Objectives
We aimed to estimate the cost-effectiveness and pregnancy outcomes of undesired rape-related pregnancies (RRP) when Medicaid abortion coverage is limited to Hyde restrictions compared to full Medicaid coverage of abortions.
Methods
We used a theoretical cohort of 80,000 individuals on Medicaid who have an undesired RRP, with cohort size determined by CDC data. We used TreeAge to model RRP outcomes when abortions are covered only by Medicaid as permitted under the Hyde amendment and compare this to outcomes when abortions are covered by Medicaid under any circumstances over a ten year span. Outcomes include cost to Medicaid, quality-adjusted life-years, Medicaid-covered abortions, out-of-pocket abortions, first trimester abortions, second trimester abortions, and uncomplicated and complicated pregnancies resulting in births. Probabilities, costs, and utilities were derived from the literature. A Medicaid perspective was assumed.
Results
Our model demonstrated that among RRPs, limiting abortion coverage to Hyde restrictions results in fewer Medicaid-paid abortions, more out-of-pocket abortions, and more pregnancies resulting in births compared to the counterfactual of full Medicaid abortion coverage. In a Hyde-only coverage scenario, there would be 44,228 fewer Medicaid-paid abortions – a 96% decrease relative to Medicaid-paid abortions with full coverage – and 21,577 more out-of-pocket abortions. Full Medicaid coverage of abortion in this population would avert 22,988 pregnancies with cost-savings of $313.6 million.
Conclusions
This study suggests that limiting Medicaid coverage of abortions to strictly Hyde Amendment exceptions decreases payment for and access to abortions for rape-related pregnancies, despite these abortions meeting Hyde criteria for federal funding. This demonstrates a failure of Medicaid to pay for 96% of abortions for undesired RRP and comes at a significantly increased cost to Medicaid.
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