NerdWallet's Smart Money Podcast - Your Guide to Reproductive Health Care Costs, Options and Economic Implications

Episode Date: October 12, 2023

Understand recent and upcoming changes in costs and access to reproductive care, as well as resources to manage them. This episode delves into the complex and ever-changing landscape of reproductive care costs. Hosts Sean Pyles and Sam Taube discuss the financial implications of recent high-profile court cases, including the overturning of Roe v. Wade and the Burwell v. Hobby Lobby decision, which significantly transformed insurance coverage for birth control. Sean and Sam break down the before-insurance costs of contraceptives and explain how a new over-the-counter birth control pill, Opill, could help make birth control more accessible.  Sam also speaks with Daily Garcia, a director at the Planned Parenthood Federation of America, about the costs and barriers associated with reproductive health care, particularly birth control and abortion. She explains how birth control and abortion costs can vary significantly based on type, insurance coverage, and individual circumstances. She also addresses the impact of state restrictions and resources available to help people overcome them. In their conversation, the Nerds discuss: costs of reproductive care, the overturning of Roe v. Wade, Burwell v. Hobby Lobby, Dobbs v. Jackson Women's Health Health Organization, access to birth control, contraceptives, over-the-counter birth control pills, the Opill, abortion costs, travel costs for abortion, insurance coverage, health insurance, the National Network of Abortion, the National Abortion Hotline, health care accessibility, systemic discrimination, neglected communities, patient navigators, court cases, bodily autonomy, health care legislation, mifepristone, misoprostol, and Planned Parenthood resources. To send the Nerds your money questions, call or text the Nerd hotline at 901-730-6373 or email [e-mail]. Like what you hear? Please leave us a review and tell a friend.

Healthcare in general is rarely, if ever, cheap. It costs the average working-age American up to 15% of their income, including insurance payments. But for people needing reproductive care, the costs can go far beyond that, taking time off work, navigating the costs of transportation and lodging associated with that travel, and oftentimes hundreds if not thousands of miles. Welcome to NerdWallet's Smart Money Podcast. I'm Sean Piles. And I'm Sam Taub. Today, we feature episode two of our nerdy deep dive into the cost of bodily autonomy. And today we're looking at the financial side of reproductive care. It's something that's really in flux right now. When you say reproductive care, you're talking about things like birth control, right? Yeah, birth control is part of it, but so is access to abortion. Indeed. So, Sam, you're taking the Smart Money podcast into some politically contentious

territory here. Well, Sean, the thing is that the cost of reproductive care is changing so fast right now because the issue is contentious. You know, laws are changing. The approval status and insurance coverage of certain medications is changing. And people's family planning is affected by that. Sure. And I just want to say, I know that we have a diversity of listeners here. And some folks who are hearing this episode might object to things like abortion and birth control, maybe for religious reasons or personal reasons. And I'm not here to change anyone's mind about those things. I am going to talk about the costs of those things, and I'm also going to talk about different resources and financial strategies to help folks afford those costs.

Because regardless of your beliefs about abortion and birth control, the fact is that they're in demand for quite a lot of people. The Centers for Disease Control and Prevention say that about a quarter of women aged 15 to 49 use either birth control pills or a contraceptive device. So we're talking about the health care needs of tens of millions of people here. Exactly. Well, let's get into it. When I think of changing laws about reproductive care, my mind goes to the overturning of Roe v. Wade last year. Sure. The Supreme Court's ruling on Dobbs v. Jackson Women's Health Organization in June of 22 got rid of the federal right to abortion that had been in place since Roe was decided in 1973. And that's had, needless to say, massive ongoing effects on the cost of reproductive care.

And we'll get to that in a bit. But I notice you keep bringing this conversation back to birth control. I do. When we talk about the changing costs of bodily autonomy health care, whether it's birth control or abortion or HIV prevention or gender affirming care or whatever, we're often talking about a chain reaction of court cases that affect the legality and the insurability of these things. And that chain reaction really starts with the Supreme Court case about birth control insurance coverage that was actually decided eight years before Dobbs. Wait, I remember this. Was this the Supreme Court case about Hobby Lobby? Indeed it was, yep. So back in 2014, the Supreme Court ruled in Burwell v. Hobby Lobby that employers don't have to provide coverage for certain kinds of birth control through their health care plans if they felt that those birth control methods were against their religion. This case established some really important precedents for limiting insurance coverage for health care that gives people autonomy over their own bodies.

