Impact of Insurance Coverage for Abortion in Hawai'i on Gestational Age at Presentation and Type of Abortion, 2010-2013

Insurance coverage for abortion varies between states, and in Hawai'i most private insurance companies and state Medicaid provide coverage for abortion. Very few patients pay out-of-pocket for an abortion. Hawai'i presents a unique opportunity to describe the sociodemographic differences between women seeking an abortion based on type of insurance coverage or who self-pay, and how this coverage impacts their care. Examined here were the differences in gestational age at time of presentation for abortion and type of abortion (medical, in-office procedure, or hospital facility procedure) chosen by 1803 patients presenting to a major abortion provider in Hawai'i from 2010 to 2013 based on payment method: private insurance, state Medicaid, and self-pay. Self-pay patients were demographically similar to those using private insurance with respect to age, race, and gestational age at time of presentation. Medicaid patients were distinct. They presented for care at a gestational age 13.3 days later than private insurance or self-pay patients even when controlling for age, race, prior parity, and prior abortion. Overall, 45.3% of Medicaid patients presented at greater than 14 weeks. Types of abortion differed between the insurance category groups, however these differences were no longer significant when stratified by gestational age. State Medicaid patients present for abortion care almost 2 weeks later than those with private insurance or who pay out of pocket, increasing personal and healthcare system costs associated with the procedure. The factors that contribute to this difference should be elucidated as they have important public health implications regarding timely access to care.