The public and economic costs of abortion policies

The leaked U.S. Supreme Court draft opinion that appears to overturn Roe v. Wade, the 1973 decision that legalized abortion, has dominated much of the news this week. Every public policy has a fiscal impact, even if it’s a downhill one. The legalization of abortion and the potential repeal of it in the pending Dobbs v. Jackson ruling both have associated costs. This week, I’ll examine a few different ways to think about that.

Taxpayer funding for abortions

Most states have followed the federal government's lead in restricting public funding for abortion. According to the ACLU, only 17 states fund abortions for low-income women on the same or similar terms as other pregnancy-related and general health services. The remaining states, with the exception of South Dakota, pay for abortions for low-income women in cases of life-endangering circumstances, rape, or incest, as mandated by federal Medicaid law. South Dakota, however, will only pay for lifesaving abortions.

• U.S. Map Illustrating Current Public Funding Restrictions

State-by-state data on publicly-funded abortions is lacking but national statistics show that only a fraction of Medicaid dollars goes toward them. According to the Guttmacher Institute, Medicaid covered slightly more than 157,000 abortions nationwide in 2015 and almost all were in states that use their own funds to cover the cost. By my estimate, this amounts to .02% of all Medicaid expenditures that year.

Data collected by the institute also shows that lack of abortion access disproportionately impacts low-income women as they make up three-quarters of abortion patients. Depending on timing, the out-of-pocket cost ranges from $500 to $1,200, the latter expense nearly equal to an entire month’s income. 

The institute also notes that low-income women are more likely than more affluent women to have an unintended pregnancy. In 2011, the unintended pregnancy rate among women with an income below the federal poverty level was more than five times the rate among women with an income at or above 200% of the poverty level. 

What this means: Red states, which are most likely to restrict access to abortions both in terms of coverage and number of reproductive care centers, are also the states with higher shares of lower-income residents. Moreover, women in these states are likely facing restricted health coverage in other ways. Most states in the Southeast, for example, have not adopted Medicaid expansion. That also leads to disparate spending between states—Mississippi, the poorest state in the union, spent 25% of its budget on Medicaid last year while New York, one of the richest, spent 35%. Abortion access, therefore, is just more way in which systemic inequities are reinforced.

A lingering question: Why is it that lower-income women are more likely to have an unintended pregnancy? According to a study by the Brookings Institution, it is because not only are they less likely to use contraception—they are also less likely to have access to an abortion (for all the reasons listed above). Fittingly, in red states where more lower-income women are carrying unplanned pregnancies to term, sex education tends to focus on abstinence instead of contraceptive use.

The human cost of unwanted pregnancies

Pro-choice advocates argue that unintended pregnancies taken to term cause adverse maternal and child outcomes. Pro-life advocates say every unborn child deserves a chance. Let’s look at these separately.