And the impact of that is going to come up several times throughout this series. I think we already touched on it in how it's affecting HIV prevention in the last episode. Yeah, we did. But let's stay on track here. What did this court case do? Right. So the immediate effect of Burwell v. Hobby Lobby was that tens of thousands of people lost birth control coverage through their employer-sponsored health insurance. And tens of millions more were put at risk of losing it if their employer decided to stop covering it. And, you know, the pre-insurance costs of birth control can be pretty hefty. Pills can cost up to $600 per year without insurance,

while some birth control devices like the NuvaRing can cost up to $1,000 a year. Not something you want to have to pay out of pocket for. No, you don't. I actually had a conversation with Dylee Garcia, a director at the Planned Parenthood Federation of America, about how people meet some of these out-of-pocket costs? Birth control related expenses, including access to free birth control, varies really from state to state and person to person. Individual costs can depend on the type of birth control a person decides to use and their insurance coverage. Luckily, thanks to the Affordable Care Act, all birth control methods should be at zero copay to patients with health insurance, including those who are covered by Medicaid. While we're on this topic, we should also probably mention the new over-the-counter

birth control pill. Yes, I've heard about this. It's called OPIL, right? Yeah, OPIL. It's a daily oral contraceptive, much like a regular birth control pill, and the FDA approved it back in July. So there are two major differences between Opil and prescription birth control pills. Number one, Opil only contains one hormone, progestin, while most birth control pills contain progestin and estrogen. Number two, Opil is available over the counter without a doctor visit required.

That number two difference seems like a pretty big deal, especially when it comes to accessibility. Oh, definitely. More than 100 million Americans don't have a primary care doctor, which is something that you generally need to get any kind of prescription drug, including prescription birth control. Also, the reality is that some people have to keep their birth control secret. And if you're hiding it, say from a disapproving parent or intimate partner, then this could make your life easier because it cuts out a visit to the doctor. It makes it easier to be discreet. Well, let's talk about the cost of Opal. Do we know what it's going to be for folks? We don't know yet. HRA Pharma, which is the company that makes Opil, hasn't released a price yet. And we also don't know how insurers are going to cover Opil if they do at all. Insurers are

required to cover birth control with no copay if it's prescribed by a doctor, but that requirement doesn't necessarily apply to over-the-counter contraceptives like condoms, for example. So it seems like cost could be a real roadblock here, especially if insurers don't cover it. It definitely could, and we just won't know for sure until HRA Pharma sets a price and insurers decide where they stand with it. But we do know two things. Number one, HRA Pharma is a business, and they presumably want Opel to be competitive in the market. So it's going to need to compete with prescription birth control pills, which, as we've discussed, can be up to $600 a year, but are often free with insurance. Number two, they're working on a consumer assistance program for people who have trouble affording Opal. I guess on the one hand, they want everyone to be able to get it. But on

the other, they think some people aren't going to be able to afford it without help. Exactly. All right, well, let's take a quick break. And when we come back, we'll dive into the costs around ending a pregnancy to share your ideas, concerns, solutions around the cost of bodily autonomy. Leave us a voicemail or text the nerd hotline at 901-730-6373. That's 901-730-NERD or email a voice memo to podcast at nerdwallet.com. So, Sean, we can't discuss the costs of reproductive health care without also mentioning abortion and how the costs of abortion are changing in the post-Roe v. Wade era. Right. It's a controversial topic, but as you said earlier, it is in demand.

Yep. About 600,000 legal abortions were performed in the U.S. in 2020, according to the CDC. Now, when we talk about abortion, it's common to center the discussion around the right and ability to end an unwanted pregnancy. But it's important to remember that people terminate pregnancies for a number of reasons. Right. The same procedures people use to end an unwanted pregnancy are also used to expedite some miscarriages and end potentially life-threatening pregnancies. And in the Dobbs ruling, the Supreme Court basically gave states the ability to restrict access to abortion procedures however they choose, no matter what the person's reason for needing one is.

