Ushma D. Upadhyay (
Chris Ahlbach, UCSF.
Health Aff (Millwood). 2022 Apr;41(4):507-515. doi: 10.1377/hlthaff.2021.01528.
The Hyde Amendment prevents federal funds, including Medicaid, from covering abortion care, and many states have legal restrictions that prevent private insurance plans from covering abortion. As a result, most people pay for abortion out of pocket. We examined patient self-pay charges for three abortion types (medication abortion, first-trimester procedural abortion, and second-trimester abortion), as well as facilities' acceptance of health insurance, during the period 2017-20. We found that during this time, median patient charges increased for medication abortion (from $495 to $560) and first-trimester procedural abortion (from $475 to $575) but not second-trimester abortion (from $935 to $895). The proportion of facilities that accept insurance decreased over time (from 89 percent to 80 percent). We noted substantial regional variation, with the South having lower costs and lower insurance acceptance. Charges for first-trimester procedural abortions are increasing, and acceptance of health insurance is declining. According to the Federal Reserve, one-quarter of Americans could not pay for a $400 emergency expense solely with the money in their bank accounts-an amount lower than any abortion cost in 2020. Lifting Hyde restrictions and requiring public and private health insurance to cover this essential, time-sensitive health service without copays or deductibles would greatly reduce the financial burden of abortion.
海德修正案禁止联邦资金（包括医疗补助）用于支付堕胎护理费用，许多州都有法律限制，禁止私人保险计划支付堕胎费用。因此，大多数人都是自费堕胎。我们研究了 2017 年至 2020 年期间三种堕胎类型（药物流产、早期程序流产和中期流产）的患者自付费用以及医疗机构对健康保险的接受情况。在此期间，我们发现药物流产（从 495 美元增加到 560 美元）和早期程序流产（从 475 美元增加到 575 美元）的患者自付费用中位数增加，但中期流产（从 935 美元增加到 895 美元）的费用没有增加。接受保险的医疗机构比例随着时间的推移而下降（从 89%降至 80%）。我们注意到地区间存在很大差异，南部地区的堕胎费用较低，保险接受度也较低。早期程序流产的费用在增加，而健康保险的接受度在下降。根据联邦储备委员会的数据，四分之一的美国人无法仅用银行账户中的资金支付 400 美元的紧急费用——这一金额低于 2020 年任何堕胎费用。取消海德修正案的限制，并要求公共和私人医疗保险在没有共同支付或扣除额的情况下覆盖这项基本的、时间敏感的健康服务，将大大减轻堕胎的经济负担。
