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Did the Massachusetts reforms decrease abortions?

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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.

By Ezra Klein  |  March 19, 2010; 4:41 PM ET
Categories:  Health Reform  
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Comments

Is it fair to say, "Reform led to a large increase in abortions" paid for by those who objected to even a penny of their tax money being spent this way?

Because you're dragging an awful lot of innocent players into the mix, when you require government funded abortions, and then you necessarily tax somebody else to pay for these procedures. Some sucker whose own moral code might never permit him or her to undergo, or pay for such a choice themselves.

PRO CHOICE. ANTI MANDATE. What part of "Be responsible and pay for your own choices" don't you understand?

Posted by: Mary42 | March 19, 2010 4:50 PM | Report abuse

Having a child is a huge econcomic responsibility. The medical expenses alone...

I can see a prospective parent thinking, "There is no way I can afford a kid." Sad, but probably true for some people.

If they knew health care wouldn't be an issue they might be more willing to carry the child to term. I guess it is possible.

But that is a whole lot of maybe.

Posted by: nisleib | March 19, 2010 4:54 PM | Report abuse

@Mary42:

I often find war to be far more repugnant. And there are plenty of pacifists out there who could make a similar (and I think far stronger) argument against their having to pay for the deaths of our soldiers and innocent civilians abroad.

there are plenty of people who have moral issues with things done in the name of the united states with their tax dollars. why should the anti-abortion contingent get special privilege to basically veto government spending on a legal activity?

Posted by: sarijoul | March 19, 2010 5:09 PM | Report abuse

Quoting omitted portions of the cited report, "the vital statistics in Massachusetts indicate that this overall downward trend continued during the first 2 years after the implementation of the law that expanded health insurance coverage" and "there was a further national slowing in the decline of abortion rates during the Bush administration and could explain the somewhat SLOWER DECLINE in the more recent Massachusetts data."

So, even though "Massachusetts is one of 17 states that provide full coverage for abortion," the abortion rate continued to decline, albeit at a slower rate, for a while even after Bush administration policies became ineffective.

I'm very much pro-choice; however, omitting portions of the study may lead some to erroneously believe that the Massachusetts health care reform slowed the rate of the teen abortions: in fact, it reversed the previous trend of slowing.

Posted by: rmgregory | March 19, 2010 5:10 PM | Report abuse

Sarijoul:
Listen to yourself. You are sickened by war ... so you want to drag others into a healthcare system that, by choice, kills off little children who are predicted to be born deformed.

In order to save money, we terminate the lives of babies who can be healthy, yet with a condition like Downs' Syndrome. And you want somebody else to justify your choice by assuming the bill of paying for it.

So long as we're clear that this is what is expected to pass for "healthcare" American style. Until it's can be repealed, if needed. (I'm still not so sure you'll con enough pro-life votes to get on board with this unholy mess...)

Posted by: Mary42 | March 19, 2010 5:15 PM | Report abuse

@Mary42
I don't think you understand my point. Why does abortion of all issues that are repugnant to all sorts of different voters get special treatment? Why should my money go to faith-based initiatives that fund the rape of children by catholic priests? Why should I have to pay for torture in gitmo? It goes on and on. I, for one, understand that I do not have veto power over all government funding of things that the government does that I don't like. but i do think i have a stronger case of being upset at funding torture with my tax dollars than do people who are upset about funding the completely legal act of abortion (which this bill does not do in the first place).

Posted by: sarijoul | March 19, 2010 5:21 PM | Report abuse

Does Massachusetts require that insurance cover the pill or implantable birth control, Ezra? The other birth control methods I can think of aren't so expensive that insurance would be a big factor.

If abortion rates are going to go down from HCR, I would think the big reason would be the up-front cost of child birth dropping. It costs $6,500 - $11,000 to have a normal childbirth. If you're uninsured (or your insurance doesn't cover childbirth) and not so poor as to be on Medicaid, that's an awfully big incentive to abort and wait until you're insured.

Posted by: jesmont | March 19, 2010 5:32 PM | Report abuse

Clearly we need a compromise: abortions for some, miniature American flags for others.

Posted by: etdean1 | March 19, 2010 5:43 PM | Report abuse

Whether or not abortions go up or down is meaningless to many pro-lifers. The argument is that abortion is wrong and so the government should not sanction it. If pro-lifers' main concern was lowering the number of abortions, there are a bunch of compromise positions available that would work (free birth control, sex education, etc). To these folks it is like slavery - there may have been lots of compromises in the early 19th century that reduced the number of slaves, but to fervent abolitionists they did not matter.

Posted by: Levijohn | March 20, 2010 12:09 PM | Report abuse

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