Today marks two years since the Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization, which eliminated the constitutional right to abortion. In those two years, we have seen ever escalating attacks on abortion access, as extreme state-level abortion bans have forced clinic closures and ever increasing travel distances for patients. In spite of the onslaught of attacks, the National Health Law Program is more committed than ever to our mission of fighting for the rights of all people to access the full range of sexual and reproductive health care services, including abortion. Comprehensive insurance coverage is a crucial part of normalizing abortion as the basic health care service that it is, which is why NHeLP will continue to fight to repeal the Hyde Amendment and push for coverage expansions and improvements at the state level.
Below we have compiled a selection of the resources NHeLP has created in the last two years in response to the Dobbs decision, organized into two main categories: general state-level advocacy responses to Dobbs and the state of Medicaid coverage of telehealth medication abortion services more specifically.
State Responses to Dobbs
In the two years since Dobbs, we have seen a groundswell of activity at the state level to protect and expand abortion access. One key trend that has emerged is a focus on expanding and improving abortion coverage – a reflection of the need to prioritize building equitable abortion access in the post-Dobbs era. The below resources were created to provide an understanding of the state landscape and share best practices learned from the Future of Abortion Council in California.
2022 State Legislative Session Highlight: Major Gains In Abortion Insurance Coverage Despite Dobbs
October, 2022
During the 2022 state legislative sessions, one important trend that emerged in the wake of the Supreme Court’s decision in Dobbs was a focus on expanding access through robust insurance coverage of abortion in private and public health care plans. While protecting the legality of abortion is vital in this post-Roe world, having the legal right means little if people have no access to abortion. Comprehensive insurance coverage is a crucial component of creating an equitable abortion access landscape and this blog highlights major changes to improve and expand coverage in 2022.
2023 State Legislative Roundup: Major Wins on Improving Abortion Coverage
November, 2023
The first year after the Dobbs v. Jackson Women’s Health Organization decision threw the abortion access landscape into chaos. While states hostile to abortion access continue to enact increasingly extreme abortion bans and restrictions, advocates secured major wins to protect and expand access to abortion in states across the country that can and should be celebrated. This blog analyzes the major trends in policy efforts to improve and expand insurance coverage of abortion and highlights major wins.
Future of Abortion Council Toolkit
January, 2024
Drawing on the experience of the creation and ongoing advocacy of the California Future of Abortion Council, this toolkit shares the best practices learned over the last several years to encourage advocates in other states to form similar spaces — regardless of your state’s current protections — to leverage the power of coalition work in the effort to improve the sexual and reproductive health landscape in the post-Dobbs world.
Hyde Amendment Exacerbates Abortion Access Crisis but States Show Path Forward
September, 2023
As the abortion access crisis escalates, the stark truth is that for Medicaid enrollees, where you live has determined your ability to access abortion for decades. This blog examines the continued negative impact of the Hyde Amendment, a budget rider prohibiting most federal funding for abortion coverage, and highlights the state advocates that continue to lead the way in making progress toward a health care system that treats abortion like the basic health care it is.
Telehealth
Telehealth medication abortion service delivery has emerged as a vital model for expanding access in the post-Dobbs landscape, as the newest data shows that nearly 20% of all abortions in the U.S. are delivered via telehealth. Comprehensive insurance coverage of all telehealth modalities is crucial to create equitable access, and NHeLP has produced several resources over the last two years that provide analysis of the existing Medicaid coverage landscape and offer recommendations on how to further improve and expand comprehensive coverage.
December, 2022
This report examines the Medicaid telehealth medication abortion (TMAB) coverage policies in 6 key states (Alaska, Connecticut, Hawaii, Maine, Montana, Oregon) as case studies for understanding how the Medicaid telehealth coverage landscape has changed in the wake of the COVID-19 pandemic. Overall, the results of our comprehensive survey of the TMAB coverage and reimbursement policies in the 6 target states revealed a lot of positive changes that improved Medicaid coverage of telehealth service delivery. However, there still exists substantial room for improvement in ensuring equitable access to TMAB through comprehensive Medicaid coverage, but the dimensions of improvement varied between states.
Asynchronous Telehealth Abortion Services for Medicaid Enrollees
January, 2024
Telehealth medication abortion (TMAB) service delivery has greatly increased, including the expansion of asynchronous service delivery models. This issue brief walks through what asynchronous service delivery of medication abortion looks like and the potential benefits of this model in addressing major access barriers, particularly for people with low incomes. It concludes with an overview of the current Medicaid asynchronous telehealth coverage landscape in the 17 states that use state funding to provide abortion coverage to Medicaid enrollees, highlighting specific policy barriers. It also contains a chart that provides an overview of the key policies implicating Medicaid coverage of asynchronous telehealth in each of the 17 states examined in this research.
FAQ: Insurance Coverage for Pharmacy-Dispensed Medication Abortion
April, 2023
The U.S. Food and Drug Administration (FDA) announced new changes to the mifepristone Risk Evaluation and Mitigation Strategy (REMS) in January 2023, opening the door to the expansion of medication abortion access through pharmacist dispensing. However, equitable abortion access under this model requires intentional benefit design in order to ensure insurance coverage at the pharmacy counter. This FAQ goes through the key concepts and issues surrounding pharmacist-dispensed medication abortion, including the policy changes that are required to facilitate insurance coverage in both public and private plans.
