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Health Care Reform: A Case for Single Payer Reimbursement for Abortion

January 1, 1970 - By Shauna Heckert, WHS Executive Director - 1 Comments

The Chilling Effect of Managed Care on Women Who Seek Abortions

The two questions most commonly asked by women when they call an abortion clinic for services are “Is abortion safe?’ and “Is my appointment confidential?” The issues surrounding abortion, unlike other medical procedures, are unique for women. The stigma of abortion in our society is so great that a woman’s concern for her confidentiality often outweighs her concern for her personal safety or future fertility.

The new managed care system is oblivious to the special climate surrounding abortion care. Although normalizing abortion care, by integrating all reproductive health services into a woman’s primary care, is an idealistic goal we are working towards, it is a lofty goal at least, and more probably, an impossible goal for the near future. The struggle over women’s bodies will not go away because we wish to be free of the conflict. A healthcare system that ignores the current dangerous and intimidating atmosphere, thereby treating abortion like other health services, unjustly punishes some women by forcing them to delay an abortion, denying them their right to privacy, and limiting their choice of providers.

Concern for Confidentiality Causes Abortion Delays

Most women find their abortion provider by asking a trusted friend or family member, or by referring to the telephone directory. Although a woman may have a private physician, this is often not the person to whom she turns for advice about abortion. The vast majority self-refer for abortion services. Some women will even drive hours out of their area to ensure their privacy. She may not want her family or personal physician to know about her abortion plans because she fears it will have the potential to negatively impact the ongoing relationship with her physician or perhaps her future care. In some cases, a woman’s primary care physician may be a family friend, local acquaintance, or someone who is adamantly against abortion, although is abortion became as acceptable as a pap smear, none of this would be an issue.

A managed care system that requires a woman to first see her physician not only subjects her to an unnecessary delay in services but may also encourage her to put off the initial inquiry for fear of reprisal or loss of privacy.

Maintaining Choice and Access in an Unfriendly Environment

Because abortion has been such a flash point of controversy, most medical practitioners and facilities have chosen not to be associated with performing this procedure. As a result, the overwhelming majority of abortions are performed in free standing clinics rather than integrated into a physician’s private practice or hospital outpatient services. Abortion facilities are often run by women and men who have a moral conviction to preserve the right to abortion access for all women-even under the most adverse conditions. In these facilities, an environment has been created wherer women could begin to have control over their reproduction.

Community-based women’s health clinics have shouldered the responsibility for abortion care through the darkest days of the last decade of terrorism and relentless attacks. Clinics have been bombed and burned, staff threatened, clinics harassed. Yet these clinics have managed, time after time, to rally the pro-choice forces in their communities to repair, to rebuild and to rebuff the opposition so women can continue to exercise their constitutionally protected right to abortion.


Amidst the antagonism, it has been some of these independent community-based clinics, like Feminist Women’s Health Centers, where a successful healthcare model has emerged- a model that curbs inflationary costs, practices true consent, and involves clients in their own healthcare. Consequently, the cost of an abortion remains relatively low, while a high quality of services are provided within an environment respectful of women’s and family’s dilemmas and choices.

Safety is Reduced by Abortion Delays

Abortions are safest when performed in the first trimester, and most women do prefer to arrange their abortion in this time period. New technology in early pregnancy detection and over-the-counter pregnancy tests allow a woman to confirm her pregnancy without visiting her physician, and presently, an abortion provider can easily confirm a woman’s pregnancy on the day of her abortion appointment. That enables a woman to receiver her abortion within the optimum window of safety.

Delays in obtaining abortion procedures are dangerous because as the gestation advances, so do the potential risks to the client’s health. The delays can also mean the difference between a simple suction procedure and a two-or-three day D&E (Dilation and Evacuation) procedure with laminaria for overnight dilation. The two and three day abortion procedures are more costly and less available than early abortion. There are few physicians or clinics trained or willing to perform this procedure. Unless a managed care health plan includes those few later abortion providers, women will be denied access to later abortion.

Any delays added to those already imposed in many states, such as waiting periods, mandatory counseling, parental notification and judicial bypass procedures, unjustly subjects each woman to an increase in health risks as her pregnancy advances and her options decrease.

Contracts for Specialty Services Create Harmful Competition

Abortion facilities differ greatly in the type of procedure, the use of general or local anesthesia, provision of counseling, availability of advocacy and follow-up care, and other medical and social restrictions. Some facilities offer only what will maximize their profit. For example, many facilities will only see a woman whose pregnancy is between the 8th and the 11th week because this is the time of the fewest complications and therefore, the least follow-up needed by the provider. Some providers refuse to perform an abortion for IV drug users. Where will the woman go for abortion services when she doesn’t fit their guidelines?

The managed care system is designed to put specialty services, like abortion, out-for-bid. Abortion facilities which offer only low-risk, routine, early abortion services, can obtain these exclusive contracts by undercutting the abortion providers who do provide a full range of abortion options. Without contracts to provide care, many of these vital community-based abortion providers cannot survive. If these independent community-based abortion providers are excluded from being a part of the managed care system, it is women who will lose.



While abortion is a safe and relatively simple procedure, and must be included as any other routine health procedure in national health insurance reform, it must be free from the controls of the “gatekeeper” and exempt from the managed health care “red tape.” To protect a women’s constitutional right to abortion, we strongly recommend:

   Either enact a single payer health care

   system or exempt abortion from the man-

   aged care requirements by allowing all

   abortion providers to contract directly

   with State or Federal Government.

While we look forward to the day when abortion care is integrated into women’s health care services without stigma or need for special provisions, it is foolhardy to ignore the very real landscape of abortion care for women as it exists in this country today.


Shauna Heckert is the Executive Director of Women’s Health Specialists, and has been active in the women’s health movement for 35 years.


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