.
Abortion costs were already soaring
From 2017 to 2020 the average cost of the two most common types of abortion—medication and a first-trimester procedure—increased 13% and 21%, respectively, according to research published in April by Dr. Upadhyay and her colleagues. That’s compared to an expected increase of 8% as a result of health care inflation alone.
The researchers noted that abortion costs will continue to rise due to increasing regulation around the country as well.
“As abortion provision becomes more regulated, often without any evidence that these regulations improve care, patient charges may continue to increase,” they wrote.
By 2020, the average cost for an abortion in the U.S. topped $500, according to the Guttmacher Institute. And due to the Hyde Amendment—which prevents federal funds from covering abortion care—as well as legal restrictions in many states that block private insurance plans from covering abortion costs, most patients pay for at least some of their abortion costs out-of-pocket.
Research by the UCSF Bixby Center, based on interviews with patients visiting 30 abortion clinics nationwide, found that 29% of patients paid out-of-pocket for the full cost of their abortions.
Even with roughly two-thirds of patients receiving some sort of financial assistance for their procedure, their total out-of-pocket costs neared $500. Those costs represented more than a third of the monthly income of more than half of the participants in the UCSF study.
As a result, 54% of patients reported that raising money for an abortion delayed them from obtaining care. And the effects of delaying abortions can be not only costly, but deadly.
Rising risks for lower-income people of color—and more ER visits
The number of maternal deaths associated with abortion increases from 0.3 for every 100,000 abortions at or before eight weeks of pregnancy to 6.7 per 100,000 at 18 weeks or later, data from the Guttmacher Institute shows. And according to Dr. Upadhyay, anti-abortion legislation is likely to push people to delay their abortions.
If Roe v. Wade is overturned, it would also be particularly devastating for people of color and those with lower incomes or limited English proficiency, she explained.
“This is extremely concerning, particularly for low-income people and people of color who don’t have the means to travel. I think it will mean that people will have to resort to either self-managed abortion or carrying unwanted pregnancies to term,” Dr. Upadhyay said, adding that she also expects many to turn to “increasingly unsafe methods.”
“I worry that people will think that abortion is illegal, and that it’s just not an option at all in the United States,” she said. “The lack of information is what I am worried about, that people won’t know that they do have options for safe abortion care.”
Dr. Upadhyay noted that some states, including California, New York, and Connecticut, are creating abortion funds specifically for people from out of state who may need assistance in paying for their abortions.
But it’s not just people seeking reproductive care who will struggle with rising costs as a result of anti-abortion legislation. A rise in self-managed abortion will also lead to increased emergency room visits, Dr. Upadhyay said, and that could mean higher costs for taxpayers in those states.
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