New abortion restrictions may push patients to more expensive, complicated care
With longer wait times, patients could be forced into their second trimester.
As more states enact near-total bans and restrictions on abortion, providers say many patients are experiencing delayed care which can force them into later stages of pregnancy.
Abortion care options are becoming more limited and complex in some cases, which often means higher costs for patients. For example, medication abortion, which is less costly than other options, is only an option up to 10 weeks into pregnancy.
The most recent data available, from 2017, shows the average cost of an abortion in the first trimester nationwide was about $550, whether it was medication or procedural, according to the Guttmacher Institute, which researches reproductive rights.
Any abortion care for pregnancies further along than 12 weeks costs more than that. The median cost of abortion care for pregnancies at 20 weeks in 2017 was $1,670, Dr. Rachel Jones, a principal research scientist at Guttmacher, told ABC News.
Jones said that access to abortion care for patients in their second trimester has always been limited, and those patients have always had to travel further.
Almost every clinic offers abortions up to nine and 10 weeks into pregnancy and 75% offer abortions until the second trimester, Jones said.
"After that, the percentage of clinics that offer abortion at each week of gestation starts dropping off. And so people are going to have to travel further to get to a facility that can provide care at those gestations. And of course this is all going to be incredibly exacerbated given the overturning of Roe," Jones said.
Dr. Bhavik Kumar, a provider in Texas and the national medical spokesperson for Planned Parenthood, told ABC News that how far along a pregnancy has to be before costs go up varies between clinics and across states.
Whether a patient has insurance coverage is also a main factor in determining cost. In some states, patients may not have to pay anything because abortion is covered by insurance, Kumar said.
Abortions for pregnancies that are further along can cost more because of fewer healthcare professionals that can provide that care and their limited availability, abortion procedures becoming more complicated and requiring medications or abortions needing to happen over two days, Jones said.
Second trimester abortions could also require more surgical preparations like medications or dilators, sometimes an extra procedure to insert dilators, all of which requires more time in the clinic and is factored into higher costs, Kumar said.
When the pandemic first hit, Texas said abortions were not essential health care, forcing patients to travel across state lines or not get care. When abortion care resumed, a study documented that there were more patients coming in at later stages of pregnancy, Jones said.
Other abortion restrictions, like having to make in-person visits or having to return to a clinic before getting care can also delay care by several days and push patients from one trimester into another, Jones said, citing Guttmacher research.
When Texas was one of the only states implementing a ban, wait times were around one to three days. As time progressed, within one to two months, providers saw wait times jump to one to three weeks depending on which clinic you look at, Kumar said.
Kumar said he is seeing a lot of patients who are looking to get care in another state seeing delays of several days or several weeks and some clinics are so overwhelmed, they are not even making appointments.
States with the least restrictions, that do not have mandatory wait times are where Kumar says he is hearing about longer wait times.
"It seems like there's sort of hotspots that are forming for abortion access and the states that come to mind are Illinois, Kansas, Colorado [and] California because of the lack of most restrictions and the ability to get care," Kumar said.
Experts said waiting longer into pregnancy increases costs.
Dr. Katie McHugh, an abortion provider who works at three clinics in Indiana, told ABC News that abortions for pregnancies that are less than 14 weeks cost around $800.
These patients are getting medication abortions or simple procedures, McHugh said.
The cost of abortion for pregnancies further along than 14 weeks range from $900 to $1,200, depending on the stage of pregnancy and need for anesthesia or if the abortion is done over multiple days, McHugh said.
Some states like Indiana had mandated that abortion care be done in a hospital after a certain number of weeks, which costs "many thousands of dollars," McHugh said. The cutoff for when care is required to be in a hospital is regulated by states and varies around the country.
It costs less to get care at a clinic than a hospital because clinics have less overhead costs. Abortions at later gestations cost more largely because they need to be done in a surgical or hospital setting, McHugh said.
Asked whether her clinic has received patients further into pregnancy because of bans or restrictions in their states, McHugh said "absolutely."
"Most of the people that we're seeing from out of state, had to be referred here because of the restrictions in their own states. And then some of them, they tried to be referred to here, but they can't get here in time. And so then we are having to refer them to Illinois," she said.
On Friday, Indiana became the first state to enact near-total abortion ban since the U.S. Supreme Court voted to overturn Roe.
Kumar said that for patients with medically complex pregnancies who need abortion care for health reasons, delaying their care complicates risks.
People likely to have complications like preeclampsia, gestational hypertension, high blood pressure, gestational diabetes or who have had past hemorrhages are also likely to be people who experience other barriers to access. Those people are often uninsured people, people of color and low-income people, Kumar said.
Patients who have to travel to get care also face other costs that vary from patient to patient.
"So much of that depends on where people are traveling from, how much work they have to miss, how much they have to pay in childcare, not to mention gas and lodging and all of those costs," McHugh said.