But even before June 2022, abortion was very hard to access for many Americans. This is another topic that I talked to Dylee Garcia about. First, can you tell me a bit about the cost before insurance of different types of abortions like medication versus surgical before giving you like a hard number i think it's important to take into consideration that cost really does vary depending on for example the type of abortion you need how far along in the pregnancy you are the state or health center where you get your care, whether you have health insurance, whether that's private or, you know, mental insurance like Medicaid, that will help you pay for your abortion, and whether you can get other types of financial assistance to help you cover

that cost. Another thing is that helps that variation is really the restrictions in certain states. So for example, if a state requires for you to have an in-person waiting period, so you have to come in twice into the clinic, then that means that it's a higher cost for the patient. Overall, the abortion pills, or how you say it, medication abortion rate rate can cost up to and around $800, but it's often less. The average cost that we see at Planned Parenthood affiliates is usually around $580. And in-clinic abortion are what a lot of people refer to as your surgical abortions. In the first trimester, they can cost a few hundred dollars all the way up to $1,500. It varies widely.

And the average cost of the first trimester in-clinic abortion at Planned Parenthood, though, it's about $600. The cost of a second trimester abortion starts at around $715. You kind of touched on my second question, but I want to kind of ask in more detail with the context of DOBs. Do insurers typically cover abortion-related costs, and has that changed because of DOBs, or is it expected to change? There are states, actually, where private insurance and Medicaid can cover the cost of an abortion. But I will also warn that the reality is that there's about 10 states that have already passed bans prohibiting comprehensive plans from covering abortion. And 25 states actually have ban coverage for abortion for the insurances that you can purchase

in their health insurance marketplace. Sometimes even those you'd have to purchase like a separate rider for those that qualify for Medicaid. Luckily, I think for a lot of patients that come to Planned Parenthood and are independent partners, so other clinics that are non-planned parenthood, there are resources that we provide to support patients to be able to afford an abortion if they find themselves unable to. There's also abortion funds that play a critical role in supporting accessibility to an abortion. We do feel like in this time uh what the dobbs v jackson case has done is really emboldened state legislatures to continue to pass more and more bans on being able to use your health insurance or being able to um to use medicaid the next thing i wanted to ask about are some of the

kind of indirect costs that can come with getting an abortion post-DOBS, like travel and lodging. If you could speak to what some patients encountered. And the other follow-up question that I want to ask is how often it's actually necessary for people to travel to a facility to get an abortion. We knew when this Supreme case happened that wealthy individuals and those with resources and power will always be able to access abortion. That was the case before Roe as well. The impact of overturning Roe is largely felt by Black, Latino, and indigenous people, immigrants, people with low incomes, and people in rural areas. If you ever try to navigate somebody out of their rural area who doesn't have a car, it is incredibly hard. These are all communities who have long-faced barriers to abortion access due to just systemic discrimination and neglect. Barriers to accessing abortion and other healthcare services can be like finding childcare, taking time off work, navigating the costs of transportation and lodging associated with that travel, and oftentimes hundreds if not thousands of miles. Those things

have always existed and are now really at the front of mind for people who have to travel for their portion. It can be very expensive when you're talking about planning a trip, how much gas is going to cost you to fill up your tank when you're having to do a road trip of hundreds of miles. How much does it cost to buy a last minute airplane ticket, right? You're talking about a time sensitive procedure. If you need to fly out, that's going to be hundreds of dollars, hundreds of dollars that often is it necessary now? I mean, Sam, when you're talking about people who live in banned states, the ability of a state where abortion is still accessible to provide a telemedicine abortion, right, or male pills, that's only available if you live in that state. So if you live in a state where abortion is banned, that is not a possibility for you. You still have to travel out of your state into a safe state to go into the clinic to access your abortion service.

So unfortunately, even though we have this amazing amount of technology and resources that is able to allow us to mail medication abortion now, it only helps those that are in safe states. It doesn't help the ones resources are available to help cover abortion related costs, whether that's the bill itself or the secondary costs we've been talking about? Our affiliates have patient navigators who support patients traveling with the cost of travel. These patient navigators use our own internal funds as well as they coordinate with local abortion funds from the National Network of Abortion Funds to help patients with basic things, like food, lodging, gas money, even flights. In states that are receiving many of the patients who are traveling from banned states,

we provide travel assistance to anywhere from 20 to 60% of the patients who need to travel out to see a Planned Parenthood. So these are Planned Parenthood-specific statistics. On average, we provide around $300 per patient for this support. Many people are living paycheck to paycheck these days, and sometimes $300 is literally all they may have in their savings. And if we're thinking about, you know, longer distances to the last minute travel, that cost of travel balloons and could be up to like $1,000. Or perhaps you have a child that you don't have any childcare with that, you know, would need to travel with you or you want your partner to come with you. That all adds up and becomes a serious barrier.

