Research suggests women living in states with abortion bans bear higher health insurance costs

New preliminary research from the University of Michigan shows women living in states with post-Dobbs abortion bans may be more likely to shoulder costs for employer-sponsored health insurance premiums,  with federal data reflecting a 5.4% increase in annual premium expenditures for those women after 2022, when most abortion bans went into effect.

The study used national data from the U.S. Census Bureau’s 2019-2025 Current Population Survey Annual Social and Economic Supplement to compare individual medical out-of-pocket costs for women of reproductive age between 18 and 44. The study, which hasn’t yet been published in a peer-reviewed journal, received financial support from the Center for Reproductive Rights, an advocacy group based in Washington, D.C. 

“State abortion bans were associated with an increase in women’s likelihood of paying out-of-pocket for health insurance premiums,” the study said.

The findings also showed even higher premium expenditures for Black and Hispanic women, at 12.8% and 13.7%, respectively. The findings were not present among men, and the majority of the women in the sample had incomes above 250% of the federal poverty level.

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“Our results are suggestive that post-Dobbs abortion bans led to insurers passing more premium costs to beneficiaries,” the study said. “Our findings shed light on the more far-reaching effects of abortion bans, quantifying the extent to which they pose an economic burden to individuals and families.”

Costs associated with pregnancy, childbirth and postpartum care averaged $20,416 nationally, including $2,743 in out-of-pocket expenses for women enrolled in employer plans over 2021-2023, according to previous research.

Joelle Abramowitz, an associate research scientist at the University of Michigan and co-author of the study, said the population survey — which is used to calculate poverty and health insurance coverage rates — was one of few sources that could offer recent insights. 

“What we see is, prior to the bans, the outcomes were looking comparable, and then after the bans were implemented, we see them diverge, with more women paying health insurance premiums in the ban states,” said Abramowitz, an economist and co-director of Michigan Federal Statistical Research Data Centers. .

Ten states with near-total abortion bans — Alabama, Arkansas, Indiana, Kentucky, Louisiana, Mississippi, North Dakota, Tennessee, Texas and West Virginia — were included in the study and compared with five states that did not implement bans: Massachusetts, Michigan, New York, Pennsylvania and Washington. States that expanded Medicaid during that time frame — Idaho, Missouri, Oklahoma and South Dakota — were excluded from the analysis to isolate the effects of the bans from Medicaid changes.

Abramowitz said there could be several factors increasing premium costs for female patients. One is that in states with bans, pregnancies that might have been terminated before the bans became deliveries with the potential for more complications and higher risks.

Prior research has shown that abortion bans are also associated with a higher rate of negative maternal and infant health outcomes, including admissions to a neonatal intensive care unit, as well as higher rates of  cesarean procedures, all of which can increase costs for insurers that get passed along through higher premiums. 

“I think this is an example of one way that these policies have more far-reaching effects beyond just the individuals who are directly affected by them,” Abramowitz said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

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