Abortion Coverage Is Limited or Unavailable at a Quarter of Large Workplaces
About a quarter of large U.S. employers heavily restrict coverage of legal abortions or don’t cover them at all under health plans for their workers, according to the latest employer health benefits survey by KFF.
The findings demonstrate another realm, beyond state laws, in which access to abortion care varies widely across America since the Supreme Court overturned the constitutional right to abortion last year in Dobbs v. Jackson Women’s Health Organization.
More than ever, where someone works and the constraints of their health insurance can determine whether an abortion is possible. Workers without coverage are left to pay out-of-pocket for abortion care and related costs.
In 2021, the median costs for people paying out-of-pocket in the first trimester were $568 for a medication abortion and $625 for an abortion procedure, according to a report from Advancing New Standards in Reproductive Health at the University of California-San Francisco. By the second trimester, the cost increased to $775 for abortion procedures.
KFF’s 2023 annual survey found that 10% of large employers — defined as those with at least 200 workers — don’t cover legal abortion care under their largest job-based health plan. An additional 18% said legal abortions are covered only in limited circumstances, such as when a pregnancy is the result of rape or incest, or endangers a person’s life or health.
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Sharply divergent state abortion laws solidified in the aftermath of the Dobbs decision compound the complexity for employers with workers across multiple states, Rae said. Many large companies employ people in places with vastly different abortion policies, and their health benefits are more likely to cover dependents who may live elsewhere.
“Those dependents can be college kids — and college kids can be anywhere — or any other type of dependent who could just spread out over an area much larger than where you just have actual physical establishments,” Rae said.
The KFF survey found that about a third of large companies said they cover legal abortions in most or all circumstances; the largest companies, with at least 5,000 employees, were more likely to offer the benefit compared with smaller firms. An additional 40% said they were unsure of their coverage — perhaps because employer policies are in flux, Rae said.
Employer health plans’ treatment of abortion has changed little since the Dobbs decision, the survey found. Among companies that said they did not cover legally provided abortion services or covered them in limited circumstances, 3% reduced or eliminated abortion coverage. By contrast, of the large companies that generally covered abortion, 12% added or significantly expanded coverage.