The Cost of Abortion Is Medical Debt—Meaning, You Can Help Cancel It

Since the Dobbs decision overturned Roe v. Wade, not only have abortion patients had to face overwhelming legal barriers to access, but also snowballing costs associated with the procedure: Bans have forced even more people to travel out of state, miss more days of work, and require more childcare. Then, in July, national reproductive rights groups put caps on patient assistance grants that left abortion funds scrambling. Both the National Abortion Federation and Planned Parenthood cut grants from 50% of each caller’s need down to just 30%. (Meaning if someone requests $2,000, they can now only qualify for $600 compared to $1,000 before the caps.) People need more time to raise money, which pushes them later into pregnancy when procedures are much more expensive.

"We're hearing for the first time that some clinics are telling people to pay with a credit card, to get a payday loan, or to borrow money, because the funds are not able to actually meet demand," Astra Taylor, co-founder of The Debt Collective, told Jezebel. "We're entering a disaster zone."

Now, in a rare bit of good news, the economic justice organization has given $50,000 to a coalition of abortion funds, the mutual aid groups that help people afford their procedures and the related costs. The donation was first reported by The American Prospect.

The Debt Collective is a debtor's union with roots in the Occupy Wall Street Movement and, since 2012, its Rolling Jubilee Fund has canceled tens of millions of dollars in medical and student loan debt. Taylor said it was only natural for the organization to get involved with abortion funds as a way to prevent more people from going into debt—specifically, "abortion debt."

"Abortion is healthcare," Taylor said. "If this was a just society, this is something that would be treated as what it is, which is a medical procedure, and it would be a medical procedure that doesn't force you to incur catastrophic expenditures."

"Catastrophic" isn't just an apt adjective—there's a metric in public health research known as catastrophic health expenditures (CHEs), which refers to healthcare costs so high they limit people's ability to pay for other basic needs. And even before Roe was overturned, abortion seekers faced crippling debt. An investigation published in JAMA Network Open last month analyzed questionnaires from 675 abortion patients who visited four clinics in 2019. The researchers found that 42% of them experienced catastrophic health expenditures, and the number jumped to 65% for patients who traveled to the clinics from out of state. Yes, forced travel also happened before Dobbs. 

In August, a group of 34 funds wrote an open letter in The Nation detailing what they said are misguided priorities of national organizations—namely, that they're hoarding resources to pursue federal protections when people need help getting abortions now. It is those same 34 funds that received the $50,000 contribution, administered via the Wild West Access Fund of Nevada, and supporters of abortion access can donate to the group directly. (Bonus: You can be Jezebel's Person of the Year if you do!)

Macy Haverda, executive director of the Wild West Access Fund, said in a statement shared with Jezebel that the patient funding crisis shows that more resources should go directly to grassroots abortion funds. “When the financial support for abortion centers on funding big national groups focused on the political fight, we are leaving behind abortion seekers and local abortion funds that need help right now,” Haverda said. "We are grateful for Debt Collective’s solidarity and for their effort to spotlight abortion care as essential health care all Americans should be able to access and afford.”

To Taylor, donating to an abortion fund is an act of solidarity to prevent or erase medical debt, first and foremost. Still, the collective has a larger goal to get a base of people organizing for universal healthcare that covers abortion. (Though given the state of federal politics, that's more likely to happen at the state level first.)

The Debt Collective is proud to have made its $50,000 contribution, but Taylor knows it's a drop in the bucket. "I mean 50,000 bucks—for us, it was a lot, but it's nothing compared to the tens of millions of dollars that are required to meet the need of abortion seekers," she said.

Debt relief has become somewhat of a mainstream, feel-good story, Taylor said. But it's like when the local news runs a piece on teachers banking their sick days so their coworker can take parental leave, or kids running a lemonade stand to pay for cancer treatment—the good vibes disintegrate when you consider the systemic failures at play. "We want to build power to change the system. We don't want to just be doing charitable acts over and over," she said, adding, "Our focus is now turning to the dual demands of medical debt abolition and also free public health care."

Those goals may seem daunting, but there's an opportunity for working-class people to build power, especially around the U.S. medical system. "In the conversations about the UnitedHealthcare CEO shooting, what we see is incredible frustration about the healthcare system as it exists and an appetite for something different," she said. "But right now, there's a lack of a movement to capture that frustration and channel it in productive ways. And that's just what the hard work of organizing is."

As we stare down the shorter-term threat of Trump's inauguration, supporting abortion funds is key, Taylor said. "As this new administration comes in, we need to resist them by providing that kind of mutual aid and support."