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Oregon Medicaid expansion helped more women access insurance coverage for abortion services, OSU study finds

The study found that after Oregon expanded Medicaid in 2014, more women were able to receive coverage for abortion services.

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By Molly Rosbach

A recent study from Oregon State University found that after Oregon expanded Medicaid in 2014, more women were able to receive insurance coverage for abortion services, rather than paying out of pocket.

In analyzing Medicaid claims data and other medical records, researchers found that the Medicaid-financed share of total abortions increased each of the first three years following the state’s Medicaid expansion. The incidence of Medicaid-financed abortions increased 18% in 2014, then 7% each in 2015 and 2016.

The total number of abortions in the state did not rise; rather, the expansion shifted who paid for them.

“According to the literature, there was a 1% decline in the abortion rate in Oregon between 2014 and 2017. During the pre-expansion period women were having to pay for abortions out of pocket, which was taking a lot of money out of their incomes that could have been going to food or clothing or caring for their children,” says Lisa Oakley, who co-authored the study as a postdoctoral researcher at OSU’s College of Public Health and Human Sciences. “What the expansion of coverage did was reduce the financial burden for women in this low-income group.”

Prior to the 2014 expansion, low-income women in Oregon became eligible for Medicaid if they became pregnant. Oregon is one of 16 states where Medicaid coverage includes abortion services.

The expansion increased eligibility to cover everyone earning less than 138% of the federal poverty level, which granted coverage to an estimated 77,000 women of childbearing age, regardless of pregnancy status.

The expanded eligibility cleared a major barrier for women seeking reproductive health care, says Marie Harvey, lead author of the study and associate dean for research in the College of Public Health and Human Sciences.

“Having to wait to be pregnant to enroll in Medicaid delays access to these services that are needed immediately,” Marie says. “Low-income women are disproportionately impacted by unintended pregnancies, and therefore experience greater need for abortion services. Being able to help these women who are most vulnerable is critical.”

Researchers note that greater access to health care overall is likely one reason why the increased share of Medicaid-financed abortions leveled off after the first year of expansion, though more studies are needed.

“Alternatively, Medicaid expansion may eventually result in a measurably decreased need for abortion services if women with low incomes gain access to contraceptive services and experience fewer unintended pregnancies,” the authors wrote.

The study also looked at the share of abortions that were performed with medication rather than surgery. Researchers found a 7.4 percentage point increase in women getting medication abortions instead of surgical abortions in the first year of Oregon’s Medicaid expansion.

Although all types of abortions in the U.S. are safe, the researchers say, early abortions such as medication abortions have been proven to be safer for women and are less costly. But typically, women can only receive medication abortions up until their 10th week of pregnancy. Before Medicaid expansion in Oregon, because it took so long to complete the Medicaid enrollment process, the choice between abortion types was taken away, Marie says.

“Access to reproductive health care, including contraceptive and abortion services, is essential for promoting reproductive autonomy and the health of all women,” she says.

Marie and Lisa were joined on the study by Susannah Gibbs, a postdoctoral researcher in the College of Public Health and Human Sciences. The study was funded by the Society of Family Planning and published in the journal Women’s Health Issues.