EThis fall, a woman desperate for an abortion sent a message to the Wild West Access Fund, a Nevada abortion fund, asking for support. She estimated that she was almost twenty weeks pregnant and didn’t even have a few hundred dollars to spend on the procedure. She wanted to prove she did everything she could to raise the money and said she was trying to pawn her vehicle.
Over the next few weeks, she bounced from clinic to clinic, trying to raise the money as the price of the abortion she sought continued to rise. The costs of a first trimester abortion is about $500, in the second about $2,000, and a third trimester abortion can range from a few thousand dollars to about $25,000. Since the U.S. Supreme Court struck down federal protections for abortion, more than a dozen states have banned the procedure entirely, while others have set pregnancy limits, increasing travel costs for pregnant people in those states.
The woman eventually stopped responding to messages, and fund staff do not know whether she ever had an abortion. Macy Haverda, executive director of the Wild West Access Fund, told me that even for a $600 procedure, “we’ve had a lot of clients talking about having to sell their belongings.”
Abortion debt is increasingly part of the abortion landscape, whether it involves pledging assets, recording procedures on credit cards, or taking out loans. I spoke to three different clinics, two abortion funds, and several organizers – all found that patient debt has increased since Roe v Wade was overturned in 2022.
To draw attention to the problem, the Debt Collective, a debtors’ union that questions the validity of student and medical debt, on Monday announced a $50,000 grant to a group of abortion funds — organizations that help people paying for abortions and the associated costs. them, such as travel and accommodation. “The Debt Collective believes that access to abortion is an issue of health care justice,” collective co-founder Astra Taylor said in a statement. “High costs, including the costs of treatment and travel, are essentially a second prohibition on healthcare.”
Politically, abortion access and medical debt relief are both popular. Abortion rights ballot measures outperformed Democrats in the 2024 elections, and medical debt, which plagues more than 100 million Americans, is part of a for-profit system so loathed that the recent murder of a health insurance CEO sparked nationwide cheers. Lindsey Muniak, who runs the Debt Collective’s medical debt project, has done just that described her own experience with hospital bills as “a constrictor, a boa or a python”.
No one has measured abortion debt on a national scale. Although healthcare debt is often (inadequately) measured by credit bureau data that rely on unpaid bills, abortion clinics rarely bill their clients—instead, they confiscate money up front to avoid invading their privacy later. On credit card statements, many extra costs associated with abortion appear harmless: travel to New Mexico or Oregon, a hotel room for two days, pick-up in New York City or Baltimore.
But while the precise extent of the problem is unknown, abortion fund and clinic officials I spoke with for this story confirmed that as costs rise, patients fall deeper into debt.
PThe trick to the problem is that the network of financing sources is shrinking. Major interest groups such as Planned Parenthood are expenditure millions on political campaigns, while funding for people in need of abortion is cut. At the same time donations to abortion funds have decreased and costs are rising as bans force people to travel further for procedures done in later stages of pregnancy.
“People are taking on medical debt to pay for these procedures that they might otherwise have had access to when they were cheaper,” said Lucy Font, patient advocacy and coordination manager at the Maryland clinic Partners in Abortion Care. The result, she says, is that while other types of patients might borrow money from loved ones, “abortion has become so highly stigmatized and now criminalized in so many places that patients really feel afraid to reveal their pregnancy to people.” As a result, “they are stuck borrowing through their bank or taking out personal loans.”
It is not surprising that patients have to fall back on bad loans. A study Based on data collected before the 2022 ruling in Dobbs v. Jackson Women’s Health Organization, it found that for more than 40% of abortion patients, the procedure resulted in what experts call “catastrophic health care expenditures,” defined as 40% or more of assets of the participants to pay. After Dobbs, abortion is banned by the state increased the distance patients must travel hundreds of miles, bringing the average travel cost well over $1,000. The Hyde Amendment, a law that bans federal funds from paying for abortions, means that Medicaid will not cover abortions unless states contribute their own funds. Some states do, but the reimbursement rates vary widely and can be extremely low.
Abortion charities, of which there are more than a hundred in the United States, are largely independent grassroots organizations that are supported by donations and operate on a shoestring budget. Destini Spaeth, a care coordinator at the Prairie Abortion Fund in North Dakota, said she helped a patient pay off a $4,500 abortion payment she put on a credit card. Haverda and Spaeth often participate in what abortion funds call ‘solidarity pledges’, in which multiple funds raise money for the abortion of one person. Destini said she has seen as many as 15 funds come together to pay for late-stage abortion. They all are stretched to the breaking point.
Victoria, a woman in her 30s who worked at the Debt Collective, has experienced the debt that can arise when abortion funds have to triage. (She asked that only her first name be used when discussing her medical history.) Victoria was studying for the bar exam in New York City when she discovered she was pregnant in 2021. The abortion created hundreds of dollars in medical debt, paid on credit. cards, for Victoria’s education debt. “All our debts,” Victoria said, “are actually linked.”
The clinics that often bear the burden are also having a hard time. Independent clinics are stepping up more than half of all abortion care in the clinic, and more than 80% for abortions longer than 22 weeks. Their margins are razor thin. As patient payments disappear due to abortion bans and cuts in abortion funding, their numbers have gone into freefall: 76 such clinics have closed since Dobbs. Many clinics regularly discount care for desperate patients, leading to shortages on the clinic’s side. Font at the Partners clinic noted that they see a lot of young people, who are less likely to know when they are pregnant, and are disproportionately likely to survive incest or sexual assault.
How many discounts can clinics survive? Since July 1, Partners has discounted more than $80,000 in fees. In late August, “we had a meeting with our accountants,” Font said, “and we thought that if we had continued at the current pace, we wouldn’t have been up and running until mid-October at this point in the year. .” Ultimately, philanthropists helped them fill the gap.
All of this points to a different kind of debt: society’s debt to the organizations that provide health care to thousands of pregnant Americans. In April, Polish abortion activists arrived presented a symbolic bill of 11.5 million euros to the country’s parliament, for the activist money and labor that had gone into providing abortion care to Polish people under extremely restrictive conditions. If activists in the US do the same, it’s easy to imagine the bill being many times as big – just the National Network of Abortion Funds issued more than $36 million the year after Dobbs.
The Debt Collective states that a large part of the debts that people carry with them should be regarded as a social responsibility. The collective tweeted on Monday: “Abortion is healthcare and healthcare should be free. And that abortion debt is medical debt and medical debt should be forgiven and prevented from happening in the first place.”
Maddy Clifford, who works on communications for the Debt Collective, joined because she had six-figure student debt and believed that education should not be a burden. She said she had an abortion nearly 20 years ago at a Seattle clinic called Aradia and got a glimpse of what good health care could be like. The feminist doctor and administrator were gracious and agreed to her appointment right away, she could not and did not pay, and the clinic assigned her an abortion doula – someone who was by her side throughout the process, offering comfort and answering questions.
In 2007, Aradi Closed after 30 years, malpractice insurance and rent had increased, and too many of their customers could not pay the full amount. “My abortion was free and I want that for everyone,” Clifford told me. She doesn’t want people to have to pawn a car like Haverda’s client, or get deeper into debt like Victoria. “I’m going to fight alongside them so they can get it.”