American Institutes for Research®, Health Program, Crystal City, Virginia, USA.
Perspect Sex Reprod Health. 2024 Sep;56(3):255-268. doi: 10.1111/psrh.12275. Epub 2024 Jul 29.
Medicaid is a major funder of reproductive health services, including family planning and pregnancy-related care, especially for people with limited income and people of color. Federal Medicaid funds cannot be used for abortion however 16 states allow state Medicaid funds to pay for abortion. In recent years, Illinois and Maine implemented, and West Virginia discontinued, state Medicaid coverage of abortion.
With retrospective procedure- and patient-level data obtained from clinics in these three states, we used an interrupted time series design, multivariable regression models, and descriptive statistics to assess changes in procedure volume and patients' share of total procedure price (patient price).
In Maine and Illinois, implementing state Medicaid coverage of abortion contributed to an immediate overall increase in abortion access (as seen by a rise in monthly procedure volume at the time of the policy's implementation), a decrease in patient price (by 36% in Maine and 44% in Illinois) after policy implementation as compared to pre-implementation, and overall improved access among people of color. Conversely, when West Virginia discontinued coverage, access to care decreased, patient price increased by 130%, and the share of abortion procedures among people of color decreased.
In the fragmented abortion access landscape of the post-Roe era, our study provides new evidence that financial assistance offered through state Medicaid policies that cover abortion may be most helpful to those facing traditional structural inequities to access, while discontinuation of Medicaid coverage of abortion further burdens those already economically marginalized.
医疗补助是生殖健康服务的主要资金来源，包括计划生育和与怀孕相关的护理，特别是为收入有限和有色人种的人提供服务。然而，联邦医疗补助基金不能用于堕胎，但是有 16 个州允许州医疗补助基金支付堕胎费用。近年来，伊利诺伊州和缅因州实施了州医疗补助对堕胎的覆盖，而西弗吉尼亚州则停止了该覆盖。
利用从这三个州的诊所获得的回顾性程序和患者水平数据，我们使用了中断时间序列设计、多变量回归模型和描述性统计方法，评估了程序量和患者总程序价格（患者价格）的变化。
在缅因州和伊利诺伊州，实施州医疗补助对堕胎的覆盖导致堕胎机会的立即整体增加（从政策实施时每月程序量的上升可以看出），与实施前相比，患者价格下降（在缅因州下降 36%，在伊利诺伊州下降 44%），以及有色人种的整体改善。相反，当西弗吉尼亚州停止覆盖时，护理的可及性下降，患者价格上涨 130%，有色人种的堕胎程序份额下降。
在后罗伊时代的堕胎机会分散的背景下，我们的研究提供了新的证据，表明通过覆盖堕胎的州医疗补助政策提供的财政援助可能对那些面临传统结构性获取障碍的人最有帮助，而停止医疗补助对堕胎的覆盖则使那些已经处于经济边缘的人进一步受到负担。