Now, Sam, in your interview, Dylee mentioned that Planned Parenthood and the National Network of Abortion Funds can help out with costs, and we'll provide links to both of those services in the show notes. But there are other organizations that provide assistance to abortion patients too, right? Definitely. There are a number of web portals and hotlines and things that can give prospective abortion patients information and connect them with organizations that can help them in their area. One of those is the National Abortion Hotline, which can be reached by phone or online. And they do consultations, they provide information, and they sometimes offer limited financial assistance. And isn't there also an abortion access website that kind of works like a search engine?

Yeah, that's ineedana.com. That one lets you filter your search for groups that provide specific kinds of assistance, like legal help or help for transportation costs or whatever that are near you. Gotcha. Well, we will also include links to those websites in the show notes as well. Yep. Now, Sean, Dobbs isn't the only recent court case that is making abortion harder to access. Yeah, there was also recently a ruling about the medications that are used in some abortions, right? Yes, there was. On April 7th, a federal judge in Texas issued a nationwide ruling that attempts to revoke the FDA approval of mifepristone, which is one of the two drugs that are used for most medication abortions.

So that would affect medication abortions nationwide, not just in states with anti-abortion laws. Correct. If the ruling goes into effect, it would still be possible to get a medication abortion using only the other medication abortion drug, which is called misoprostol. But that drug on its own might be less effective and often causes more painful side effects. People who want an abortion but aren't comfortable with those side effects might then need to travel to a clinic to get a procedure done instead of receiving virtual care and medication abortion. So this might be another example of making abortions more expensive via travel costs.

Exactly. Sam, you said if the ruling goes into effect. Is there a question about that at this point? Yeah, so the ruling hasn't been implemented yet because it's tied up in appeals right now. The Supreme Court has basically blocked the decision for now, so Mifepristone is still available while those appeals are being decided. So Sam, we've talked about a lot of costs in this show. Hundreds of dollars for birth control, hundreds of dollars for abortions, hundreds or even thousands of dollars in travel costs for people living in states with anti-abortion laws. That's right.

And we've also talked about how the insurance coverage of all of these things is in flux. Yeah. With all these court cases between Burwell v. Hobby Lobby and Dobbs v. Jackson Women's Health Organization, it's hard to keep track of what the actual costs of these things are. It seems like one consequence of all of this is that a lot more people might face surprise bills for reproductive care in the years ahead. Are there any strategies our listeners can use to financially prepare for those kinds of bills? You know, I don't know if there are any silver bullets, but there are a few things that can definitely help. One is just knowing your options for health insurance.

What do you mean by that? Well, as we've discussed, Burwell v. Hobby Lobby gave employers the right to opt out of providing insurance coverage for birth control. So if you have employer-sponsored health insurance, as so many people do, it's important to read your plan materials and maybe even call the insurer to figure out what is and isn't covered. And if you have a plan that does exclude birth control, you do have other options. You can get to your state's online health insurance marketplace via healthcare.gov, although some people find those state marketplace sites kind of difficult to use. And at NerdWallet, we have a tool that makes that a lot easier, don't we? Yes, we do, Sean. We will leave a link to NerdWallet's health insurance shopping tool

in the show notes here. All right, Sam. Well, what's next for our series on the cost of bodily autonomy? In the next episode, we'll be looking at some of the unique healthcare costs faced by LGBTQ plus people, how recent events have increased those costs, and where LGBTQ plus Americans can find help affording healthcare. You can easily expect to be out for two, three, maybe as long as six months, depending on your surgical regimen and what's going on and other existing conditions. The ability to not earn income in three to six months, that will add up quickly to 10 to 20 to $30,000, depending on what your income is and where you live. All right, that's it for this episode of NerdWallet's Smart Money Podcast.

Do you have a money question of your own? Turn to the nerds and call or text us your questions at 901-730-6373. That's 901-730-NERD. You can also email us at podcast at nerdwallet.com. Visit nerdwallet.com slash podcast for more info on this episode. And remember to follow, rate, and review us wherever you're getting this podcast. This episode was produced by Tess Vigeland and me, Sam Taub. Sean helped with the editing, as did Liz Weston.

Alana Benson and Pamela De La Fuente did our fact-checking. Kevin Tidmarsh mixed our audio. And a big thank you to the folks on the NerdWallet copy desk for all their help. Here's our brief disclaimer. We are not financial or investment advisors. This nerdy info is provided for general educational and entertainment purposes and may not apply to your specific circumstances. And with that, until next time, turn to the nerds.