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Nearly 97% of abortions in Michigan aren't covered by insurance. That could change.

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Amanda Mazur was 20 weeks pregnant with her second child in 2017 when a routine ultrasound revealed a problem. There was more testing, then appointments with specialists, and finally, the devastating diagnosis: a fatal genetic anomaly.

“The issues with my pregnancy (were) so severe, there was little chance I'd be able to carry to term,” Mazur told a committee of state lawmakers at a hearing in Lansing on Thursday. “And if I did manage to give birth, there was no possibility my baby would survive.”

She and her family were shocked and heartbroken. But they needed to make a difficult decision, and quickly. “Abortion was the compassionate decision for myself, my family and the child we'd hoped for,” Mazur said.

She was told only two medical centers in Michigan would perform abortions this late in a pregnancy. By the time they could get an appointment, Mazur was 23 weeks pregnant, arranging childcare for her toddler and a place to stay during the 200-mile round-trip trek to Ann Arbor from her home in rural northern Michigan.

Then they got the hospital bill.

Amanda Mazur speaks to state lawmakers at a hearing on Thursday.
Amanda Mazur speaks to state lawmakers at a hearing on Thursday.

“Because of state laws that prohibit public and private insurance from covering the costs of abortion care, and because I never would have expected needing a special rider from my private insurance, we were stuck with a hospital bill that topped $26,000,” she said.

How much do abortions actually cost? From $500 to much, much more.

Mazur was one of several citizens and experts to testify about the Reproductive Health Act, a package of bills introduced by Democrats last week that would remove numerous restrictions on abortion in Michigan. That includes the mandatory 24-hour waiting period and signed informed consent form, which Planned Parenthood says leads to at least 150 patients having to cancel their appointments each month.

But perhaps most significantly, the bills would also allow state Medicaid dollars to cover elective abortions — something opponents say would violate the ethical and religious imperatives of those who don’t want their tax dollars going to abortions.

“Removing the longstanding protection for all Michigan taxpayers from having to pay for other people's elective abortions is a dangerous precedent to set,” said Genevieve Marnon, legislative director for Right to Life of Michigan, in an email. “And I think most Michiganders would be opposed to that infringement on their personal incomes, particularly in an environment in which inflation remains so high and personal finances are under such strain.”

Genevieve Marnon, legislative director of Right to Life of Michigan, speaks in opposition to the Reproductive Health Act on Thursday.
Genevieve Marnon, legislative director of Right to Life of Michigan, speaks in opposition to the Reproductive Health Act on Thursday.

The Reproductive Health Act would also allow private insurers in Michigan to cover elective abortions as part of their regular plans. Currently, employers must purchase separate riders to cover abortions. “Which one, is an exorbitant cost, and two, it's frankly insulting,” said state Representative Laurie Pohutsky (D-Livonia), the sponsor of the bills. “There are not individual riders for every type of health care. There's just a coverage.”

The typical cost of abortions in the state ranges widely, from $500 to $700 for a medication abortion to well over $1,000 for a surgical abortion. According to state data, nearly 97% of the more than 27,000 Michigan residents who had an abortion last year paid out of pocket, and less than 3% used insurance to cover the cost.

While abortion funds and clinics try to help as many low-income patients as possible, the costs are still a burden, said Dr. Sarah Wallett, chief medical officer of Planned Parenthood of Michigan. Wallett said they recently had a patient come in for her appointment who was visibly exhausted.

“When we asked if she was okay, she told us she had gotten less than one hour of sleep the night before, because she had realized just hours before her appointment that she was $49 short of the estimated cost we had provided,” Wallet testified on Thursday. “She was worried that we wouldn't see her if she didn't have the full fee in hand by morning. She didn't want to have to cancel and try to make another appointment. So instead she stayed up all night to drive DoorDash.”

But abortions can cost far more if patients need to be admitted to the hospital, said Dr. Charita Roque, an obstetrician and gynecologist at Western Michigan University’s School of Medicine. She described a patient who developed a heart condition during pregnancy that was potentially fatal. She chose to end the pregnancy rather than risk leaving her child motherless, Roque told lawmakers. But her abortion had to be delayed because she didn't have access to a printer, and wasn't able to bring in the required informed consent form.

“During that time, her cardiac status became even higher risk, and it was evident that she would need a higher level of care in a hospital setting,” Roque said on Thursday. “This meant that the cost would be much, much higher: over $10,000. And since her insurance was legally prohibited from covering abortion care (without a pre-purchased rider) she anticipated she would have to incur significant medical debt.”

Medicaid coverage would allow state dollars to fund abortions 

Expanding Medicaid coverage to include abortion care would "would increase state Medicaid costs by $2.0 million to $6.0 million," according to a House Fiscal Agency analysis.

But using taxpayer dollars for abortions is a decades-old battle, going back to the 1977 Hyde Amendment, which blocks federal funds from covering abortions (except in the case of rape, incest or to save the life of the pregnant person.)

But states are allowed to use their own funding to cover a wider range of abortions, and more than a dozen states currently cover “all or most medically necessary abortions” under their Medicaid programs, according to the Guttmacher Institute.

“The use of taxpayer dollars to finance abortion is an affront to people with a conscientious objection to abortion and ignores the will of the people, as 57% of Michigan voters voted to retain the ban on Medicaid-funded abortions the last time the issue was before voters,” Right to Life of Michigan said in a press release earlier this week.

That was in 1988, when voters passed the Medicaid Abortion Funding Ban, which prohibited the use of Medicaid funding for an abortion except to save the life of the pregnant person. Some proponents of the ban argued it would save the state money: about $6 million each year.

But researchers said in 1993 that over a five-year period, the “number of children born as a result of withdrawal of abortion funding and the number of those children likely to require welfare” actually ended up costing taxpayers anywhere from $51 million to $139 million, according to a 1993 study in the Journal of Obstetrics and Gynecology.

And Democrats say voters today feel very differently than they did in 1988, pointing to an August 2023 poll released by Governor Gretchen Whitmer’s office. Of the 800 voters polled in “battleground districts,” 54% said they support allowing Medicaid to “cover all pregnancy-related health care, including abortion.”

But opponents of the RHA say lawmakers must “respect the vote” Michiganders took in 1988. In Thursday’s hearing, Eileen McNeil with Citizens for Traditional Values said this wasn’t about abortion access in general. “Women can choose abortion, but Michigan residents, even those who support abortion, decided definitively that they shouldn't be compelled to pay for other people's elective abortions.”

Updated: October 6, 2023 at 11:21 AM EDT
Kate Wells is a Peabody Award-winning journalist currently covering public health. She was a 2023 Pulitzer Prize finalist for her abortion coverage.
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