Did the Massachusetts reforms decrease abortions?
Putting aside the question of whether health-care insurance should cover abortions, what happens when it does cover abortions? One answer is that abortions go up, because they're cheaper. Another is they go down, because women have more access to birth control. Another answer is that there's no change because abortions are related to pregnancy rather than health-care coverage, and most women don't know that their insurance covers abortions anyway.
Writing in The New England Journal of Medicine, Patrick Whelan decided to look into the data from Massachusetts, where they passed a health-care reform law much like the Senate bill but that covered abortion. The answer? Abortions dropped after passage of the bill.
The number of abortions in Massachusetts in 2006, the year before the new law was implemented, was 24,245, including 4,024 among teenagers. I obtained data from the Massachusetts Department of Public Health for each of the two subsequent years. Some 158,000 people were enrolled in Commonwealth Care plans during the first year. The Urban Institute estimated that between the fall of 2006 and the fall of 2008, the proportion of adults with incomes below 300% of the poverty line who were uninsured fell from 24% to 8%; 63% of all newly insured adults were in either Commonwealth Care or the state Medicaid program.
In 2007, the first year of Commonwealth Care, the number of abortions fell to 24,128, and in 2008, it fell to 23,883 — a decline of 1.5% from the 2006 level (see graph). The number of abortions among teenagers in 2008 fell to 3,726, a 7.4% decline from 2006. These decreases occurred during a period of rising birth rates, from 55.6 per 1,000 women 15 to 44 years of age to 56.9 per 1,000 in 2006, and 57.2 per 1,000 in 2007 (the latest year for which data are available from the Massachusetts Department of Public Health), and an increase in overall population (in 2008, the Massachusetts population surpassed 6.5 million for the first time, and it was nearly 6.6 million in 2009, according to the Census Bureau). The abortion rate thus declined from 3.8 per 1,000 population in 2006 to 3.6 per 1,000 in 2008.
Now, abortions were on a longer-term downward trend in Massachusetts, so it's possible (I might even say likely) that the reform didn't matter and abortion was dropping for other reasons. But it's hard to look at this data and say that the reforms led to a large increase in abortions.
March 19, 2010; 4:41 PM ET
Categories: Health Reform
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